Comparison of scleral and corneal Tono-Pen readings.

PURPOSE: To compare scleral Tono-Pen (Medtronic Solan, Jacksonville, FL) readings to corneal Tono-Pen readings. METHODS: Intraocular pressure (IOP) was measured prospectively in 72 eyes of 37 adult patients and in 10 eyes of 5 children. Measurements were taken on the central cornea and on the sclera. Recorded measurements were within 5% confidence levels by Tono-Pen. RESULTS: Corneal IOP ranged from 10 to 28 mm Hg (mean +/- standard deviation, 17.0 +/- 3.8 mm Hg). Scleral measurements ranged from 4 to 99 mm Hg (40.4 +/- 23.0 mm Hg). Scleral measurements ranged from 11 mm Hg lower to 76 mm Hg higher than corneal measurements. CONCLUSIONS: Tono-Pen readings obtained from sclera are of no clinical value and should not be used to approximate corneal IOP.     

A pilot study of cadre training to promote responsible self-medication in Indonesia: Which is better specific or general modules?

In 2015, the Indonesian Government initiated ‘Smart Use of Medications Movement’ (‘GeMa CerMat’) which included cadre training to promote responsible self-medication. Evaluation of a pilot training conducted across Indonesia suggested the need to improve those training modules. This study aimed to assess cadre’ knowledge gained following training with newly developed general or specific training modules. Five types of modules were developed and used to train cadres at five Community Health Centres (CHCs) in Surabaya, Indonesia: 1) Sidosermo CHC (general-drugs module), 2) Tenggilis CHC (common cold drugs module), 3) Gunung Anyar CHC (analgesic drugs module), 4) Kalirungkut CHC (anti-diarrhoeal drugs module), and 5) Jagir CHC (indigestion drugs module). Cadres’ knowledge improvements were evaluated using pre-/post-test scores and the difference scores depending on the module being tested. Multifactorial ANOVA explored the effects of the type of module on difference scores. A total of 279 cadres across five CHCs were involved in the training, giving response rates from 65% to 93%. There was an increase in the post-test scores after the training with all modules. However, significant differences were reported only for the specific-drugs module groups (all p < .001). Furthermore, the general module group had the lowest difference score (1.12; 95% CI [−0.45, 2.92]) while the common cold module group had the highest gain (5.02; 95% CI [1.95, 5.17]). Multifactorial ANOVA revealed that there was a significant main effect of the type of modules on difference scores [F (4, 263) = 8.37, p <.001]. In conclusion, this preliminary study indicated that the development of modules for specific minor illnesses could be beneficial in facilitating effective community-based training to promote responsible self-medication in Indonesia. The priority for therapeutic areas chosen for the module should be based on the local needs. Further research is required to confirm the findings in broader community members.     

Optimizing T-cell receptor avidity with somatic hypermutation

Adoptive transfer of T cells that have been genetically modified to express an antitumor T-cell receptor (TCR) is a potent immunotherapy, but only if TCR avidity is sufficiently high. Endogenous TCRs specific to shared (self) tumor-associated antigens (TAAs) have low affinity due to central tolerance. Therefore, for effective therapy, anti-TAA TCRs with higher and optimal avidity must be generated. Here, we describe a new in vitro system for directed evolution of TCR avidity using somatic hypermutation (SHM), a mechanism used in nature by B cells for antibody optimization. We identified 44 point mutations to the Pmel-1 TCR, specific for the H-2D^b-gp100_25-33 melanoma antigen. Primary T cells transduced with TCRs containing two or three of these mutations had enhanced activity in vitro. Furthermore, the triple-mutant TCR improved in vivo therapy of tumor-bearing mice, which exhibited improved survival, smaller tumors and delayed or no relapse. TCR avidity maturation by SHM may be an effective strategy to improve cancer immunotherapy.     

Validity and Test-Retest Reliability of a Thai Stroke Physical Activity Questionnaire

Background and objectivesThis study evaluated the validity and reliability of the Stroke Physical Activity Questionnaire (SPAQ), a Thai self-report questionnaire for assessing physical activity (PA) in participants with chronic stroke.MethodsThe validity of the SPAQ was tested by correlating PA data from the SPAQ with data obtained from a waist worn accelerometer which participants wore for seven days. The participants completed the SPAQ twice, one week apart and test-retest reliability was calculated using intraclass correlation coefficient.ResultsForty-one participants, at least 3 months post-stroke (24 men and 17 women) were enrolled. The average age was 55.3 years (SD 11.9). Correlation coefficients of 0.58 and 0.57 were found between SPAQ and the accelerometer data for moderate PA and moderate to vigorous PA (MVPA), respectively. There was no significant correlation between light PA determined from SPAQ and accelerometer. The intraclass correlation coefficients were 0.56, 0.91 and 0.90 for light, moderate PA and MVPA, respectively.ConclusionsThe validity of the SPAQ for moderate and MVPA was acceptable and the test-retest reliability of the SPAQ was excellent. This suggests the SPAQ is a useful tool for assessing moderate PA and MVPA among chronic stroke participants. However, it cannot be used to quantify light PA.     

Caregiver empowerment program based on the adaptation model increase stroke family caregiver outcome

Objective: Post-stroke disability and psychosocial disorders cause burdens for the families of stroke patients, including physical and financial burdens. The physical and psychological health of family caregivers determines the quality of care they provide to patients.The purpose of this study was to identify the effectiveness of the Caregiver Empowerment Program Based on the Adaptation Model (CEP-BAM) in increasing the family caregiver's coping ability against various problems and reducing their burden while caring for the stroke patient.Methods: This research was a quasi-experimental study with pre- and post-test control group design. The intervention group received CEP-BAM, while the control group received a conventional intervention in the form of a discharge planning program for family caregivers in the hospital. The samples were caregivers who care for and facilitate the recovery of stroke patients during their convalescence at home. We selected the samples from the population using the stratified random sampling method. The number of samples completed in the study was 40 in the intervention group and 40 in the control group. Measurement of outcome variables (coping and caregiver burden) was carried out 4 times including pre-test before the intervention, post-test 1 at 4 months after the intervention, post-test 2 at 5 months after the intervention, and post-test 3 at 6 months after the intervention.Results: There were significant differences in caregiver's coping (P = 0.016) and caregiver's burden (P = 0.009) in measurements between the two groups.Conclusions: The CEP-BAM interventions were effective in increasing adaptive coping strategies and reducing the burden of caregivers 4 months and continuing 6 months after the intervention.     

Robotic Guidance Does Not Improve Component Position or Short-Term Outcome in Medial Unicompartmental Knee Arthroplasty

We performed a retrospective review in a matched group of patients on the use of robotic-assisted UKA implantation versus UKA performed using standard operative techniques to assess differences between procedures. While both techniques resulted in reproducible and excellent outcomes with low complication rates, the results demonstrate little to no clinical or radiographic difference in outcomes between cohorts. Average operative time differed significantly with, and average of 20 minutes greater in, the robotic-assisted UKA group (P = 0.010). Our minimal clinical and radiographic differences lend to the argument that it is difficult to justify the routine use of expensive robotic techniques for standard medial UKA surgery, especially in a well-trained, high-volume surgeon. Further surgical, clinical and economical study of this technology is necessary.     

Antioxidant Activity and Cytotoxicity of the Traditional Indonesian Medicine Tahongai (Kleinhovia hospita L.) Extract

We investigated the leaves of Kleinhovia hospita, a plant which has been traditionally used in Indonesia as phytotherapy to cure liver disease, to describe antioxidant materials from plant sources. K. hospita leaves were extracted with methanol and further partitioned into n-hexane, diethyl ether, and ethyl acetate. The antioxidant activity of each fraction and the residue was assessed using a 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging method and their cytotoxicity on HepG2 liver cancer cells was determined by a MTT assay. The K. hospita leaf methanol extract showed strong antioxidant activity (96%) compared with vitamin C (98%) by the DPPH method and the measured activity from the subsequent extracts of the methanol extract were 48.9% for n-hexane, 74.0% for diethyl ether, 84.3% for ethyl acetate, and 77.1% for the residue. The MTT assay showed the cytotoxicity of the methanol extract on HepG2 cells at 14%, 76%, and 80% at concentrations of 50μg/mL, 87.5μg/mL, and 125μg/mL, respectively. Leaf extracts of the medicinal plant K. hospita showed potent antioxidant activity and moderate cytotoxicity on HepG2 liver cancer cells.