Publications by authors named "Edward Hughes"

67 Publications

Heterozygous COL9A3 variants cause severe peripheral vitreoretinal degeneration and retinal detachment.

Eur J Hum Genet 2021 Feb 25. Epub 2021 Feb 25.

Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia.

The COL9A3 gene encodes one of the three alpha chains of Type IX collagen, with heterozygous variants reported to cause multiple epiphyseal dysplasia, and suggested as contributory in some cases of sensorineural hearing loss. Patients with homozygous variants have midface hypoplasia, myopia, sensorineural hearing loss, epiphyseal changes and carry a diagnosis of Stickler syndrome. Variants in COL9A3 have not previously been reported to cause vitreoretinal degeneration and/or retinal detachments. This report describes two families with autosomal dominant inheritance and predominant features of peripheral vitreoretinal lattice degeneration and retinal detachment. Genomic sequencing revealed a heterozygous splice variant in COL9A3 [NG_016353.1(NM_001853.4):c.1107 + 1G>C, NC_000020.10(NM_001853.4):c.1107 + 1G>C, LRG1253t1] in Family 1, and a heterozygous missense variant [NG_016353.1(NM_001853.4):c.388G>A p.(Gly130Ser)] in Family 2, each segregating with disease. cDNA studies of the splice variant demonstrated an in-frame deletion in the COL2 domain, and the missense variant occurred in the COL3 domain, both indicating the critical role of Type IX collagen in the vitreous base of the eye.
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http://dx.doi.org/10.1038/s41431-021-00820-1DOI Listing
February 2021

Aerosol generation through pars plana vitrectomy.

Br J Ophthalmol 2020 Oct 14. Epub 2020 Oct 14.

Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK

Purpose: To assess whether pars plana vitrectomy (PPV) is an aerosol-generating procedure (AGP) in an ex vivo experimental model.

Methods: In this ex vivo study on 10 porcine eyes, optical particle counter was used to measure particles ≤10 μm using cumulative mode in the six in-built channels: 0.3 μm, 0.5 μm, 1 μm, 2.5 μm, 5 μm and 10 μm aerosols during PPV. Two parts of the study were as follows: (1) to assess the pre-experimental baseline aerosol count in the theatre environment where there are dynamic changes in temperature and humidity and (2) to measure aerosol generation with 23-gauge and 25-gauge set-up. For each porcine eye, five measurements were taken for each consecutive step in the experiment including pre-PPV, during PPV, fluid-air exchange (FAX) and venting using a flute with 23-gauge set-up and a chimney with 25-gauge set-up. Therefore, a total of 200 measurements were recorded.

Results: With 23-gauge and 25-gauge PPV, there was no significant difference in aerosol generation in all six channels comparing pre-PPV versus PPV or pre-PPV versus FAX. Venting using flute with 23-gauge PPV showed significant reduction of aerosol ≤1 μm. Air venting using chimney with 25-gauge set-up showed no significant difference in aerosol of ≤1 μm. For cumulative aerosol counts of all particles measuring ≤5 μm, compared with pre-PPV, PPV or FAX, flute venting in 23-gauge set-up showed significant reduction unlike the same comparison for chimney venting in 25-gauge set-up.

Conclusion: PPV and its associate steps do not generate aerosols ≤10 μm with 23-gauge and 25-gauge set-ups.
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http://dx.doi.org/10.1136/bjophthalmol-2020-317214DOI Listing
October 2020

Molecular genetic profiling reveals novel association between FLT3 mutation and survival in glioma.

J Neurooncol 2020 Jul 24;148(3):473-480. Epub 2020 Jun 24.

Geisel School of Medicine At Dartmouth, Hanover, NH, Germany.

Introduction: Recent molecular characterization of gliomas has uncovered somatic gene variation and DNA methylation changes that are associated with etiology, prognosis, and therapeutic response. Here we describe genomic profiling of gliomas assessed for associations between genetic mutations and patient outcomes, including overall survival (OS) and recurrence-free survival (RFS).

Methods: Mutations in a 50-gene cancer panel, 1p19q co-deletion, and MGMT promoter methylation (MGMT methylation) status were obtained from tumor tissue of 293 glioma patients. Multivariable regression models for overall survival (OS) and recurrence-free survival (RFS) were constructed for MGMT methylation, 1p19q co-deletion, and gene mutations controlling for age, treatment status, and WHO grade.

Results: Mutational profiles of gliomas significantly differed based on WHO Grade, such as high prevalence of BRAF V600E, IDH1, and PTEN mutations in WHO Grade I, II/III, and IV tumors, respectively. In multivariate regression analysis, MGMT methylation and IDH1 mutations were significantly associated with improved OS (HR = 0.44, p = 0.0004 and HR = 0.21, p = 0.007, respectively), while FLT3 and TP53 mutations were significantly associated with poorer OS (HR = 19.46, p < 0.0001 and HR = 1.67, p = 0.014, respectively). MGMT methylation and IDH1 mutations were the only significant alterations associated with improved RFS in the model (HR = 0.42, p < 0.0001 and HR = 0.37, p = 0.002, respectively). These factors were then included in a combined model, which significantly exceeded the predictive value of the base model alone (age, surgery, radiation, chemo, grade) (likelihood ratio test OS p = 1.64 × 10 and RFS p = 3.80 × 10).

Conclusions: This study highlights the genomic landscape of gliomas in a single-institution cohort and identifies a novel association between FLT3 mutation and OS in gliomas.
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http://dx.doi.org/10.1007/s11060-020-03567-9DOI Listing
July 2020

Atypical presentation of Coats' Syndrome in facioscapulohumeral dystrophy - Reflecting the variation in phenotypic manifestations.

Am J Ophthalmol Case Rep 2018 Sep 21;11:17-18. Epub 2018 Apr 21.

Brighton and Sussex University Hospitals NHS Trust, Sussex Eye Hospital, Eastern Road, Brighton, BN2 5BF, United Kingdom.

Purpose: To report a unique case of atypical Coats' Syndrome in an 80 year old female with facioscapulohumeral dystrophy.

Observations: An 80 years old female was diagnosed clinically of retinal telangiectasia with exudation threatening the fovia. She received a successful macular laser photocoagulation with subsequent cessation of leakage.

Conclusions And Importance: This case is in keeping with Coats' syndrome in fascioscapulohumeral dystrophy, which classically affects young male subjects - making this patient an obvious outlier. This once again reflects the variation in phenotypic manifestations of inherited disorders.
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http://dx.doi.org/10.1016/j.ajoc.2018.04.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6061899PMC
September 2018

Effects of Human Electro-Muscular Incapacitation (HEMI) Devices on Cardiovascular Changes in Anesthetized Swine as Measured by Transesophageal Echocardiography (TEE).

J Forensic Sci 2019 Mar 14;64(2):446-453. Epub 2018 May 14.

Applied Research Lab, The Pennsylvania State University, State College, PA.

The abundance of, and reliance upon, human electro-muscular incapacitation (HEMI) devices, especially in law enforcement, has generated scrutiny and examination of these technologies. The purpose of this study was to examine cardiovascular effects resulting from typical (5 sec) and longer activation (20 sec) HEMI applications studying myocardial function and peripheral vascular system using a combination of invasive cardiovascular catheters and transesophageal echocardiography (TEE). Six healthy swine (Sus scrofa) 3-5 months in age and weighing between 60 and 86 kg were anesthetized and exposed to the TASER Model X26 waveform while transesophageal echocardiography was performed. Stroke volume was shown to statistically decrease during HEMI application indicating an increase in systemic vascular resistance, but HEMI application did not result in myocardial dysfunction ("cardiac stunning").
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http://dx.doi.org/10.1111/1556-4029.13814DOI Listing
March 2019

Controlled Ovarian Hyperstimulation with Intrauterine Insemination Is More Successful After r-hCG Administration Than Spontaneous LH Surge.

J Reprod Infertil 2017 Jul-Sep;18(3):316-322

- Division of Gynecologic Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.

Background: The purpose of this study was to evaluate whether clinical pregnancy rate is affected by timing intrauterine insemination (IUI) according to serum LH surge, r-hCG trigger, or a combination of LH surge and r-hCG trigger in controlled ovarian hyperstimulation (COH) cycles for patients with a variety of infertility etiologies.

Methods: The last 365 consecutive COH-IUI cycles performed at ONE Fertility Burlington in 2014 were reviewed and categorized according to method of IUI timing. Associations between categorical variables were analyzed using a combination of Chi-square and Fisher's Exact tests, and between continuous variables using independent sample t-tests and logistic regression to a level of significance of p<0.05.

Results: The overall clinical pregnancy rate in this sample was 18.1% (66/365). Administration of r-hCG prior to IUI resulted in a higher clinical pregnancy rate compared with spontaneous serum LH surge: 18.2% . 5.8%, p=0.012. Patients in whom r-hCG was administered concomitantly with a serum LH surge had a higher clinical pregnancy than the r-hCG trigger group (30.8% . 18.2%, p=0.004) and LH surge group (30.8% . 5.8%, p<0.001). A sub-group analysis revealed that patients receiving r-FSH, rather than clomiphene or letrozole, had a significantly higher clinical pregnancy rate after r-hCG trigger as compared to the LH surge group (21.7% . 2.1%, p=0.01).

Conclusion: In subfertile couples undergoing COH-IUI, r-hCG administration was associated with an increased clinical pregnancy rate compared with spontaneous serum LH surge. When r-hCG was administered concomitantly with a serum LH surge, this benefit was amplified. The effect appears to be of particular importance in r-FSH-medicated cycles.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641441PMC
October 2017

An unusual presentation of Roth spots in Cogan's syndrome.

Can J Ophthalmol 2017 10 20;52(5):e196-e197. Epub 2017 Apr 20.

Sussex Eye Hospital, Brighton, United Kingdom.

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http://dx.doi.org/10.1016/j.jcjo.2017.02.010DOI Listing
October 2017

The art of medicine: arts-based training in observation and mindfulness for fostering the empathic response in medical residents.

Med Humanit 2017 Sep 27;43(3):192-198. Epub 2017 Apr 27.

Department of Family Medicine, McMaster University, Hamilton, Ontario, USA.

Empathy is an essential attribute for medical professionals. Yet, evidence indicates that medical learners' empathy levels decline dramatically during medical school. Training in evidence-based observation and mindfulness has the potential to bolster the acquisition and demonstration of empathic behaviours for medical learners. In this prospective cohort study, we explore the impact of a course in arts-based visual literacy and mindfulness practice () on the empathic response of medical residents engaged in obstetrics and gynaecology and family medicine training. Following this multifaceted arts-based programme that integrates the facilitated viewing of art and dance, art-making, and mindfulness-based practices into a practitioner-patient context, 15 resident trainees completed the previously validated Interpersonal Reactivity Index, Compassion, and Mindfulness Scales. Fourteen participants also participated in semistructured interviews that probed their perceived impacts of the programme on their empathic clinical practice. The results indicated that programme participants improved in the Mindfulness Scale domains related to self-confidence and communication relative to a group of control participants following the arts-based programme. However, the majority of the psychometric measures did not reveal differences between groups over the duration of the programme. Importantly, thematic qualitative analysis of the interview data revealed that the programme had a positive impact on the participants' perceived empathy towards colleagues and patients and on the perception of personal and professional well-being. The study concludes that a multifaceted arts-based curriculum focusing on evidence-based observation and mindfulness is a useful tool in bolstering the empathic response, improving communication, and fostering professional well-being among medical residents.
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http://dx.doi.org/10.1136/medhum-2016-011180DOI Listing
September 2017

Poppers: legal highs with questionable contents? A case series of poppers maculopathy.

Br J Ophthalmol 2017 11 10;101(11):1530-1534. Epub 2017 Apr 10.

School of Chemistry, University of Lincoln, Lincoln, Lincolnshire, UK.

Background: Poppers are volatile alkyl nitrite compounds that are inhaled to enhance sexual experience and for their psychoactive effects. A less well-known side effect is foveal maculopathy, which has emerged following changes in their chemical composition. It is unclear if certain individuals are more susceptible to retinal damage or if there is a relationship between pattern of inhalation and brands used.

Methods: A case series of 12 patients presenting to Sussex Eye Hospital, Brighton, with poppers-related visual impairment. Follow-up data were available in 10 cases, at a median time interval of 5 months (range 0-31 months). Eight samples of poppers were analysed using proton nuclear magnetic resonance spectroscopy.

Results: Patients presented with disrupted central vision occurring soon after inhalation. All demonstrated disruption of the inner segment/outer segment junction on spectral domain optical coherence tomography. Six of the brands implicated in causing visual symptoms contained isopropyl nitrite, while Jungle Juice Plus varieties, used without side effects in one case, contained amyl nitrite, 2-methyl butyl nitrite and isobutyl alcohol. In general, symptomatic resolution, alongside partial, if not full, recovery of foveal architecture was observed following abstention.

Discussion: On the basis of the products tested here, it seems that isopropyl nitrite is toxic to the fovea and can cause significant visual disturbance. The production of poppers is unregulated and their popularity is concerning, particularly given their exemption from the Psychoactive Substances Act 2016, which might suggest that they are harmless chemicals.
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http://dx.doi.org/10.1136/bjophthalmol-2016-310023DOI Listing
November 2017

Feasibility of an altruistic sperm donation program in Canada: results from a population-based model.

Reprod Health 2017 Jan 14;14(1). Epub 2017 Jan 14.

Department of Obstetrics & Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada, L8N 3Z5.

Background: Stringent donor-screening criteria and legislation prohibiting payment for donor gametes have contributed to the radical decline of donor insemination (DI) using sperm provided by Canadian men. Thus, many individuals rely on imported sperm. This paper examines the feasibility of an altruistic sperm donation (ASD) program to meet the needs of Canadians.

Methods: Using Canadian census data, published literature and expert opinions, two population-based, top-down mathematical models were developed to estimate the supply and demand for donor sperm and the feasibility of an ASD program.

Results: It was estimated that 63 donors would pass Canadian screening criteria, which would provide 1,575 donations. The demand for DI by women was 7,866 samples (4,319 same sex couples, 1,287 single women and 2,260 heterosexual couples).

Conclusion: Considerable effort would be necessary to create the required increase in awareness of the program and change in societal behaviour towards sperm donation for an ASD program to be feasible in Canada.
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http://dx.doi.org/10.1186/s12978-016-0275-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5237486PMC
January 2017

Intra-uterine insemination for unexplained subfertility.

Cochrane Database Syst Rev 2016 Feb 19;2:CD001838. Epub 2016 Feb 19.

University Medical Center Utrecht, Department of Reproductive Medicine and Gynecology, Room F5.126, PO Box 85500,, Utrecht, Netherlands, 3508 GA.

Background: Intra-uterine insemination (IUI) is a widely used fertility treatment for couples with unexplained subfertility. Although IUI is less invasive and less expensive thAppendixan in vitro fertilisation (IVF), the safety of IUI in combination with ovarian hyperstimulation (OH) is debated. The main concern about IUI treatment with OH is the increase in multiple pregnancy rate. This is an update of a Cochrane review (Veltman-Verhulst 2012) originally published in 2006 and updated in 2012.

Objectives: To determine whether, for couples with unexplained subfertility, IUI improves the live birth rate compared with timed intercourse (TI), or expectant management, both with and without ovarian hyperstimulation (OH).

Search Methods: We searched the Cochrane Gynaecology and Fertility (formerly Cochrane Menstrual Disorders and Subfertility Group) Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, inception to Issue 11, 2015), Ovid MEDLINE, Ovid EMBASE, PsycINFO and trial registers, all from inception to December 2015 and reference lists of articles. Authors of identified studies were contacted for missing or unpublished data. The evidence is current to December 2015.

Selection Criteria: Truly randomised controlled trial (RCT) comparisons of IUI versus TI, in natural or stimulated cycles. Only couples with unexplained subfertility were included.

Data Collection And Analysis: Two review authors independently performed study selection, quality assessment and data extraction. We extracted outcomes, and pooled data and, where possible, we carried out subgroup and sensitivity analyses.

Main Results: We included 14 trials including 1867 women. IUI versus TI or expectant management both in natural cycleLive birth rate (all cycles)There was no evidence of a difference in cumulative live births between the two groups (Odds Ratio (OR) 1.60, 95% confidence interval (CI) 0.92 to 2.78; 1 RCT; n = 334; moderate quality evidence). The evidence suggested that if the chance of a live birth in TI was assumed to be 16%, that of IUI would be between 15% and 34%.Multiple pregnancy rateThere was no evidence of a difference in multiple pregnancy rate between the two treatment groups (OR 0.50, 95% CI 0.04 to 5.53; 1 RCT; n = 334; moderate quality evidence). IUI versus TI or expectant management both in stimulated cycleLive birth rate (all cycles)There was no evidence of a difference between the two treatment groups (OR 1.59, 95% CI 0.88 to 2.88; 2 RCTs; n = 208; I(2) = 72%; moderate quality evidence). The evidence suggested that if the chance of achieving a live birth in TI was assumed to be 26%, the chance of a live birth with IUI would be between 23% and 50%.Multiple pregnancy rateThere was no evidence of a difference in multiple pregnancy rates between the two treatment groups (OR 1.46, 95% CI 0.55 to 3.87; 4 RCTs, n = 316; I(2) = 0%; low quality evidence). IUI in a natural cycle versus IUI in a stimulated cycle Live birth rate (all cycles)An increase in live birth rate was found for women who were treated with IUI in a stimulated cycle compared with those who underwent IUI in natural cycle (OR 0.48, 95% CI 0.29 to 0.82; 4 RCTs, n = 396; I(2) = 0%; moderate quality evidence). The evidence suggested that if the chance of a live birth in IUI in a stimulated cycle was assumed to be 25%, the chance of a live birth in IUI in a natural cycle would be between 9% and 21%.Multiple pregnancy rateThere was no evidence of a difference in multiple pregnancy rate between the two treatment groups (OR 0.33, 95% CI 0.01 to 8.70; 2 RCTs; n = 65; low quality evidence). IUI in a stimulated cycle versus TI or expectant management in a natural cycleLive birth rate (all cycles)There was no evidence of a difference in live birth rate between the two treatment groups (OR 0.82, 95% CI 0.45 to 1.49; 1 RCT; n = 253; moderate quality evidence). The evidence suggested that if the chance of a live birth in TI or expectant management in a natural cycle was assumed to be 24%, the chance of a live birth in IUI in a stimulated cycle would be between 12% and 32%.Multiple pregnancy rateThere was no evidence of a difference in multiple pregnancy rate between the two treatment groups (OR 2.00, 95% CI 0.18 to 22.34; 2 RCTs; n = 304; moderate quality evidence). IUI in natural cycle versus TI or expectant management in stimulated cycle Live birth rate (all cycles)There was evidence of an increase in live births for IUI (OR 1.95, 95% CI 1.10 to 3.44; 1 RCT, n = 342; moderate quality evidence). The evidence suggested that if the chance of a live birth in TI in a stimulated cycle was assumed to be 13%, the chance of a live birth in IUI in a natural cycle would be between 14% and 34%.Multiple pregnancy rateThere was no evidence of a difference in multiple pregnancy rate between the groups (OR 1.05, 95% CI 0.07 to 16.90; 1 RCT; n = 342; moderate quality evidence).The quality of the evidence was assessed using GRADE methods. Quality ranged from low to moderate, the main limitation being imprecision in the findings for both live birth and multiple pregnancy..

Authors' Conclusions: This systematic review did not find conclusive evidence of a difference in live birth or multiple pregnancy in most of the comparisons for couples with unexplained subfertility treated with intra-uterine insemination (IUI) when compared with timed intercourse (TI), both with and without ovarian hyperstimulation (OH). There were insufficient studies to allow for pooling of data on the important outcome measures for each of the comparisons.
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http://dx.doi.org/10.1002/14651858.CD001838.pub5DOI Listing
February 2016

Cross-border reproductive care in North America: a pilot study testing a prospective data collection program for in vitro fertilization clinics in Canada and the United States.

Fertil Steril 2016 Mar 13;105(3):786-790. Epub 2015 Dec 13.

Palo Alto Medical Foundation Fertility Physicians of Northern California, San Jose, California.

Objective: To develop and test a nonidentifying prospective data collection system for cross-border reproductive care (CBRC) in Canada and the United States (U.S.).

Design: Survey and cross-sectional study.

Setting: Fertility clinics.

Patient(s): Women traveling to and from Canada and the U.S. for reproductive care.

Intervention(s): None.

Main Outcome Measure(s): Patients' home country, reason for crossing borders, and type of care received.

Result(s): Of 32 Canadian and 440 U.S. clinics contacted, seven and 46, respectively, responded to the initial questionnaire. Three out of seven Canadian and 44 out of 46 U.S. clinics reported providing CBRC. Seventy five percent agreed that nonidentifying data on country of origin and reason for travel should be collected. However, only one of seven Canadian and none of 46 U.S. clinics that expressed initial interest actually collected data, despite multiple communications.

Conclusion(s): Although CBRC is a major component of assisted reproductive technology in North America (3%-10% of IVF cycles are provided to out-of-country patients in Canada and the U.S.), clinicians are not motivated to collect the simplest of data regarding CBRC patients. Despite this, reliable data are needed to help better understand the reasons for and impact of CBRC.
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http://dx.doi.org/10.1016/j.fertnstert.2015.11.048DOI Listing
March 2016

Are health care providers adequately educating couples for embryo disposition decisions?

Fertil Steril 2016 Mar 13;105(3):684-689. Epub 2015 Dec 13.

Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada; ONE Fertility, Burlington, Ontario, Canada.

Objective: To determine the effectiveness of education provided by health care professionals during and after IVF treatment in preparing couples for surplus embryo disposition decisions.

Design: Cross-sectional survey.

Setting: University-affiliated fertility center.

Patient(s): Couples with embryos cryopreserved for more than 2 years.

Intervention(s): Self-administered questionnaire.

Main Outcome Measure(s): A Likert scale was used to rate the response to questions about patients' preparedness to make decisions regarding their surplus embryos.

Result(s): The survey response rate was 70% (131 of 187). Education provided by health care professionals before initiating treatment met the needs of the majority of participants (n = 86). After treatment, the education received was not adequate to assist couples in making embryo disposition decisions. Of the 127 respondents who provided feedback on their intention for their cryopreserved embryos, 37% (n = 47) had no intention of using cryopreserved embryos for their own reproduction, 24% (n = 30) intended to use embryos for procreation, and the remaining 39% (n = 50) remained undecided regarding their future use of their embryos. Participants with more than 3 years of infertility (n = 49) were most likely to feel conflicted about the decision after treatment.

Conclusion(s): The education received after treatment was considered inadequate. Couples with a long duration of infertility and those conflicted about final embryo disposition may be appropriate targets for further intervention. More written information and/or counseling services after treatment may help patients make informed and timely decisions regarding their surplus embryos.
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http://dx.doi.org/10.1016/j.fertnstert.2015.11.025DOI Listing
March 2016

Direct cost of pars plana vitrectomy for the treatment of macular hole, epiretinal membrane and vitreomacular traction: a bottom-up approach.

Eur J Health Econ 2016 Nov 24;17(8):991-999. Epub 2015 Nov 24.

LSE Health and Social Care, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.

Purpose: The direct cost to the National Health Service (NHS) in England of pars plana vitrectomy (PPV) is unknown since a bottom-up costing exercise has not been undertaken. Healthcare resource group (HRG) costing relies on a top-down approach. We aimed to quantify the direct cost of intermediate complexity PPV.

Methods: Five NHS vitreoretinal units prospectively recorded all consumables, equipment and staff salaries during PPV undertaken for vitreomacular traction, epiretinal membrane and macular hole. Out-of-surgery costs between admission and discharge were estimated using a representative accounting method.

Results: The average patient time in theatre for 57 PPVs was 72 min. The average in-surgery cost for staff was £297, consumables £619, and equipment £82 (total £997). The average out-of-surgery costs were £260, including nursing and medical staff, other consumables, eye drops and hospitalisation. The total cost was therefore £1634, including 30 % overheads. This cost estimate was an under-estimate because it did not include out-of-theatre consumables or equipment. The average reimbursed HRG tariff was £1701.

Conclusions: The cost of undertaking PPV of intermediate complexity is likely to be higher than the reimbursed tariff, except for hospitals with high throughput, where amortisation costs benefit from economies of scale. Although this research was set in England, the methodology may provide a useful template for other countries.
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http://dx.doi.org/10.1007/s10198-015-0741-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047926PMC
November 2016

Singleton birth at term: an old alarm or a new debate?

Authors:
Edward G Hughes

Hum Reprod 2015 Oct;30(10):2254-6

Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada L8N 3Z5

In 2004, Human Reproduction published a debate series focusing on the rising tide of multiple pregnancy associated with IVF. The premise of the primary report in that debate was that by considering IVF outcomes differently-by focusing on healthy singleton birth at term rather than clinical pregnancy, the standard currency at that time-the necessary shift toward reduced numbers of embryos transferred might be accelerated. The choice of end-point in that debate-Birth Emphasizing a Successful Singleton at Term (BESST)-was not an effort to 'dumb down' the complex equation linking risks and benefits. That balance is a dynamic and various mix of issues that clinicians discuss with patients on a daily basis. And BESST was certainly not proposed as a new primary outcome for application to other treatment modalities in reproductive medicine, such as ovulation induction. It was simply a responsible and brave call for change in the accelerating and competitive world of IVF.
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http://dx.doi.org/10.1093/humrep/dev205DOI Listing
October 2015

WITHDRAWN: Gonadotrophin therapy for ovulation induction in subfertility associated with polycystic ovary syndrome.

Cochrane Database Syst Rev 2015 Aug 24(8):CD000410. Epub 2015 Aug 24.

Onocology, St james university Hospital, Bexley Wing (level 4), Beckett Street, Leeds, UK, LS9 7TF.

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http://dx.doi.org/10.1002/14651858.CD000410.pub2DOI Listing
August 2015

An integrated approach to male-factor subfertility: bridging the gap between fertility specialists trained in urology and gynaecology.

J Obstet Gynaecol Can 2015 Mar;37(3):258-265

Department of Surgery, McGill University Montreal QC.

Subfertile men and women are usually cared for by different clinicians, namely urologists and gynaecologists. While these doctors share each other's goals, they may not always appreciate the content or implications of their opposite number's clinical decisions; to some degree they may practice in "silos." We address this problem by reviewing the effectiveness of medical treatments for male factor subfertility in the context of female factors. The effectiveness of treatments for couples with male factor subfertility, other than IVF with ICSI, appears modest. However, data from randomized controlled trials suggest benefits from some treatments: clomiphene and tamoxifen for the male (common odds ratio for pregnancy [COR] 2.42; 95% CI 1.47 to 3.94), antioxidants (COR 4.18; 95% CI 2.65 to 6.59) and surgical management of a clinical varicocele (COR 2.39; 95% CI 1.56 to 3.66). Nevertheless, close attention to female age and the duration of subfertility help to avoid lost opportunity through delays in treatment when IVF with ICSI is indicated. Making treatment decisions squarely in the context of the couple's overall prognosis is key for optimal outcomes. Future trials of male fertility treatments should focus on pregnancy as the primary outcome, rather than less important surrogates such as sperm quality.
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http://dx.doi.org/10.1016/S1701-2163(15)30312-1DOI Listing
March 2015

Tubal flushing for subfertility.

Cochrane Database Syst Rev 2015 May 1(5):CD003718. Epub 2015 May 1.

St Mary's Hospital, Oxford Road, Manchester, UK, M13 9WL.

Background: Establishing the patency of the fallopian tubes is a commonly undertaken diagnostic investigation for women with subfertility. This is usually achieved by flushing contrast medium through the tubes and taking radiographs. However, it has been noted that many women conceive in the first three to six months after the tubal flushing, which has raised the possibility that tubal flushing could also be a treatment for infertility. There has been debate about which contrast medium should be used (water-soluble or oil-soluble media) as this may influence pregnancy rates.

Objectives: To evaluate the effect of flushing fallopian tubes with oil- or water-soluble contrast media on live birth and pregnancy rates in women with subfertility.

Search Methods: We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register of trials, MEDLINE, EMBASE, Biological Abstracts, trial registers and reference lists of identified articles. The most recent search was conducted in June 2014.

Selection Criteria: Randomised controlled trials (RCTs) comparing tubal flushing with oil-soluble or water-soluble contrast media, or with no treatment, in women with subfertility.

Data Collection And Analysis: Two authors independently selected the trials, assessed risk of bias and extracted data. We contacted study authors for additional information. The overall quality of the evidence was assessed using GRADE methods.

Main Results: Thirteen trials involving 2914 women were included, of whom 2494 were included in the analysis. Oil-soluble contrast media (OSCM) versus no interventionThe OSCM group had a higher rate of live birth (odds ratio (OR) 3.09, 95% CI 1.39 to 6.91, 1 RCT, 158 women, low quality evidence) and ongoing pregnancy (OR 3.59, 95% CI 2.06 to 6.26, 3 RCTs, 382 women, I(2) = 0%, low quality evidence) than women who had no intervention. Our findings suggest that among subfertile women with a 17% chance of an ongoing pregnancy if they have no intervention, the rate will increase to between 29% and 55% if they have tubal flushing with OSCM. Water-soluble contrast media (WSCM) versus no interventionThere was no evidence of a difference between the groups in rates of live birth (OR 1.13, 95% CI 0.67 to 1.91, 1 RCT, 334 women, very low quality evidence) or ongoing pregnancy (OR 1.14, 95% CI 0.71 to 1.84, 1 RCT, 334 women, very low quality evidence). OSCM versus WSCMTwo RCTs reported live birth: one found a higher live birth rate in the oil-soluble group and the other found no evidence of a difference between the groups. These studies were not pooled due to very high heterogeneity (I(2) = 93%). There was no evidence of a difference between the groups in rates of ongoing pregnancy, however there was high heterogeneity (OR 1.44, 95% CI 0.84 to 2.47, 5 RCTs, 1454 women, I(2) = 76%, random-effects model, very low quality evidence). OSCM plus WSCM versus WSCM aloneThere was no evidence of a difference between the groups in rates of live birth (OR 1.06, 95% CI 0.64 to 1.77, 1 RCT, 393 women, very low quality evidence) or ongoing pregnancy (OR 1.23, 95% CI 0.87 to 1.72, 4 RCTs, 633 women, I(2) = 0%, low quality evidence).There was no evidence of a difference between any of the interventions in rates of adverse events, but such events were poorly reported in most studies.

Authors' Conclusions: The evidence suggests that tubal flushing with oil-soluble contrast media may increase the chance of pregnancy and live birth compared to no intervention. Findings for other comparisons were inconclusive due to inconsistency and lack of statistical power. There was insufficient evidence on adverse events to reach firm conclusions. Further robust randomised controlled trials are needed.
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http://dx.doi.org/10.1002/14651858.CD003718.pub4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7133784PMC
May 2015

Developing small-area predictions for smoking and obesity prevalence in the United States for use in Environmental Public Health Tracking.

Environ Res 2014 Oct 28;134:435-52. Epub 2014 Sep 28.

University of California, Berkeley, School of Public Health, Division of Environmental Health Sciences, 50 University Hall MC7360 Mail Drop, Berkeley, CA 94720-7360, United States.

Background: Globally and in the United States, smoking and obesity are leading causes of death and disability. Reliable estimates of prevalence for these risk factors are often missing variables in public health surveillance programs. This may limit the capacity of public health surveillance to target interventions or to assess associations between other environmental risk factors (e.g., air pollution) and health because smoking and obesity are often important confounders.

Objectives: To generate prevalence estimates of smoking and obesity rates over small areas for the United States (i.e., at the ZIP code and census tract levels).

Methods: We predicted smoking and obesity prevalence using a combined approach first using a lasso-based variable selection procedure followed by a two-level random effects regression with a Poisson link clustered on state and county. We used data from the Behavioral Risk Factor Surveillance System (BRFSS) from 1991 to 2010 to estimate the model. We used 10-fold cross-validated mean squared errors and the variance of the residuals to test our model. To downscale the estimates we combined the prediction equations with 1990 and 2000 U.S. Census data for each of the four five-year time periods in this time range at the ZIP code and census tract levels. Several sensitivity analyses were conducted using models that included only basic terms, that accounted for spatial autocorrelation, and used Generalized Linear Models that did not include random effects.

Results: The two-level random effects model produced improved estimates compared to the fixed effects-only models. Estimates were particularly improved for the two-thirds of the conterminous U.S. where BRFSS data were available to estimate the county level random effects. We downscaled the smoking and obesity rate predictions to derive ZIP code and census tract estimates.

Conclusions: To our knowledge these smoking and obesity predictions are the first to be developed for the entire conterminous U.S. for census tracts and ZIP codes. Our estimates could have significant utility for public health surveillance.
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http://dx.doi.org/10.1016/j.envres.2014.07.029DOI Listing
October 2014

Correction of JOI Letter to the Editor Vol 39.

J Oral Implantol 2014 Sep 18. Epub 2014 Sep 18.

E, Richard Hughes, D.D.S., /Surgical Staff, E, Richard Hughes, D.D.S.

Abstract This is an accurate historical account of the development of the blade and plate form dental implants. The two are similar and dissimilar in certain respects.
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http://dx.doi.org/10.1563/aaid-joi-D-14-00178DOI Listing
September 2014

Electrooculogram (EOG) findings in a case of acute exudative polymorphous vitelliform maculopathy (AEPVM) detected following trauma.

Doc Ophthalmol 2013 Dec 20;127(3):255-9. Epub 2013 Sep 20.

Sussex Eye Hospital, Brighton, UK,

Purpose: The purpose of this study was to monitor a case of acute exudative polymorphous vitelliform maculopathy detected following trauma.

Methods: Clinical examination included fundus photographs, optical coherence tomography (OCT) and fluorescein angiography. Pattern and full-field electroretinograms (PERG; ERG) and serial electrooculograms (EOG) were performed, incorporating the international standards.

Results: A 45-year-old Caucasian woman developed blurring of vision in both eyes 5 days after a serious road traffic accident. On examination, bilateral serous macular detachments and multiple small yellow subretinal lesions were observed in both eyes associated with areas of serous retinal detachment superior and inferior to the yellow lesions in the left eye. OCT showed retinal elevation with a band of high reflectance on the outer retina but no intra-retinal fluid or elevation of the retinal pigment epithelium (RPE). There was bilateral EOG reduction in keeping with generalised RPE dysfunction and pattern ERG evidence of left macular involvement. After 9 months, the patient reported spontaneous improvement in vision with gravitational settling and coalescence of the subretinal yellow deposits. At 37 months, there was improvement in the EOG and visual acuity.

Conclusions: A rare case of AEPVM is described that was detected following trauma and which gradually improved over 37 months. The EOG showed evidence of generalised RPE dysfunction that resolved and may be useful in the monitoring of AEPVM.
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http://dx.doi.org/10.1007/s10633-013-9408-8DOI Listing
December 2013

Spatial analysis of air pollution and mortality in California.

Am J Respir Crit Care Med 2013 Sep;188(5):593-9

Division of Environmental Health Sciences, School of Public Health, University of California Berkeley, USA.

Rationale: Although substantial scientific evidence suggests that chronic exposure to ambient air pollution contributes to premature mortality, uncertainties exist in the size and consistency of this association. Uncertainty may arise from inaccurate exposure assessment.

Objectives: To assess the associations of three types of air pollutants (fine particulate matter, ozone [O3], and nitrogen dioxide [NO2]) with the risk of mortality in a large cohort of California adults using individualized exposure assessments.

Methods: For fine particulate matter and NO2, we used land use regression models to derive predicted individualized exposure at the home address. For O3, we estimated exposure with an inverse distance weighting interpolation. Standard and multilevel Cox survival models were used to assess the association between air pollution and mortality.

Measurements And Main Results: Data for 73,711 subjects who resided in California were abstracted from the American Cancer Society Cancer Prevention II Study cohort, with baseline ascertainment of individual characteristics in 1982 and follow-up of vital status through to 2000. Exposure data were derived from government monitors. Exposure to fine particulate matter, O3, and NO2 was positively associated with ischemic heart disease mortality. NO2 (a marker for traffic pollution) and fine particulate matter were also associated with mortality from all causes combined. Only NO2 had significant positive association with lung cancer mortality.

Conclusions: Using the first individualized exposure assignments in this important cohort, we found positive associations of fine particulate matter, O3, and NO2 with mortality. The positive associations of NO2 suggest that traffic pollution relates to premature death.
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http://dx.doi.org/10.1164/rccm.201303-0609OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447295PMC
September 2013

The effects of continuous application of the TASER X26 waveform on Sus scrofa.

J Forensic Sci 2013 May 12;58(3):684-92. Epub 2013 Mar 12.

Penn State Applied Research Laboratory, PO Box 30, State College, PA 16804, USA.

This study investigated and evaluated the safety margins of the continuous long duration (up to 30 min) effect of the TASER X26 waveform, using a Sus scrofa model. Long duration continuous stimulus has not been evaluated on humans or human surrogates prior to this study. Swine were used as models due to similarities with humans in their skin and cardiovascular systems. Very long duration was used to determine both exposure dose and possible adverse physiological effects of dose. The trial began with an application of 10 min, and subsequent animals received increasing exposure time up to a survived maximum duration of 30 min. At the onset of this work, it was hypothesized that there would be a time limit after which most animals would not survive consistent with increased dose response. However, this hypothesis was not supported by the experimental results. All animals (10 of 10) survived up to 3 min. Seven of the 10 animals survived up to a 10-min exposure and 3 of 5 animals with a 30-min target exposure survived the full exposure. Surviving animals were recovered and observed for 24 h, with no postrecovery deaths. This suggests that swine (based on physiology) will not experience a fatal event when exposed to the TASER X26 for a continuous 3 min. Conclusions regarding longer duration (10-30 min) are not as certain due to the small sample sizes at these time intervals.
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http://dx.doi.org/10.1111/1556-4029.12070DOI Listing
May 2013

Measuring the effect of pars plana vitrectomy on vitreous oxygenation using magnetic resonance imaging.

Invest Ophthalmol Vis Sci 2013 Mar 21;54(3):2028-34. Epub 2013 Mar 21.

Sussex Eye Hospital, Brighton, United Kingdom.

Purpose: To study the effect of pars plana vitrectomy (PPV) on vitreous oxygenation (pO2) using magnetic resonance imaging (MRI).

Methods: Patients due to undergo PPV for either macular hole or epiretinal membrane were recruited. MRI scanning was performed 1 week before and at least 3 months after PPV. MRI T1 mapping was performed using an inversion recovery-true fast imaging with steady-state precession (TrueFISP) sequence at several inversion times, from a single slice positioned through the center of both eyes in the axial oblique plane. Additional phantom data were measured in porcine vitreous, to define the relationships between T1 relaxation times and balanced salt solution (BSS), to simulate human vitreous and aqueous, respectively, for a suitable pO2 range (5-70 mm Hg). Pre-PPV pO2 was also measured intraoperatively using a polarographic oxygen probe.

Results: Eleven participants (age range 59-84) were recruited; two declined the post-PPV scan. Corrected T1 times indicated that the mean (±SD) pO2 increased significantly following PPV, from 13.2 ± 5.8 to 34.5 ± 8.0 mm Hg (P < 0.001). In the nonsurgical (control) eye, pO2 did not change significantly from the first to second MRI scan (13.7 ± 7.8 vs. 16.3 ± 8.7 mm Hg, P = 0.239). Mean pO2 measured intraoperatively was 7.2 ± 0.6 mm Hg (n = 10).

Conclusions: These results confirm that vitrectomy substantially increases vitreous pO2. MRI is a noninvasive technique that can be used to study vitreous oxygenation in both vitrectomized and nonvitrectomized eyes.
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http://dx.doi.org/10.1167/iovs.12-11258DOI Listing
March 2013

Seeking medical help to conceive.

Health Rep 2012 Dec;23(4):7-13

Health Analysis Division, Statistics Canada, Ottawa, Ontario, K1A 0T6.

Background: The demand for therapies to assist conception is growing in a number of countries including Canada. This study provides estimates of the number and characteristics of couples who sought medical help for conception and identifies the interventions and/or techniques they used.

Data And Methods: The data are from the Infertility Component of the 2009/2010 Canadian Community Health Survey. The analysis examines couples in which the woman was aged 18 to 44, resulting in 3,656 respondents. Percentages, means and confidence intervals were calculated. Two logistic regression models were run to estimate associations between socio-demographic characteristics and seeking medical help to conceive.

Results: About three in four couples reported having tried to become pregnant. Of these, 15% had sought medical help for conception. Among those who had sought help for conception, 68% reported tracking the menstrual cycle and ovulation; 42% reported using fertility-enhancing drugs; 19% reported using assisted reproductive techniques; and 29% reported "other" medical treatment.

Interpretation: Given the trend toward delayed childbearing, the demand for medical help to conceive may be greater in the future.
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December 2012

Intra-uterine insemination for unexplained subfertility.

Cochrane Database Syst Rev 2012 Sep 12(9):CD001838. Epub 2012 Sep 12.

University Medical Center Utrecht, Department of Reproductive Medicine and Gynecology, Utrecht, Netherlands.

Background: Intra-uterine insemination (IUI) is a widely used fertility treatment for couples with unexplained subfertility. Although IUI is less invasive and less expensive than in vitro fertilisation (IVF), the safety of IUI in combination with ovarian hyperstimulation (OH) is debated. The main concern about IUI treatment with OH is the increase in multiple pregnancy rate.

Objectives: To determine whether, for couples with unexplained subfertility, IUI improves the live birth rate compared with timed intercourse (TI), both with and without ovarian hyperstimulation (OH).

Search Methods: We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched July 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 7), MEDLINE (1966 to July 2011), EMBASE (1980 to July 2011), PsycINFO (1806 to July 2011), SCIsearch and reference lists of articles. Authors of identified studies were contacted for missing or unpublished data.

Selection Criteria: Truly randomised controlled trials (RCTs) with at least one of the following comparisons were included: IUI versus TI, both in a natural cycle; IUI versus TI, both in a stimulated cycle; IUI in a natural cycle versus IUI in a stimulated cycle; IUI with OH versus TI in a natural cycle; IUI in a natural cycle versus TI with OH. Only couples with unexplained subfertility were included.

Data Collection And Analysis: Quality assessment and data extraction were performed independently by two review authors. Outcomes were extracted and the data were pooled. Subgroup and sensitivity analyses were done where possible.

Main Results: One trial compared IUI in a natural cycle with expectant management and showed no evidence of increased live births (334 women: odds ratio (OR) 1.60, 95% confidence interval (CI) 0.92 to 2.8). In the six trials where IUI was compared with TI, both in stimulated cycles, there was evidence of an increased chance of pregnancy after IUI (six RCTs, 517 women: OR 1.68, 95% CI 1.13 to 2.50). A significant increase in live birth rate was found for women where IUI with OH was compared with IUI in a natural cycle (four RCTs, 396 women: OR 2.07, 95% CI 1.22 to 3.50). However the trials provided insufficient data to investigate the impact of IUI with or without OH on several important outcomes including live births, multiple pregnancies, miscarriage and risk of ovarian hyperstimulation. There was no evidence of a difference in pregnancy rate for IUI with OH compared with TI in a natural cycle (two RCTs, total 304 women: data not pooled). The final comparison of IUI in natural cycle to TI with OH showed a marginal, significant increase in live births for IUI (one RCT, 342 women: OR 1.95, 95% CI 1.10 to 3.44).

Authors' Conclusions: There is evidence that IUI with OH increases the live birth rate compared to IUI alone. The likelihood of pregnancy was also increased for treatment with IUI compared to TI in stimulated cycles. One adequately powered multicentre trial showed no evidence of effect of IUI in natural cycles compared with expectant management. There is insufficient data on multiple pregnancies and other adverse events for treatment with OH. Therefore couples should be fully informed about the risks of IUI and OH as well as alternative treatment options.
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http://dx.doi.org/10.1002/14651858.CD001838.pub4DOI Listing
September 2012

Reversible mental status change and renal dysfunction associated with the use of high-dose oral valaciclovir therapy for acute retinal necrosis.

Retin Cases Brief Rep 2012 ;6(3):266-8

*Sussex Eye Hospital, Brighton, United Kingdom †Royal Sussex County Hospital, Brighton, United Kingdom.

Purpose: The purpose of this study was to report the case of a patient with acute retinal necrosis who developed neurotoxicity while being treated with oral valaciclovir antiviral therapy.

Methods: Testing used was clinical examination including fundus photographs, renal biochemistry, cerebrospinal fluid analysis, and renal ultrasound.

Results: A 63-year-old, healthy, white woman was being treated with oral valaciclovir for acute retinal necrosis. Several days later, she developed visual hallucinations and confusion. Renal biochemistry was abnormal, and renal ultrasound was normal. Cerebrospinal fluid cellularity was normal, but cerebrospinal fluid 9-carboxymethoxymethylguanine, an aciclovir metabolite, level was elevated. Treatment was changed to intravenous aciclovir titrated based on serum aciclovir levels with intravenous fluid supplementation to good effect.

Conclusion: Regular monitoring of renal function and ample fluid intake are important when high doses of aciclovir/valaciclovir are used, even in patients with no previous history of renal failure. Monitoring of serum aciclovir level is useful in those with renal impairment to titrate doses, and high-dose oral valaciclovir should be used with caution.
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http://dx.doi.org/10.1097/ICB.0b013e3182252859DOI Listing
November 2014

The diagnosis and management of ovarian hyperstimulation syndrome: No. 268, November 2011.

Int J Gynaecol Obstet 2012 Mar;116(3):268-73

Objective: To review the clinical aspects of ovarian hyperstimulation syndrome and provide recommendations on its diagnosis and clinical management.

Outcomes: These guidelines will assist in the early recognition and management of ovarian hyperstimulation. Early recognition and prompt systematic supportive care will help avert poor outcomes.

Evidence: Medline, Embase, and the Cochrane database were searched for relevant articles, using the key words "ovarian hyperstimulation syndrome" and "gonadotropins," and guidelines created by other professional societies were reviewed.

Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table 1).
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http://dx.doi.org/10.1016/j.ijgo.2011.11.001DOI Listing
March 2012

Acute idiopathic maculopathy with coxsackievirus infection.

Retin Cases Brief Rep 2012 ;6(1):19-21

From the Retinal Department, Sydney Eye Hospital, Sydney, New South Wales, Australia.

Purpose: To report a case of visual loss immediately after hand, foot, and mouth disease and demonstrate the high-resolution optical coherence tomography findings.

Methods: A retrospective case report of a 19-year-old nursery worker with resolving hand, foot, and mouth disease and acute unilateral visual loss.

Results: The clinical features were characteristic of unilateral acute idiopathic maculopathy. High-resolution optical coherence tomography demonstrated highly reflective subretinal material at the macula of one eye with disruption of the photoreceptor inner segment/outer segment junction. Vision remained poor for 4 weeks when there was rapid recovery coinciding with reconstitution of the inner segment/outer segment junction on optical coherence tomography.

Conclusion: Unilateral acute idiopathic maculopathy may be caused by Coxsackievirus infection. Optical coherence tomography and clinical findings suggest an acute viral retinal pigment epitheliitis to be the main pathologic feature.
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http://dx.doi.org/10.1097/ICB.0b013e3181f7f7eeDOI Listing
November 2014

Human electromuscular incapacitation devices characterization: a comparative study on stress and the physiological effects on swine.

J Strength Cond Res 2012 Mar;26(3):804-10

Animal Resource Program, The Pennsylvania State University, University Park, Pennsylvania, USA.

Human electromuscular incapacitation devices or electromuscular disruption (EMD) devices are increasingly used in police and military applications. Most individuals who experience electromuscular incapacitation are in a stress-filled state, and the effects of prolonged or repeated exposures are not well understood. Three different commercially available EMD devices were tested randomly on 6 anesthetized pigs each for a total of 18 pigs. Each animal was exposed to an initial 60-second application of the EMD device as an initial stressor. The animals were then allowed to rest under anesthesia for 60 minutes followed immediately by a 180-second application of the same device. Arterial blood gases and serum samples were collected throughout the experiment to measure catecholamines (epinephrine, norepinephrine, and dopamine) and cortisol. All the devices produced some level of muscle tetany as a result of the electrical delivery to the animal. All the pigs showed a mixed metabolic and respiratory acidosis. Cortisol tended to decrease after the initial exposure and slightly increased over the rest period. The extreme muscular work caused by the electrical stimulation resulting in muscle contractions did not result in a strong stress response but did result in an immediate sympathetic response during both applications of the device leading to the conclusion that initial stressor followed by rest and prolonged EMD device application did not exhaust the sympathetic system. For healthy adult animals, despite the prolonged muscular exertion and physiological stress caused by EMD devices, the body should be able to mount an appropriate sympathetic response and recover normally.
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http://dx.doi.org/10.1519/JSC.0b013e31824432fbDOI Listing
March 2012