Salivary gland transplantation for dry eye disease: Indications,techniques, and outcomes

The transplantation of salivary glands to the eye serves as a substitute for restoring tear volume in patients with severe dry eye disease. The lacrimal gland and salivary glands share similar acinar-ductal organization with some differences in the nature of secretions. This review summarizes the comparative anatomy of salivary and lacrimal glands, various salivary gland transplantation techniques, their indications, outcomes and complications along with future perspectives. Autologous microvascular submandibular gland transplantation (SMGT) into the temporal fossa with duct placement into the conjunctival fornix improves tear volume considerably but provides a hyposmolar tear film, which can induce corneal edema (in 3.5-40% of eyes). The transplanted submandibular graft improves tear volume and stability but visual acuity and conjunctival inflammation remain unchanged. The transplanted submandibular gland maintains stable function in the long-term and can have hypersecretion in 24–60% secondary to persistent autonomic innervation. Partial SMGT, gland reduction surgery, topical atropine gel or Botulinum Toxin A injection are options for treatment of postoperative epiphora. Minor salivary gland transplantation (MSGT) into the upper and/or lower conjunctival fornix results in an average improvement of 2–4 mm in Schirmer values compared to 16 to > 30 mm observed in eyes after SMGT. Reflex epiphora is rarely a problem in MSGT. Both MSGT or SMGT can improve the ocular surface and quality of life of patients with severe, debilitating dry eye disease. However, postoperative visual acuity and outcomes of corneal transplantation are still inconsistent. More studies and additional technical improvements are needed to further improve the results of these procedures.     

Test–Retest Reliability of the Preroad DriveABLE Competence Screen

ABSTRACT

Objective: To determine the test–retest reliability of a computerized preroad screen of prerequisite skills required for safe driving. Subjects & Methods: Driveable Screen administered to 39 individuals referred for driving evaluation due to cognitive decline or stroke. The Screen provides three recommendations—driving cessation, indeterminate, no evidence of reduced competence. Predicted probability of failing the road test is also generated. Results: Reliability according to the recommendation was substantial for the entire group (K = 0.654; CI = 0.459–0.848) and subgroup with stroke (K = 0.742; CI = 0.540–0.944). The numbers of participants with cognitive decline was too small to allow subgroup analyses. Of the nine participants with test–retest disagreement in recommendation, Test 2 was always better (McNemar's X² = 9.00, p = 0.01). Excellent reliability was found on probability of failing the Road Test (Intraclass Correlation Coefficient = 0.908; CI = 0.832–0.950). The test–retest reliability of the subtests ranged from fair to substantial. Conclusions: The Screen demonstrates sufficient test–retest reliability to encourage its use. However, the finding of significantly better scores on Test 2 for a portion of participants raises concern regarding its validity with repeat testing.     

Quantification of Lipopolysaccharides in Human Bile with or without Gram-Negative Bacteria

Lipopolysaccharide (LPS) was assayed in 78 samples of human common-duct bile, obtained at endoscopic retrograde cholangiography. The LPS was assayed by a chromogenic limulus amebocyte lysate (LAL) test, after dilution of bile samples in heparinized plasma and inactivation of inhibitors. The assay was not influenced by other biliary constituents, as demonstrated by the recovery of standards. Bile pigments did not influence the results. The LAL test was positive in 60 of the samples, 59 of which had a positive culture for gram-negative bacteria or Candidasp. The levels of LPS were significantly correlated to the total number of bacteria (n = 16, R = 0.55, p < 0.05). The median LPS level was 35,250 ng/l and showed a very large variation (140 ng/l to 27.8 mg/l). In four of the samples gram-negative bacteria were present, but no LPS could be detected. The study demonstrates the presence of LPS in great quantities in human bile and supports the feasibility of using the LAL test on bile samples. The presence of LPS (within the detection limit) appears to be associated with local microbial colonization.     

Characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae and in vitro synergy of the colistin–meropenem combination

Abstract

In this prospective study, consecutive isolates of Klebsiella pneumoniae were tested for different mechanisms of carbapenem resistance using the modified Hodge test (MHT), Rosco Neo-Sensitabs (ROSCO). Phenylalanine arginine beta-naphthylamide assay (PABN) inhibitor-based test was done on isolates in which the mechanism of resistance was not identifiable by the ROSCO. Among 105 selected isolates, carbapenemase production was noted in 100 (95%) by MHT and ROSCO showed 97 (92·4%) inhibition with dipicolinic acid signifying the production of MBL. PCR amplification was positive in 90 (86%) isolates for bla_NDM-1 and 46 (44%) isolates for bla_OXA-48. 54 (51%) isolates were positive for bla_CTX-M and all belonged to bla_CTX-M group 1. Isolates co produced bla_OXA-48 (31/105, 30%) and bla_CTX-M (40/105, 38%) in combination with the carbapenemase (bla_NDM-1) gene. Five colistin-resistant isolates were positive for bla_OXA-48. Eight isolates did not show inhibition with any of the inhibitor containing disks and found to be positive for bla_OXA-48. Isolates were tested for colistin-meropenem synergy and detection rate was higher by the checkerboard (48%) than E-test method (35%). Our study necessitates continuous surveillance to recognize the predominant machinery of resistance in a particular geographical region to formulate effective control measures.     

凝血检验标本采集与处理过程中的质量控制分析

目的观察分析凝血检验标本采集与处理过程中的质量控制。方法选择凝血检验标本采集与处理强化质控措施实施后(2018年3月至2019年2月)和实施前(2017年3月至2018年2月)在本院行凝血检验的健康体检者各41例,分别作为观察组和对照组。收集两组待检查者的标本采集、处理过程记录,比较两组标本不合格发生率。结果观察组凝血检验标本不合格发生率(2.44%,1/41)显著低于对照组(19.51%,8/41),差异有统计学意义(P<0.05)。结论强化质控措施可有效提升凝血检验标本采集与处理过程规范性,降低不合格标本风险,有助于保障凝血检验准确性和有效性,临床应用价值较高。     

Rapid Detection of ESBL-Producing Enterobacteriaceae in Blood Cultures

We rapidly identified extended-spectrum β-lactamase (ESBL) producers prospectively among 245 gram-negative bacilli–positive cultured blood specimens using the Rapid ESBL Nordmann/Dortet/Poirel test and direct bacterial identification using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. This combination identified ESBL-producing Enterobacteriaceae within 30 min and had high predictive values.     

National survey of physicians in Japan regarding their use of diagnostic tests for legionellosis

IntroductionBacterial culture remains the gold standard for the diagnosis of legionellosis. However, past reports indicate that most physicians use the urinary antigen test (UAT) alone. Combining it with other tests is important, especially in patients with negative UAT results. The aim of this study was to investigate the current situation of legionellosis diagnostics and clarify the issues that need to be addressed.MethodsBetween March 1, 2021 and April 30, 2021, a questionnaire survey was conducted in an anonymous manner among physicians working in Japan. Questionnaires were generated on a website and asked questions in a multiple-choice format.ResultsValid responses were received from 309 physicians during the study period. Most (92.9%) physicians reported using UAT as the initial test for patients suspected of having legionellosis, and <10% reported using other tests (e.g., culture, nucleic acid amplification test [NAAT], Gimenez staining, and serum antibody titer measurement [ATM]). When the initial test result was negative, 63% of physicians reported not conducting additional tests. Even when they chose to run additional tests, at most 27.8%, 23.6%, 12.3%, and 10.4% of all physicians used NAAT, culture, Gimenez staining, and serum ATM, respectively. The major reasons for not using tests other than UAT were “unavailability in the medical facility,” “long turn-around time,” and “difficult to collect sputum.”ConclusionsThe present survey revealed that most physicians in Japan used UAT alone for diagnosing legionellosis. Eliminating barriers to creating a reasonable environment and edification of physicians are needed to improve the current situation.     

Flexor and extensor muscle tone evaluated using the quantitative pendulum test in stroke and parkinsonian patients

The aim of this study was to evaluate the flexor and extensor muscle tone of the upper limbs in patients with spasticity or rigidity and to investigate the difference in hypertonia between spasticity and rigidity. The two experimental groups consisted of stroke patients and parkinsonian patients. The control group consisted of age and sex-matched normal subjects. Quantitative upper limb pendulum tests starting from both flexed and extended joint positions were conducted. System identification with a simple linear model was performed and model parameters were derived. The differences between the three groups and two starting positions were investigated by these model parameters and tested by two-way analysis of variance. In total, 57 subjects were recruited, including 22 controls, 14 stroke patients and 21 parkinsonian patients. While stiffness coefficient showed no difference among groups, the number of swings, relaxation index and damping coefficient showed changes suggesting significant hypertonia in the two patient groups. There was no difference between these two patient groups. The test starting from the extended position constantly manifested higher muscle tone in all three groups. In conclusion, the hypertonia of parkinsonian and stroke patients could not be differentiated by the modified pendulum test; the elbow extensors showed a higher muscle tone in both control and patient groups; and hypertonia of both parkinsonian and stroke patients is velocity dependent.