Hanmcginnis5324

6% to 89.1%; p = 0.001), an increase in total eye drop cost by $2117 per month (95% confidence interval [CI], $1354-$2880; p < 0.001), an increase in per-patient costs by $984 per 1000 patients per month (95% CI, $674-$1293). Contrastingly, RGH did not experience similar changes. Ultimately, the cost of switching to single-use minims was $22 481 (95% CI, $7830-$31 336) over a 12-month period.

If safe eye drop practices are enforced via proper protocols, the use of multidose bottles may be a more cost-effective option than single-use minims for routine clinical practice.

If safe eye drop practices are enforced via proper protocols, the use of multidose bottles may be a more cost-effective option than single-use minims for routine clinical practice.

School-based vision programs (SBVPs) are one approach to increase access to vision care by providing vision screenings, eye examinations, and eyeglasses directly in schools. Few studies report on the perspectives of teachers and staff, who are important stakeholders, on SBVPs. We examined teacher and staff perspectives on their involvement in SBVPs.

Qualitative study using focus groups.

Teachers and staff at Baltimore and Chicago public schools served by SBVPs between 2016 and 2018.

We conducted 21 semistructured focus groups with 117 teachers and staff in 10 Baltimore and 11 Chicago public preK-12 schools that participated in SBVPs. Sessions were recorded, transcribed, and coded using inductive thematic analysis.

Participants identified 2 main themes regarding teacher and staff involvement in SBVPs (i) program outreach, including using multiple communication modalities to engage parents, explaining program details to families, and helping with program consent form return and (ii) promoting vision health, including identifying vision problems in the classroom, encouraging eyeglasses wear, and supporting eyeglasses maintenance. Participants also discussed limitations in capacity to partake in these activities.

Teachers interact with parents and students throughout the SBVP process, undertaking important roles in outreach and health promotion to ensure uptake of SBVP services. SBVPs and other school-based health programs should explore strategies to support teachers in the roles they fill to optimize program impact.

Teachers interact with parents and students throughout the SBVP process, undertaking important roles in outreach and health promotion to ensure uptake of SBVP services. SBVPs and other school-based health programs should explore strategies to support teachers in the roles they fill to optimize program impact.

To describe 5-year postoperative outcomes of a small series of Fuchs' endothelial dystrophy (FED) patients who underwent Descemet stripping only (DSO) with a scraping technique.

DSO technique and early clinical outcomes of 5 patients with mild central FED were previously reported. In the same cohort of patients, corrected distance visual acuity, central corneal ultrasound pachymetry, refractive spherical equivalent, endothelial cell count, slit-lamp photography, and corneal Scheimpflug tomography were obtained at baseline, 6 months, and 1 and 5 years postoperatively. No patient used topical Rho-kinase inhibitors at any point in time.

One patient (20%) failed to clear the early postoperative edema and 1 patient (20%) developed corneal decompensation 1 year after DSO. Both patients underwent successful Descemet stripping automated endothelial keratoplasty. The remaining 3 patients had stable corrected distance visual acuity, progressive reduction of corneal ultrasound pachymetry, and mild myopic shift of the refractive spherical equivalent over the follow-up time. selleck kinase inhibitor An improvement in posterior stromal opacities and irregular astigmatism was observed, whereas posterior elevation at Scheimpflug tomography remained unchanged.

At 5 years postoperatively, DSO with a scraping technique and without Rho-kinase inhibitors resulted in sustained clinical amelioration of 3 of 5 patients (60%) with mild FED.

At 5 years postoperatively, DSO with a scraping technique and without Rho-kinase inhibitors resulted in sustained clinical amelioration of 3 of 5 patients (60%) with mild FED.Attachment of sugars to nitrogen and oxygen in peptides is ubiquitous in biology, but glycosylation of sulfur atoms has only been recently described. Here, we characterize two S-glycosyltransferases SunS and ThuS that selectively glycosylate one of five Cys residues in their substrate peptides; substitution of this Cys with Ser results in a strong decrease in glycosylation activity. Crystal structures of SunS and ThuS in complex with UDP-glucose or a derivative reveal an unusual architecture in which a glycosyltransferase type A (GTA) fold is decorated with additional domains to support homodimerization. Dimer formation creates an extended cavity for the substrate peptide, drawing functional analogy with O-glycosyltransferases involved in cell wall biosynthesis. This extended cavity contains a sharp bend that may explain the site selectivity of the glycosylation because the target Cys is in a Gly-rich stretch that can accommodate the bend. These studies establish a molecular framework for understanding the unusual S-glycosyltransferases.We report the case of a 25-year-old female who developed severe aortic regurgitation because of pulmonary autograft root dilatation late after Ross-Konno procedure. The geometric heights of all three cusps were relatively small, allowing for the David operation with a 24-mm straight graft. We carefully dissected the aortic root and, the dissection process was relatively straightforward, and the basal ring could be sutured properly. The latest follow-up TTE showed normal autograft valve function and mild aortic regurgitation. Even in the Ross-Konno procedure, valve-sparing root replacement is possible, as in the Ross procedure.The Ross-Konno operation is effective for enlargement of a hypoplastic aortic annulus and left ventricular outflow tract. It is, however, an invasive operation with the potential for early and late cardiac morbidity. We propose a new technique of annular and outflow tract enlargement which avoids the septal incision while effectively opening up the outflow tract and aortic annulus.The management of dextro-transposition of the great arteries with left ventricular outflow tract obstruction continues to evolve. Even when large intracardiac shunts are present, it remains a lethal cyanotic congenital heart disease if it is not surgically corrected soon after birth. We present our experience with a 25-year-old lady who presented with transposition of great arteries with severe left ventricular outflow tract obstruction and underwent a successful single-stage arterial switch operation with preservation of aortic and pulmonary valves.Although the incidence rate of retained surgical items (RSIs) is low, it remains an important cause of patient injury and can lead to harm, death and waste of time and resources when looking for the missing item. Perioperative counting of equipment is a common method to identify missing surgical items. We present a rare case report of a missing vessel loop that was suctioned by a suction irrigator device. The diagnosis of a RSIs is extremely important, special attention should be paid when suctioning body liquids, with small surgical items nearby to prevent incidences of missing items after the surgery.The influence of COVID-19 on heart transplantation is considerable. Reports of COVID-19 infection in recently transplanted patients are scarce. We present a 60-year-old patient with COVID-19 infection, diagnosed six days after transplantation. His clinical course revealed two phases Initially, there were mild respiratory symptoms for which he was treated with remdesivir and noninvasive respiratory support. In a second phase with clinical deterioration on postoperative day 22, further respiratory decline led to the administration of convalescent plasma, with satisfactory response and further improvement of his condition.Primary pulmonary artery (PA) sarcoma (PAS) is a rare disease with poor prognosis. Radical resection provides the best curative chances. Our 60-year old male patient underwent PAS excision with pericardial patch repair of the main PA in 2017, but required reoperation in 2019 due to recurrence. Total PA bifurcation replacement was performed using a handmade two-limbed bovine pericardial tube graft, which has not previously been described in the literature. This technique is safe and reproducible, and may offer a valuable alternative surgical strategy for this patient cohort. Our patient is still alive four years after initial presentation.Unifocalization of the major aorto-pulmonary collaterals (MAPCAs) followed by intra-cardiac repair with ventricular septal defect (VSD) closure and restoration of right ventricle to pulmonary artery (RV-PA) continuity is the ultimate treatment goal in a case of VSD with pulmonary atresia (PA) and MAPCAs. It may be achieved in a single stage or may require multiple surgeries. We present a case of a 2 year old boy with VSD/PA who underwent single stage unifocalization of MAPCAs through midline followed by intra-cardiac repair using two polytetrafluoroethylene (PTFE) tube grafts; one for unifocalization and other as a bicuspid valved RV-PA conduit.

To measure and explore complex cardiac anatomy in research and preoperative simulation, a virtual imaging technology, the Vesalius 3D suite, combines Vesalius 3D three-dimensional (3D) image-processing software with an optic-tracking navigation system running PST-Client software. We present a novel method of evaluating dynamic aortic root geometry in vivo using this visualization system.

Based on electrocardiography-gated cardiac computed tomography data in systole and diastole, images of the aortic root in a normal healthy adult were reconstructed for 3D visualization. Virtual interaction tools were used to explore and measure the aortic root structures.

Virtually reconstructed images revealed the aortic root internal structures in exquisite detail. Highly accessible 3D interpretation promptly permitted precise measurements of repair-relevant anatomical parameters including geometrically complex curves of the aortic root wall and dynamic changes in the aortic valves. Measurement accuracy examined against a known prosthesis showed within 1mm of error (< 0.5%).

This technology may promote understanding of aortic root form and function, and facilitate valve-sparing surgery, and seems valuable for 3D exploration-and-measurement of cardiac anatomy in vivo.

This technology may promote understanding of aortic root form and function, and facilitate valve-sparing surgery, and seems valuable for 3D exploration-and-measurement of cardiac anatomy in vivo.Left atrial-esophageal fistula (AEF) following radiofrequency ablation for atrial fibrillation is a rare and potentially lethal complication. Although surgical management is associated with improved outcomes, the optimal approach remains to be elucidated. We describe a case of AEF which was treated with a simultaneous repair of the atrium and esophagus via a right thoracotomy with an extra-pericardial off-pump approach.