The influence of hypotonicity on large-conductance calcium-activated potassium channels in human retinal pigment epithelial cells.

The aim of this study was to characterize the effects of hypotonicity on the activity of large-conductance Ca(2+)-activated K+ (BK(Ca)) channels in human retinal pigment epithelial (RPE R-50) cells. Effects of hypotonicity on ion currents were investigated with the aid of the patch-clamp technique. A regulatory volume decrease in response to a hypotonic solution (200 mOsm/L) was observed that could be blunted by paxilline. In whole-cell current recordings, a hypotonic solution (200 mOsm/L) reversibly increased the amplitude of K+ outward currents (I(K)). The increase of I(K) could be reversed by iberiotoxin (200 nM), paxilline (1 microM), or tetrandrine (5 microM), but not by glibenclamide (10 microM), disulphonic acid (DIDS) (100 microM), or dequalinium dichloride (10 microM). In RPE R-50 cells pretreated with thapsigargin, aristolochic acid, or pertussis toxin, the increased amplitude of I(K) in response to hypotonicity was unaltered. In cell-attached patches, an increase in BK(Ca)-channel activity was observed during hypotonicity-induced cell swelling. The enhanced channel activity elicited under this condition was mainly mediated by an increase in the number of long-lived openings. These findings support the evidence for the coupling of volume swelling to the functional activity of BK(Ca) channels.     

A lack of ongoing diabetes is an important factor in preserving eyes from late or suboptimally treated endogenous endophthalmitis secondary to Klebsiella pneumoniae liver abscess

Purpose:

The purpose of this study is to identify the possible factors for preserving the eyes after late or suboptimally treated endogenous endophthalmitis secondary to Klebsiella pneumoniae (KP) liver abscess.

Methods:

A retrospective chart review was conducted for patients admitted with KP liver abscess from January 1991 to June 2012.

Results:

Six hundred and ninety-three patients with KP liver abscess were recorded, in which endophthalmitis was identified in 53 cases (65 eyes, 8.29%). Diabetes was significantly associated with the development of endophthalmitis (p = 0.014). Eleven eyes received their last ocular treatment ≥10 days and final vision ≥ counting fingers, and were defined as benign type KP endophthalmitis. The absence of diabetes was the only consistent candidate factor for benign type KP endophthalmitis.

Conclusion:

A lack of ongoing diabetes is an important factor in preserving eyes with late or suboptimally treated endogenous endophthalmitis second to KP liver abscess.     

Tailored internal limiting membrane flap technique for primary macular hole

Graefe's Archive for Clinical and Experimental Ophthalmology - To investigate the outcomes of primary full-thickness macular hole (MH) after surgical intervention with tailored internal...     

Choroidal osteoma masquerading as central serous chorioretinopathy

We report a rare case of choroidal osteoma masquerading as central serous chorioretinopathy. A 39-year-old man complained of intermittent episodes of blurred vision in the left eye for 2 months. Fundus examination of the left eye showed a dome-shaped elevation at the macular center. Fluorescein angiography showed a patch of pinpoint leakage resulting in a well-defined pool of dye at the macular center. Initial diagnosis was recurrent central serous chorioretinopathy with sequelae in the left eye. Five months later, serous detachment recurred. Computerized tomography and ultrasonography showed a bony plaque at the choroid level, and choroidal osteoma was diagnosed.     

Intravitreal tissue plasminogen activator and pneumatic displacement of submacular hemorrhage secondary to retinal artery macroaneurysm.

PURPOSE: To assess the efficacy of treating submacular hemorrhages secondary to retinal arterial macroaneurysm with intravitreous tissue plasminogen activator (tPA) and gas. PATIENTS AND METHODS: Six consecutive patients (6 eyes) with submacular hemorrhage secondary to retinal arterial macroaneurysm were included in this study. Tissue plasminogen activator, at a dose of 50 microg/0.1 mL, was injected through the pars plana into the vitreous cavity. Gas (0.3-0.5 mL of perfluoropropane) instillation followed tPA injection, either immediately after injection or sometime during the next day. RESULTS: Best postoperative visual acuity improved in 5 of 6 eyes (83%) and was unchanged in 1 of 6 (17%) eyes. In 5 of 6 (83%) eyes, the procedure resulted in complete or partial displacement of submacular hemorrhage out of the foveal area. CONCLUSIONS: Intravitreous injection of tPA and gas, followed by prone positioning of the patient, is an effective and simple treatment of submacular hemorrhage secondary to retinal arterial macroaneurysm. No complication occurred in this series.     

Update on uveomeningoencephalitides

PURPOSE OF REVIEW: Uveomeningoencephalitides, commonly known as Vogt-Koyanagi-Harada (VKH) disease, are characterized by chronic bilateral granulomatous panuveitis involving the central nervous, auditory and integumentary systems. Visual prognosis is generally favourable, but outcomes in patients with VKH disease may vary. Also, the treatment of choice differs in different parts of the world. This review addresses the literature on the possible pathogenesis, diagnosis and treatment of this disorder. RECENT FINDINGS: Atypical presentations of VKH disease, as well as those associated with interferon-alpha therapy, have been reported. Most reports suggest an association with autoimmunity. The diagnostic criteria were revised by the International Workshop on VKH in 1999, allowing for the presence of different ocular findings in the early and late stages of the disease. New techniques have also been developed to aid in the rapid diagnosis of VKH disease and evaluation of treatment. Different routes of administration of corticosteroid and adjuvant therapy were tried, with positive results. SUMMARY: Although the pathogenesis of VKH disease is uncertain and antigen-specific treatment strategies have not yet been developed, reports increasingly suggest an autoimmune nature for uveomeningoencephalitides. Currently, systemic corticosteroid therapy remains the standard initial treatment. Different routes of administration are used to reduce the frequency of side effects of systemic corticosteroids, and there are various adjuvant therapies. With the aid of modern equipment, early diagnosis and prompt and appropriate treatment, resulting in better visual outcomes, can be anticipated. A large-scale, multinational, prospective study is warranted to determine the optimal initial therapy.     

The role of community mental health nurses caring for people with schizophrenia in Taiwan: a substantive grounded theory

Aim and objectives. The aim was to develop a practice theory that can be used to guide the direction of community nursing practice to help clients with schizophrenia and those who care for them. Design. Substantive grounded theory was developed through use of grounded theory method of Strauss and Corbin. Methods. Two groups of participants in Taiwan were selected using theoretical sampling: one group consisted of community mental health nurses and the other group was clients with schizophrenia and those who cared for them. The number of participants in each group was determined by theoretical saturation. Semi‐structured one‐to‐one in‐depth interviews and unstructured non‐participant observation were utilized for data collection. Data analysis involved three stages: open, axial and selective coding. During the process of coding and analysis, both inductive and deductive thinking were utilized and the constant comparative analysis process continued until data saturation occurred. To establish trustworthiness, the four criteria of credibility, transferability, dependability and confirmability were followed along with field trial, audit trial, member check and peer debriefing for reliability and validity. Results. A substantive grounded theory, the role of community mental health nurses caring for people with schizophrenia in Taiwan, was developed through utilization of grounded theory method of Strauss and Corbin. Conclusion. In this paper, results and discussion focus on causal conditions, context, intervening conditions, consequences and phenomenon. Relevance to clinical practice. The theory is the first to contribute knowledge about the field of mental health home visiting services in Taiwan to provide guidance for the delivery of quality care to assist people in the community with schizophrenia and their carers.     

What caring means to geriatric nurses

Caring is the major concept in nursing. The purpose of this study was to describe the meaning of caring for nurses caring for elderly patients. Parse' s phenomenology was addressed in the research design, which included four steps: participant selection, dialogical engagement, extraction-synthesis, and heuristic interpretation. By stratified sampling, 30 nurses who worked in medical-surgical wards in a general teaching hospital were selected as participants. Dialogical engagement was completed through in-depth, tape-recorded interviews on the open question, " What is the meaning of caring for you as a provider of care to the elderly? ". Data were interpreted by process of Parse' s phenomenology, which included extracting the essence, synthesizing the essence, formulating a proposition, extracting concepts, and structuring the meaning. The meaning of caring for nurses engaged in caring for the elderly was: " Through the initiative deliberation from sincerity, the nurse is to dedication by the empathy and tolerance". The core concepts of caring were: deliberation, initiative, sincerity, tolerance, empathy, and dedication. It should develop and apply the caring concept and theory actively to geriatric nursing care.     

Applying the synactive theory of development to the care of a premature infant with sucking problems

Sucking problems in an infant born prematurely at 24 weeks and 5 days were identified through systematic behavioral observation and family assessment. Reasons underlying the infant's sucking problems included poor sucking and swallowing skills due to an immature nervous system, a chaotic care environment and ecology, and unimplemented sucking and feeding care procedures. Due to the paucity of domestic diagrams related to oral-sucking training for premature babies, in addition to reviewing the literature and establishing a sucking training program to help the infant establish a regular sucking pattern, we also applied the synactive theory of development and improved the hospital feeding environment and ecology to reduce environmental factors that could affect sucking care such as ambient light and noise and feeding schedules. We observed implied infant sucking pattern actions such as restlessness, mouth shakes, and irritation and provided the mother with an appropriate feeding schedule. We helped foster parent-child attachment and enhanced the mother's post-discharge caring confidence. Home visits were also conducted after discharge to assess the home care environment and give instant consultation, providing holistic health care with sustained quality of care.