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Evaluate the effects of corneoconjunctival transposition (CCT), posterior lamellar keratoplasty (PLK) and modified deep lamellar endothelial keratoplasty (DLEK) on streak retinoscopy in equine cadaver eyes.Intraocular pressure (IOP) was maintained at 25 ± 3 mmHg in 35 equine cadaver eyes. Streak retinoscopy was performed prior to (NO VISCO) and following (VISCO) intracameral injection of 1.0 ml of viscoelastic. Following optical coherence tomography (OCT), an axial CCT [n = 11] or PLK [n = 12], or peripheral DLEK [n = 12] was performed. Streak retinoscopy and OCT were repeated postoperatively.Postsurgical net meridional and spherical refraction for CCT [Horizontal (H): 3.4 (95% CI 2.4-4.4) diopters (D), p .001, Vertical (V): 3.5 (95% CI 2.7-4.4) D, p .001, Spherical: 3.5 (95% CI 2.6-4.3) D, p .001] and PLK [H: 3.2 (95% CI 2.2-4.1) D, p .001, V: 2.8 (95% CI 2.0-3.6) D, p .001, Spherical: 3.0 (95% CI 2.2-3.8) D, p .001] were significantly increased from presurgical (VISCO) values. No difference between presurgical (VISCO) and postsurgical values were identified for the DLEK. Postoperative OCT revealed space between anterior and posterior corneal grafts and corneal undulation associated with suture placement.Meridional and spherical refraction had a hyperopic shift following CCT and PLK, with a significantly higher value in the vertical meridian for the CCT. Pre- and postoperative refraction was not significantly different for the DLEK. This supports that the DLEK has a lesser effect on immediate postoperative refraction compared with CCT or PLK.

OBJECTIVE To compare image quality and acquisition time of corneal and retinal spectral domain optical coherence tomography (SD-OCT) under 3 different sedation-anesthesia conditions in horses. ANIMALS 6 middle-aged geldings free of ocular disease. PROCEDURES 1 randomly selected eye of each horse was evaluated via SD-OCT under the following 3 conditions: standing sedation without retrobulbar anesthetic block (RB), standing sedation with RB, and general anesthesia with RB. Five regions of interest were evaluated in the cornea (axial and 12, 3, 6, and 9 o’clock positions) and fundus (optic nerve head). Three diagnostic scans of predetermined quality were obtained per anatomical region. Image acquisition times and total scans per site were recorded. Corneal and retinal SD-OCT image quality was graded on a subjective scale from 0 (nondiagnostic) to 4 (excellent). RESULTS Mean values for the standing sedation without RB, standing sedation with RB, and general anesthesia conditions were 24, 23, and 17, respectively, for total cornea scan attempts; 23, 19, and 19 for total retina-scan attempts; 14.6, 13.2, and 9.2 minutes for total cornea scan time; 19.1, 9.2, and 13.0 for total retina scan time; 2.0, 2.3, and 2.5 for cornea grade; and 2.7, 2.9, and 2.5 for retina grade. CONCLUSIONS AND CLINICAL RELEVANCE The RB facilitated globe akinesia and improved the percentage of scans in frame and region of interest accuracy for retinal imaging via OCT in horses. Retrobulbar blocks improved clinical image acquisition while minimizing motion artifact.

Objective Investigate histopathology and spectral-domain optical coherence tomography (OCT) imaging of wild owls with chorioretinitis and identify any potential correlation with an infectious etiology. Materials and methods Ophthalmic examination and retinal OCT imaging were performed on fifteen great horned (Strix varia) and barred (Bubo virginianus) owls (30 eyes) with chorioretinitis and five owls with normal eyes (10 eyes). Testing to investigate the presence of potential infectious diseases included a complete blood count, biochemistry, protein electrophoresis, West Nile virus (WNV) plaque reduction neutralization test, Toxoplasma gondii modified direct agglutination test, WNV RT-PCR, and Avian Influenza RT-PCR. A necropsy was performed on all owls, including ocular histopathology. Results Fundus lesions included retinal detachment (7/15 owls), depigmented lesions (12/15), pigment clumping (8/15), and retinal tear (4/15). All birds were negative for WNV and Avian Influenza on RT-PCR. Of the owls with chorioretinitis, 3/15 were seropositive for WNV and 7/15 for T. gondii. Optical coherence tomography of 25/30 affected eyes revealed outer retinal lesions (19/25 eyes), retinal detachment (16/25), and retinal tears (3/25). Histopathological examination revealed outer nuclear layer atrophy (19/30 eyes), retinal detachment (18/30), retinal tears (7/30), suprachoroidal hemorrhage (12/30), scleral rupture (3/30), and ossicle fracture (3/30). Conclusions Although 20% of birds were seropositive for WNV and 46.6% for T. gondii, histopathologic findings supported that the posterior segment lesions in the study group were likely due to blunt ocular trauma rather than an infectious etiology. The results of OCT imaging and histopathology documented retinal changes most consistent with blunt ocular trauma.

Objective To document a case series using corneoconjunctival transposition (CCT) surgery with and without bioscaffolding matrix (ACell® ) to repair deep corneal ulcers and perforations in dogs. Animals studied Eighteen dogs of various breeds that presented with deep or perforating corneal ulcers. Procedures Corneoconjunctival transposition grafts with or without ACell® were sutured using a simple interrupted 8-0 or 9-0 polyglactin 910 pattern. Results A total of eighteen dogs (19 eyes) were diagnosed with deep corneal ulcers (n = 7) and perforating corneal ulcers (n = 12). A CCT was performed in all eyes, with ten of them additionally receiving an ACell® graft. The majority of lesions were located axially in 14/19 (81%) eyes. Grafts were harvested from dorsal (n = 8), temporal (n = 5), ventral (n = 4), or nasal (n = 2) quadrants. Brachycephalic breeds (13/18) were over-represented. Keratoconjunctivitis sicca was present in 10/19 eyes (52.6%). Bacterial isolates were cultured from 8/19 eyes. Post-operative therapy included topical antibiotics, plasma, cycloplegics, oral antibiotics, and oral nonsteroidal anti-inflammatory drugs. CCT integration with and without ACell® occurred at a median of 20 days (range 7-38 days) post-operatively with no significant difference between groups. Median follow-up time was 188 days. Short-term post-operative complications included granulation tissue formation (19/19), corneal edema (4/19), graft retraction (4/19), and anterior synechia (1/19). Long-term complications in 14 eyes with follow-up >30 days included superficial corneal pigmentation (6/14) and epithelial inclusion cysts (5/14). Two eyes were nonvisual at last follow-up due to cataract formation. Conclusions Corneoconjunctival transposition with ACell® can be utilized for corneal ulcer repair in dogs.

Objective To report the surgical excision of an iridociliary adenoma and iridal melanocytoma using a postero-anterior cyclo-iridectomy in two dogs. Procedure A 7 year old neutered male English springer spaniel (case 1) and a 7 year old neutered male Labrador mix (case 2) were presented for evaluation of an intrairidal mass OS. Results Complete ophthalmic examination revealed a large, dorsonasal, well-demarcated, intrairidal mass OS. A tan to pink intrairidal mass extending into the iridocorneal angle (case 1) and a pigmented intrairidal mass (case 2) were present. B-mode ultrasonography showed a focal, soft tissue, homogenous mass within the uvea adjacent to and contacting the lens. Neither pars plana involvement nor vitreal extension was present. A postero-anterior cyclo-iridectomy was performed through a polyhedral scleral flap. Thermocautery was used to complete the cyclo-iridectomy (case 1) and partial iridectomy (case 2) to excise the mass en bloc. Histopathology revealed a completely excised iridociliary adenoma (case 1) and iris melanocytoma (case 2). The surgery sites healed without complication. Mild uveitis (cases 1 and 2), scant vitreal hemorrhage (case 1), and mild hyphema (case 2) were present three days postoperatively but had resolved ten days postoperatively. The patients remain visual twenty-two months (case 1) and seven months (case 2) postoperatively with a normal intraocular examination other than an iridal defect and mild dorsonasal lens capsular opacities. Conclusions The surgical approach described in these cases is utilized in physician-based medicine. This approach and the use of thermocautery provide a viable surgical option for excision of large iridociliary tumors in dogs.

Welcome to this issue focussing on literacy as well as the self (self-studies). As is befitting an international Journal, you will see investigations from researchers representing a range of cultur...

Reading and writing, literacy, is undoubtedly vital for every-day life for learning, expressing, leisure, cultural enhancement, prosperity and protection of human rights (Goodwin & Jimenez, 2019; S...

Objective This study aimed to examine associations between sleep duration, BMI, and cortisol levels across childhood. Methods Participants included 361 children adopted domestically in the United States. Random-intercept cross-lagged panel models tested for between-person and bidirectional within-person associations of sleep duration, BMI, and morning and evening cortisol at age 4.5 to 9 years. Results Sleep duration and BMI were stable during childhood, inversely associated at the between-person level, and unrelated to morning or evening cortisol. BMI at age 6 years predicted longer sleep duration and lower evening cortisol at age 7 years, and lower morning cortisol at age 7 years predicted higher BMI at age 9 years within individuals. Conclusions The association between sleep and BMI is more likely a stable between-person phenomenon rather than a unidirectional association that develops within individuals over time.

To document a case series using corneoconjunctival transposition (CCT) surgery with and without bioscaffolding matrix (ACellEighteen dogs of various breeds that presented with deep or perforating corneal ulcers.Corneoconjunctival transposition grafts with or without ACellA total of eighteen dogs (19 eyes) were diagnosed with deep corneal ulcers (n = 7) and perforating corneal ulcers (n = 12). A CCT was performed in all eyes, with ten of them additionally receiving an ACellCorneoconjunctival transposition with ACell

As Editors of Educational Psychology, we are pleased to report that 2018 was a rewarding year for the Journal, which published 69 high-quality manuscripts reporting outstanding research and practic...

Western economies have seen a shift away from a model of job security to a model of work precarity. Cycles of unemployment are a defining feature of the new precarious economy. Given these ...

Objective To describe and evaluate a modified penetrating keratoplasty technique utilizing ACell® for management of equine deep stromal or full-thickness corneal stromal abscesses (SA). Methods Cases presenting to the University of Georgia Ophthalmology service for surgical management of SA necessitating penetrating keratoplasty (PK) were included in the study population. Surgery entailed the use of an ACell® disk sutured within the deep level of a stepped full-thickness corneal incision with an overlying conjunctival pedicle flap placed in the superficial step incision. Patients were evaluated for success as defined by a comfortable, visual outcome. Results Surgery was performed in seven horses. Conjunctival flap incorporation and globe retention occurred in all patients. Functional vision was maintained in six of seven eyes (85.7%) at last follow-up examination (mean of 87.6 days [range 41–251 days]). Mean size of ACell® implant was six millimeters (range 4–8 mm). Postoperative complications included moderate to severe anterior uveitis (n = 2), diffuse keratitis (n = 1), incipient cataract formation (n = 3), and anterior and posterior synechiae (n = 1). Conclusions This technique is a viable option for treatment of equine SA requiring PK. The use of bioscaffold implant is an alternative to frozen and fresh donor cornea transplantation.

Author(s): Boss, Christine; La Croix, Noelle; Moore, Phillip A; Wilkie, David A; Maggio, Federica; Wiggans, Kenneth Tomo; Maggs, David J; Kaiser, Kevin; Sapienza, John S; Kim, Kay; Strauss, Rachel; van der Woerdt, Alexandra; Schmidt, Gretchen | Abstract: ObjectiveTo compare complication rates and visual outcomes following phacoemulsification in Pugs versus dogs of other breeds.Animals studiedThirty-two pure-bred Pugs (55 eyes) and 32 dogs of other breeds (56 eyes) undergoing phacoemulsification.ProceduresMulti-institutional retrospective medical record review of perioperative factors, postoperative complications, and visual outcomes. The reference population of dogs of varying breeds included surgical cases following each Pug case at the same institutions. Perioperative risk factors and postoperative complication rates were compared between the two populations.ResultsPigmentary keratitis and diabetes mellitus were the most common preoperative comorbidities, found in 75% (Pnln.001) and 72% (Pn=n.12) of Pugs, respectively. No perioperative factors were significantly associated with postoperative complications in Pugs. Postoperative complication rates were similar between groups; however, the most common complication in Pugs was corneal ulceration (15% of operated eyes), whereas glaucoma was most common in the reference population (13% of operated eyes). Three months postoperatively, vision was preserved in 91% of eyes of Pugs (50/55) and 95% of the reference population (53/56). One year postoperatively, 80% (32/40) of Pug eyes and 82% (28/34) of eyes in the reference population remained sighted.ConclusionsComorbidities and complications of cataract surgery in Pugs of this study demonstrate a predisposition for corneal disease. This highlights the importance of preoperative evaluation of factors associated with PK and corneal clarity, and postoperative monitoring for corneal ulceration in this breed.

Objectives We sought to develop a scoring system that predicts the risk of serious adverse events (SAE's) for individual pediatric patients undergoing cardiac catheterization procedures. Background Systematic assessment of risk of SAE in pediatric catheterization can be challenging in view of a wide variation in procedure and patient complexity as well as rapidly evolving technology. Methods A 10 component scoring system was originally developed based on expert consensus and review of the existing literature. Data from an international multi-institutional catheterization registry (CCISC) between 2008 and 2013 were used to validate this scoring system. In addition we used multivariate methods to further refine the original risk score to improve its predictive power of SAE's. Results: Univariate analysis confirmed the strong correlation of each of the 10 components of the original risk score with SAE attributed to a pediatric cardiac catheterization (P

The education of nurse practitioners has undergone substantial evolution since Ford and Silver (1967) first reported on the preparation of nurses to assume the role of primary care providers for children. From this modest beginning in Colorado emerged a worldwide movement to prepare nurses to diagnose and treat patients in ways that in the past had been restricted to physicians. The early programs were not usually located in schools or colleges of nursing but rather were short-term continuing education programs. Later, nurse practitioner programs were transitioned to master’s degree programs and more recently began to evolve to Doctor of Nursing Practice (DNP) Programs. The American Association of Colleges of Nursing (2014) currently lists 243 active DNP programs and 70 planned programs.

Background: Risk standardization for adverse events after congenital cardiac catheterization is needed to equitably compare patient outcomes among different hospitals as a foundation for quality improvement. The goal of this project was to develop a risk-standardization methodology to adjust for patient characteristics when comparing major adverse outcomes in the NCDR’s (National Cardiovascular Data Registry) IMPACT Registry (Improving Pediatric and Adult Congenital Treatment). Methods: Between January 2011 and March 2014, 39 725 consecutive patients within IMPACT undergoing cardiac catheterization were identified. Given the heterogeneity of interventional procedures for congenital heart disease, new procedure-type risk categories were derived with empirical data and expert opinion, as were markers of hemodynamic vulnerability. A multivariable hierarchical logistic regression model to identify patient and procedural characteristics predictive of a major adverse event or death after cardiac catheterization was derived in 70% of the cohort and validated in the remaining 30%. Results: The rate of major adverse event or death was 7.1% and 7.2% in the derivation and validation cohorts, respectively. Six procedure-type risk categories and 6 independent indicators of hemodynamic vulnerability were identified. The final risk adjustment model included procedure-type risk category, number of hemodynamic vulnerability indicators, renal insufficiency, single-ventricle physiology, and coagulation disorder. The model had good discrimination, with a C-statistic of 0.76 and 0.75 in the derivation and validation cohorts, respectively. Model calibration in the validation cohort was excellent, with a slope of 0.97 (standard error, 0.04; P value [for difference from 1] =0.53) and an intercept of 0.007 (standard error, 0.12; P value [for difference from 0] =0.95). Conclusions: The creation of a validated risk-standardization model for adverse outcomes after congenital cardiac catheterization can support reporting of risk-adjusted outcomes in the IMPACT Registry as a foundation for quality improvement.

Many countries project that they will have difficulty to meet their demand for primary care based on an inadequate supply of primary care doctors. There are many reasons for this, and they tend to vary by country. The policy options available to these countries are to increase the number of local primary care doctors, recruit doctors from other countries, ration primary care, shift more primary care to specialists, or authorize other disciplines to provide primary care. This article examines lessons learned in the United States over the past 50 years and proposes that expanding the use of nurse practitioners is the best solution when measured by feasibility, costs, ethics, and scope of the care delivered. Using nurse practitioners trained in country meets the World Health Organization global code of practice regarding the international recruitment of health personnel.

Background— Melody Transcatheter Pulmonary Valve (TPV) replacement therapy represents an important advance in congenital cardiovascular interventions. The off-label extension of the Melody TPV to patients with nonconduit outflow tracts (right ventricular outflow tract [RVOT]) has the potential to vastly expand the population of patients eligible to benefit from nonsurgical restoration of RVOT function. However, knowledge on the performance of the Melody TPV in this setting is limited. Methods and Results— This is a multicenter, retrospective review of the Melody TPV when placed in nonconduit RVOTs, in which at least a portion of the circumference was composed of native tissue. Five centers contributed data on 31 patients. The median age at implantation was 24 years (range, 7–66). At a median follow-up of 15 months, all patients were alive. No patient had greater than mild TPV insufficiency, and the median maximum instantaneous gradients across the RVOT was 23 mm Hg. Stent fracture occurred in 32%. Eight patients developed more than mild TPV obstruction, of whom 6 were associated with identified stent fracture. Three patients developed blood stream infections. There were 5 reinterventions in 3 patients, including 3 repeat TPV implantations and 2 TPV explantations. Conclusions— Melody TPV implantation is feasible in selected patients with RVOTs comprised solely or predominantly native tissue and has the potential to expand the population of patients eligible to benefit from nonsurgical restoration of RVOT function. In early follow-up, valve competency seems preserved. The dominant mechanism of valve dysfunction seems to be related to stent fracture with recurrent obstruction. Additional data are necessary to better understand how to safely expand TPV therapy to this population.

This issue of Educational Psychology complements the theme of The Self developed in an earlier issue (see Urhahne, 2017) by an expanded focus on self as well as the self and bullying. To me, the ar...

To describe and evaluate a modified penetrating keratoplasty technique utilizing ACellCases presenting to the University of Georgia Ophthalmology service for surgical management of SA necessitating penetrating keratoplasty (PK) were included in the study population. Surgery entailed the use of an ACellSurgery was performed in seven horses. Conjunctival flap incorporation and globe retention occurred in all patients. Functional vision was maintained in six of seven eyes (85.7%) at last follow-up examination (mean of 87.6 days [range 41-251 days]). Mean size of ACellThis technique is a viable option for treatment of equine SA requiring PK. The use of bioscaffold implant is an alternative to frozen and fresh donor cornea transplantation.

A 4-month-old intact female English Springer Spaniel presented to the University of Georgia Veterinary Teaching Hospital for evaluation of unilateral, progressive exophthalmos oculus sinister (OS) of 2 weeks' duration. Complete ophthalmic examination revealed moderate OS exophthalmos and lateral globe deviation. No other abnormalities were noted on physical or ophthalmic examination, ocular ultrasound, complete bloodwork, or thoracic radiography. Skull computed tomography (CT) revealed a large, focal, smoothly irregular, cavitated, expansile bony lesion involving the left caudal maxillary and left frontal bones. Biopsies, obtained through a frontal sinusotomy approach to preserve the left globe integrity, demonstrated normal reactive trabecular bone with locally extensive fibrosis. Calvarial hyperostosis was diagnosed based upon appearance on imaging, lesion unilaterality, absence of mandibular involvement, and histopathology. Six months after initial presentation, skull CT was repeated and marked reduction in the degree of frontal bone thickening was demonstrated with complete resolution of cavitations. There was marked clinical improvement with mild, nonpainful exophthalmos, and lateral globe deviation OS on ophthalmic examination. Eleven months after initial presentation, there was complete resolution of the frontal bone lesion with mild thickening of the left calvarial bones on repeat skull CT. There was no exophthalmos or globe deviation present on clinical ophthalmic examination. The proliferative osteopathic lesion was self-resolving with resolution of the exophthalmos and has not recurred to date. To the authors' knowledge, this is the first report of calvarial hyperostosis in a previously unreported breed presenting as unilateral exophthalmos.

Objective Equine recurrent uveitis (ERU) is a spontaneous disease that is the most common cause of blindness in horses, affecting up to 15% of the horse population. Th17 cells are a major cell population driving the pathogenesis in several mouse models of autoimmune inflammation, including experimental autoimmune uveitis. The purpose of this study is to investigate the role a Th17 cell-mediated response plays in the pathogenesis of ERU. Procedure Banked, Davidson’s-fixed equine globes histopathologically diagnosed with ERU (n = 7) were compared immunohistochemically with healthy control globes (n = 7). Immunohistochemical staining was performed using a pan-Leptospira antibody and antibodies against IL-6, IL-17, and IL-23. Additionally, immunostaining was performed for T-cell (CD3) and B-cell (CD79α) markers. Specificity of immunoreactivity was confirmed by western blot analysis. Results Immunohistochemical staining was positive for IL-6, IL-17, and IL-23 within the cytoplasm of nonpigmented ciliary epithelial cells and mononuclear inflammatory cells infiltrating the iris, and ciliary body of ERU horses (n = 7) but negative in controls (n = 7). ERU-affected eyes were CD3 positive (n = 7) and CD79α negative (n = 7). Staining for Leptospira was negative in all ERU and control globes. Conclusions Strong immunoreactivity for IL-6, IL-17, and IL-23, in conjunction with the fact that T lymphocytes are the predominating inflammatory cells present in ERU, suggests that IL-17-secreting helper T-cells play a role in the pathogenesis of ERU. These findings suggest that horses with ERU may serve as a naturally occurring animal model for autoimmune uveitis.

Objective To report concurrent clinical intraocular findings in horses with depigmented punctate chorioretinal foci and to document any correlation with equine recurrent uveitis (ERU). Procedure Records of 131 horses (241 eyes) examined at the University of Georgia Veterinary Teaching hospital from 2001 to 2010 were reviewed with either clinically normal fundi or depigmented punctate chorioretinal foci in the absence of other fundic pathology. Data collected included patient signalment, concurrent clinical ocular findings and follow-up information. Sex, presence of no other intraocular findings, presence of ERU, presence of cataracts, and presence of vitreal disease were compared between normal and foci groups using chi-squared analysis. Age and length of follow-up time were compared using a student’s t-test. Results Ninety-one horses (167 eyes) with chorioretinal foci and forty horses (74 eyes) with clinically normal ocular fundi were examined. Fifty-eight (64%) horses with chorioretinal foci and 20 (50%) horses with clinically normal fundi had a normal intraocular examination. There was no significant difference in any of the criteria examined between groups. Conclusions Horses with depigmented punctate chorioretinal foci, in the absence of other fundic pathology, are not more likely to have intraocular disease or ERU than horses with clinically normal ocular fundi. These findings suggest that depigmented punctate fundic foci in horses are not indicative of or associated with ERU.

An 11-year-old Fox Terrier dog was evaluated for a 10-month history of progressive exophthalmia and visual deficits in the right eye. Ophthalmologic examination revealed severe corneal fibrosis and pigmentation, which obscured examination of the anterior chamber of the right eye. There was decreased retropulsion of the right eye. Neurological examination revealed an absent menace response bilaterally. Pupillary light reflex was normal in the left eye. Due to the corneal pathology, pupillary light reflex was unable to be evaluated in the right eye. A retrobulbar mass with heterogeneous echotexture was identified using ultrasonography. Cytological evaluation of a fine-needle aspirate of the mass disclosed a neoplastic cell population consisting of round to polygonal cells with lightly basophilic to gray cytoplasm and round to ovoid nuclei having a coarse granular chromatin pattern. Magnetic resonance imaging disclosed a right-sided retrobulbar mass that extended through the optic canal and was contiguous with an extra-axial mass in the ventral right rostral and middle cranial fossae. The mass displayed homogenous and strong contrast enhancement. Following exenteration, histological examination of the retrobulbar mass was consistent with meningioma. Immunohistochemically, tumor cells stained positive for vimentin (cytoplasmic) and E-cadherin (membranous), and negative for S100, pancytokeratin, and cytokeratins AE1 and AE3.

Objective Human corneal cells have detectable levels of TLRs 1-10. TLRs 2 and 4 are the major corneal receptors, recognizing the PAMPs associated with fungal invasion in humans. The conjunctiva and limbus contain TLRs 2, 4, and 9. Our purpose was to determine the expression of TLRs 2, 3, 4, 6, 9, and MD-2 in the normal equine cornea, conjunctiva, and limbus. Methods Corneal, limbal, and conjunctival tissues were collected from seven euthanized horses having no evidence of ocular disease. RNA extraction with DNase-1 digestion was performed followed by RT-PCR to determine expression of TLRs 2, 3, 4, 6, 9, and MD-2. Products were resolved by electrophoresis on 1.5% agarose gels and visualized using ethidium bromide staining. Results Expression of TLRs 2, 3, 4, 6, 9, and MD-2 was present in the cornea, limbus, and conjunctiva of each horse, except one horse, where TLR3 expression was unable to be demonstrated in the dorsal and ventral conjunctiva. Conclusions Confirming the expression of TLRs in equine ocular tissues is an initial step in identifying how they play a role in infectious keratitis, particularly fungal. The results further support the use of equine ocular tissues as a model for human fungal keratitis. Studies of the TLR expression together with their cytokine profile induced during equine fungal keratitis may help further clarify the pathogenesis of the disease and possibly lead to the development of new treatment protocols for both equines and humans.

A late Miocene (6–6.5 Ma; Kapitean and latest Tongaporutuan stages) fossil leaf locality is situated at Mataora in the southern Coromandel Peninsula of the North Island, New Zealand (latitude 37°S). It includes well-preserved remains of a new genus and species of conifer, Mataoraphyllum miocenicus, considered to be a phyllodinous Taxaceae. Other conifers include a new species of Phyllocladus, P. palmerii, and a small scale-leafed Podocarpaceae. There are five angiosperms, including a small-leafed Epacridaceae species, Myrsine waihiensis sp. nov., (Mysinaceae) Pseudopanax (Araliaceae), and two of unknown affinity. The relatively small leaf size, low biodiversity and taxonomic content suggest low, open vegetation under a relatively cool but wet climate; current subalpine to upper forest limit vegetation is a close analogy. The fossil assemblage indicates that mean annual temperatures may have been cooler at 37°S than today for the late Miocene.

This study is concerned with the attribution of secondary students. Causal interpretations for academic success and failure were analysed to investigate the effect of gender, year level and achievement level on students’ academic attributions in Hong Kong, a Confucian Heritage Culture. The sample for the study comprised 14,846 students currently enrolled in Secondary 1 to Secondary 6 in Hong Kong. Multivariate analyses of variance found significant gender differences in ascriptions to ability, effort and strategy use reasons for school performance of students who shared a common cultural background. These effects remained after controlling for achievement and year levels. Chinese females in this sample were more inclined than Chinese males to explain their academic failure in terms of their lack of ability and strategy use. Females were also more likely to explain their academic success in terms of their effort or strategy use. Nevertheless, the study found secondary students of both genders and across al...

A 5-year-old Draft Horse gelding presented for evaluation of a large, fleshy, ulcerated third eyelid mass OD of 3 weeks duration. Complete ophthalmic examination, ocular ultrasound and skull radiographs revealed a large soft-tissue mass involving the entire third eyelid OD and extending into the ventral right orbit to the level of the globe equator. No other abnormalities were noted on physical or ophthalmic examination. Surgical removal via exenteration was performed 3 months after initial presentation. A lacrimal adenocarcinoma of the third eyelid was diagnosed based on histopathology. Concurrent asymptomatic intra-ductal and intra-acinar Demodex caballi parasites were found in the eyelid sebaceous glands, likely as an incidental finding. No tumor recurrence or metastasis has occurred 12 months after excision. To the author's knowledge, this case is the first reported primary lacrimal adenocarcinoma in a horse. Complete surgical excision was curative.

Introduction La maladie renovasculaire est associee a une hypertrophie ventriculaire gauche (HVG) et a une dysfonction ventriculaire gauche diastolique, toutes deux egalement associees a une augmentation de la mortalite et des evenements cardiovasculaires. Cependant, les effets de la revascularisation arterielle renale sur la morphologie et la fonction cardiaque sont peu compris et generalement bases sur les resultats d’etudes retrospectives. Afin de caracteriser les modifications de la fonction et de la morphologie ventriculaire apres revascularisation arterielle renale, nous identifions une cohorte de patients ayant des echocardiographies preoperatoires et les etudions par echocardiographies repetees 6–12 mois apres la revascularisation. Methodes Les adultes ayant eu une echocardiographie preoperatoire et une revascularisation arterielle renale apres Mars 2006 etaient identifies a partir du registre operatoire. Il etait demande a ces patients de faire une nouvelle echocardiographie, une mesure de la pression arterielle, et de rapporter leur histoire clinique et medicamenteuse 6–12 mois apres la revascularisation renale. Les nouvelles echocardiographies etaient realisees et interpretees selon les recommandations de l’American Society of Echocardiography sur l’etude clinique de l’insuffisance cardiaque ainsi que selon les autres recommandations publiees. La fonction systolique etait estimee par la fraction d’ejection (FE), et calculee suivant la methode de Simpson modifiee. La fonction diastolique etait classee en normale, dysfonction minime, dysfonction moderee, ou dysfonction severe sur la base des recommandations publiees. La significativite des modifications longitudinales des variables echocardiographiques continues etait determinee par test t apparie, tandis que les modifications longitudinales des variables categorielles etaient determinees par le test de McNemar. Resultats Vingt patients etaient recrutes pour une nouvelle echocardiographie 7,7 mois en moyenne apres revascularisation arterielle renale. La fonction systolique basale etait relativement preservee; La FE moyenne etait de 61,3±8,5%, et seulement 2/20 patients (10%) avaient FE p =0,018) etait observee au cours du suivi. Aucun changement n’etait detecte significatif au niveau de la FE. Concernant la dysfonction diastolique, les changements de categorie (normale/minime versus moderee/severe) n’etaient pas significatifs ( p =0,25), deux patients progressant d’une fonction normale/dysfonction minime a une dysfonction moderee/severe au cours du suivi alors que les autres patients ne changeaient pas de categorie. Conclusion Une diminution de la masse ventriculaire gauche etait observee apres revascularisation arterielle renale, alors que la fonction diastolique restait globalement inchangee. La regression de l’HVG etait associee a une diminution de la mortalite et de la morbidite cardio-vasculaire, et de nouvelles investigations sont necessaires pour comprendre les effets a long terme de la revascularisation renale sur la survie et sur la fonction ventriculaire. Dans le cadre d’une stenose arterielle renale symptomatique, l’evaluation de la fonction cardiaque devrait inclure la recherche d’une dysfonction diastolique, qui pourrait representer la premiere forme de lesion chez les patients porteurs de ce diagnostic.

BACKGROUND.: Alemtuzumab and rabbit antithymocyte globulin (rATG) are commonly used for induction of immunsuppression for kidney and pancreas transplantation, but the two agents have not been compared directly. METHODS.: We conducted a prospective randomized single-center trial comparing alemtuzumab and rATG induction in adult kidney and pancreas transplantation in patients treated with similar maintenance immunosuppression. RESULTS.: Between February 1, 2005, and September 1, 2007, 222 patients randomly received either alemtuzumab (n=113) or rATG (n=109) induction; 180 (81%) underwent kidney alone, 38 (17%) simultaneous pancreas-kidney, and 4 (2%) pancreas after kidney transplants. Of 180 kidney-alone transplants, 152 (84%) were from deceased donors, including 61 (34%) from expanded criteria donors. Retransplantation, human leukocyte antigen match, antibody titer, expanded criteria donors, race, cytomegalovirus status, delayed graft function, and immunologic risks were similar between the two induction groups. With a median follow-up of 2 years (minimum 1 year), overall patient, kidney, and pancreas graft survival rates were 96%, 89%, and 90%, respectively. Survival, initial length of stay, and maintenance immunosuppression (including early steroid elimination) were similar between alemtuzumab and rATG groups, but biopsy-proven acute rejection (BPAR) episodes occurred in 16 (14%) alemtuzumab patients compared with 28 (26%) rATG patients (P=0.02). Late BPAR (>12 months after transplant) occurred in 1 (8%) alemtuzumab patient and 3 (11%) rATG patients (P=NS). Infections and malignancy were similar between the two induction arms. CONCLUSION.: Alemtuzumab and rATG induction therapies were equally safe, but alemtuzumab was associated with less BPAR.

Shave biopsy (SB) is used for the diagnosis of suspicious skin lesions, including melanoma. Its accuracy for melanoma has not been confirmed. We examined our experience with SB to determine its ability to predict true Breslow depth (BD). We performed a retrospective review of the tumor registry for all patients diagnosed with melanoma by SB from 1995 to 2004. Site and depth of lesion, tumor stage, correlation of BD between SB and wide local excision (WLE), and changes in surgical management due to discordance were examined. Melanoma-in-situ was defined as a depth of 0 for this analysis. One hundred thirty-nine patients were diagnosed with melanoma by SB. Pathology after WLE were as follows: 54 (39%) patients had no residual disease, 67 (48%) had a BD equal to or less than the SB, and 18 (13%) had a thicker BD compared with the SB. For these 18 patients, the median BD by SB and WLE was 1.1 mm (range 0-6.5) and 3.5 mm (range 0.5-20.5), respectively ( P = 0.0017). Upstaging of final BD from SB to WLE was significantly associated with increasing tumor depth and higher stage of melanoma ( P < 0.0001). Only seven of the 139 patients (5%) required further surgery because of the increased depth of the WLE. SB underestimated the final BD of melanoma in 13 per cent of patients, but changed the management of few patients. SB is a valuable tool for practitioners in the diagnosis of melanoma. Nevertheless, patients diagnosed with melanoma by SB should be counseled about the rare need for additional surgery.

This article aims to investigate reasons underpinning academic help-seeking behaviours of Chinese students in Hong Kong, Macau and Taiwan. Data were collected from 23,563 secondary students. The study found significant differences both in attitudes and reported behaviour among secondary school students from the three locations, however, the effect sizes were all very small. Importantly, it was found that no matter which location, students considered grade enhancement to be the least important benefit of help-seeking. Rather, the most important benefit was that help-seeking enabled them to solve their learning difficulties or to solve their learning problems. The study also found that losing face was the last deterrent for the students not to seek help. Instead, Chinese secondary school students refrained from seeking help because they were afraid to disturb others in the act of help-seeking. In addition, a high proportion of students reported seeking help in the past two months in order to get ad...

Objective We review the management of 31 cases of atypical mycobacterial lymphadenitis presenting to a tertiary referral pediatric otolaryngology department between February 2002 and February 2007. Study Design Retrospective case review. Subjects and Methods Cases were identified by using the hospital’s correspondence and pathology databases. Demographic and clinical information was collected. Descriptive and nonparametric inferential statistics (SPSS; SPSS Inc, Chicago, IL) were calculated. Results Four patients were treated conservatively with triple-therapy antibiotics. Twenty-seven underwent surgical excision plus 3 months of clarithromycin postoperatively. Thirteen percent developed nodal recurrence; this appeared to be unrelated to the operation performed (χ28 = 5.8, P = 0.69) or the management modality used (P = 0.35). Patients with previous surgery were more likely to have recurrent infection (χ22 = 9.3, P = 0.01). Conclusions In our experience, nodal excision plus postoperative clarithromycin remains the best treatment option for most children, although those with limited disease may benefit from combination antibiotic therapy. Previous incision and drainage leads to high recurrence rates after later excision and therefore, heightened awareness of these infections is essential to ensure appropriate early management.

Purpose The purpose of this study was to identify the most active matrix metalloproteinases (MMP) within the aqueous humor and iridocorneal angle tissue involved in the normal canine eye, and to compare these results to the MMP activity in dogs with glaucoma. Animal studied Aqueous humor samples from 32 normal eyes and 26 glaucomatous eyes were obtained through aqueous centesis and analyzed for MMP activity. Iridocorneal angle tissue from 16 enucleated normal canine eyes and 5 enucleated glaucomatous eyes were dissected and homogenized into solution. Procedure Bradford total protein assays were determined for aqueous humor samples and iridocorneal angle tissue samples. Substrate gelatin zymography was performed using 0.2 µL volumes of an MMP-2/MMP-9 control, 2 µL volumes of aqueous humor samples, and 10 µg weights of total protein from iridocorneal angle tissue. The presence of MMP gel bands were identified visually and measured quantitatively by densitometry technique. A statistical analysis was performed on the data using Student's t-test, multiple logistic Wald's chi-squared regression, Pearson correlations, and repeated measures analysis. Results Within the aqueous humor of canine eyes, MMP-2 latent form was found to be the most relevant MMP. The quantity of latent MMP-2 within the aqueous humor of the glaucoma samples was significantly increased compared to the normal aqueous samples (P

Background: We report a multiinstitutional study on intermediate-term outcome of intravascular stenting for treatment of coarctation of the aorta using integrated arch imaging (IAI) techniques. Methods and Results: Medical records of 578 patients from 17 institutions were reviewed. A total of 588 procedures were performed between May 1989 and Aug 2005. About 27% (160/588) procedures were followed up by further IAI of their aorta (MRI/CT/repeat cardiac catheterization) after initial stent procedures. Abnormal imaging studies included: the presence of dissection or aneurysm formation, stent fracture, or the presence of reobstruction within the stent (instent restenosis or significant intimal build-up within the stent). Forty-one abnormal imaging studies were reported in the intermediate follow-up at median 12 months (0.5–92 months). Smaller postintervention of the aorta (CoA) diameter and an increased persistent systolic pressure gradient were associated with encountering abnormal follow-up imaging studies. Aortic wall abnormalities included dissections (n = 5) and aneurysm (n = 13). The risk of encountering aortic wall abnormalities increased with larger percent increase in CoA diameter poststent implant, increasing balloon/coarc ratio, and performing prestent angioplasty. Stent restenosis was observed in 5/6 parts encountering stent fracture and neointimal buildup (n = 16). Small CoA diameter poststent implant and increased poststent residual pressure gradient increased the likelihood of encountering instent restenosis at intermediate follow-up. Conclusions: Abnormalities were observed at intermediate follow-up following IS placement for treatment of native and recurrent coarctation of the aorta. Not exceeding a balloon:coarctation ratio of 3.5 and avoidance of prestent angioplasty decreased the likelihood of encountering an abnormal follow-up imaging study in patients undergoing intravascular stent placement for the treatment of coarctation of the aorta. We recommend IAI for all patients undergoing IS placement for treatment of CoA. © 2007 Wiley-Liss, Inc.

We sought to develop a scoring system that predicts the risk of serious adverse events (SAE's) for individual pediatric patients undergoing cardiac catheterization procedures.Systematic assessment of risk of SAE in pediatric catheterization can be challenging in view of a wide variation in procedure and patient complexity as well as rapidly evolving technology.A 10 component scoring system was originally developed based on expert consensus and review of the existing literature. Data from an international multi-institutional catheterization registry (CCISC) between 2008 and 2013 were used to validate this scoring system. In addition we used multivariate methods to further refine the original risk score to improve its predictive power of SAE's.Univariate analysis confirmed the strong correlation of each of the 10 components of the original risk score with SAE attributed to a pediatric cardiac catheterization (P 0.001 for all variables). Multivariate analysis resulted in a modified risk score (CRISP) that corresponds to an increase in value of area under a receiver operating characteristic curve (AUC) from 0.715 to 0.741.The CRISP score predicts risk of occurrence of an SAE for individual patients undergoing pediatric cardiac catheterization procedures.

Dual kidney transplantation (DKT) from donors at the extremes of age represents one approach to expanding the organ donor pool. The purpose of this study was to review our experience with DKT from older donors and en bloc KT (EBKT) from small pediatric donors.Deceased donor KTs performed at our center between October 2001 and November 2005, were reviewed retrospectively. If the calculated creatinine clearance in an expanded criteria donor was65 mL/min, then the kidneys were transplanted dually into a single adult recipient. If a pediatric donor weighed15 kg, then the kidneys were transplanted en bloc. In both instances, low-risk recipients were chosen (primary transplant, low sensitization, body mass index25 kg/m(2), human leukocyte antigen matching). Donor, recipient, and transplant characteristics, waiting time, and outcomes were examined.Of a total of 279 deceased donor KTs during the 49-month study period, 15 (5%) recipients underwent DKT and 5 (2%) underwent EBKT. Mean donor age was 65.4 years and 21.4 months in the DKT and EBKT groups, respectively. Patient survival rates in both groups were 100% with a mean follow-up of 22 months (minimum, 6 months). Kidney graft survival rates were 80% (12/15) and 60% (3/5) in the DKT and EBKT groups, respectively. The combined incidence of delayed graft function was 10%. Mean 12-month glomerular filtration rates were 46 mL/min and 66 mL/min in the DKT and EBKT groups, respectively.DKT using kidneys from marginal elderly donors and EBKT from small pediatric donors appear to offer a viable option to counteract the shortage of acceptable kidney donors.

This paper reports the development of performance indicators for measuring primary and secondary students’ affective and social outcomes of schooling. Psychometric properties as well as norms for the selected performance indicators for Hong Kong students were developed. The performance indicator system developed in this study has been subsequently used for school self‐evaluation and continuous self‐improvement in Hong Kong.