Role of chemokine receptors in transplant rejection and graft-versus-host disease.

Organ transplantation increases life expectancy and improves the quality of life of patients experiencing specific conditions such as terminal organ failure. Despite matching efforts between donor and recipient, immune activation can interfere with allograft survival after transplantation if immunosuppression is not used. With both innate and adaptive responses, this is a complicated immunological process.

Establishment and review of educational programs to train optometrists in laser procedures and injections.

Current scope of practice for optometrists in many countries include topical and oral medication with injectable and lasers being added more recently to scope in the United States (US), Canada, the United Kingdom (UK) and New Zealand (NZ). This expanded scope of optometric practice improves access to eyecare and is critical since an ageing population with a higher prevalence of vision disorders and higher healthcare costs looms. Expanded scope has been shown alongside strong safety records.

Vitamin D deficiency after allogeneic hematopoietic cell transplantation promotes T-cell activation and is inversely associated with an EZH2-ID3 signature.

Vitamin D promotes a shift from a proinflammatory to a more tolerogenic immune state in allogeneic hematopoietic cell transplant (HCT) recipients. The dominant mechanism responsible for this shift has not been elucidated. We took a multifaceted approach to evaluating the clinical and immunologic impact of low vitamin D levels in 53 HCT recipients.

Acute community ophthalmology services provided by independent prescribing optometrists supporting hospital eye services during the COVID-19 outbreak.

Background: Specialised Independent Prescribing (IP) community optometrists provided acute eye care during the COVID-19 crisis ensuring that over-stretched hospital emergency eye care was supported, therefore local overall urgent eye care provision was not affected.

Subjects/methods: Number of cases seen by hospital Rapid Access Clinic (RAC) between January 2020 and June 2020 were compared to number of cases seen by IP optometrists in community Acute Primary Care Ophthalmology Service (APCOS) during the same time period. Specifically, comparisons were made between the number of cases seen in RAC and the number of cases seen by APCOS during the period before COVID-19 emergency (January-March 2020) and for a similar timeframe thereafter (April-June 2020).

Application of Bayes' to the prediction of referral decisions made by specialist optometrists in relation to chronic open angle glaucoma.

Purpose: To determine the accuracy of a Bayesian learning scheme (Bayes') applied to the prediction of clinical decisions made by specialist optometrists in relation to the referral refinement of chronic open angle glaucoma.

Methods: This cross-sectional observational study involved collection of data from the worst affected or right eyes of a consecutive sample of cases (n = 1,006) referred into the West Kent Clinical Commissioning Group Community Ophthalmology Team (COT) by high street optometrists. Multilevel classification of each case was based on race, sex, age, family history of chronic open angle glaucoma, reason for referral, Goldmann Applanation Tonometry (intraocular pressure and interocular asymmetry), optic nerve head assessment (vertical size, cup disc ratio and interocular asymmetry), central corneal thickness and visual field analysis (Hodapp-Parrish-Anderson classification).

Mobilisation of the splenic monocyte reservoir and peripheral CX₃CR1 deficiency adversely affects recovery from spinal cord injury.

Macrophages in the injured spinal cord originate from resident microglia and blood monocytes. Whether this diversity in origins contributes to their seemingly dual role in immunopathology and repair processes has remained poorly understood. Here we took advantage of Cx₃cr1(gfp) mice to visualise monocyte-derived macrophages in the injured spinal cord via adoptive cell transfer and bone marrow (BM) chimera approaches.

Beware of finger tourniquets: a case report and update by the National Patient Safety Agency.

Finger tourniquets have been used in finger surgery for a long time to provide a bloodless field while operating on digits. Many different techniques have been described for a 'safe and reliable' finger tourniquet including Penrose drains, coloured rubber gloves and gloves with haemostat. The potential injury that can be caused by leaving the tourniquet in situ for longer than is necessary is devastating to the patient.

Standardized patient methodology to assess refractive error reproducibility.

Purpose: Standardized patient (SP) methodology is the gold standard for evaluating clinical practice. This approach was used to investigate the content of typical optometric eyecare in England and the reproducibility of refractive error measurement using prescriptions obtained by three SPs.

Methods: The three SPs were independently examined by three to four expert optometric clinicians to obtain "benchmark" estimates of refractive error.

The content of optometric eye examinations for a presbyopic patient presenting with symptoms of flashing lights.

Background: Standardised patients (SPs) are the gold standard methodology for evaluating clinical care. This approach was used to investigate the content of optometric eyecare for a presbyopic patient who presented with recent photopsia.

Methods: A total of 102 community optometrists consented to be visited by an actor for a recorded eye examination.

Community-based orthopaedic follow-up. Is it what doctors and patients want?

Introduction: The objective of this study was to investigate how patients, general practitioners (GPs) and orthopaedic trainees, feel about the proposed governmental changes to reduce orthopaedic out-patient clinics by having GPs and specialist nurses follow-up postoperative orthopaedic patients in the community.

Subjects And Methods: The design was a cross-sectional questionnaire study including a teaching hospital and general practitioners in the Norfolk primary care trust. Participants were 73 orthopaedic postoperative patients who attended out-patients over a 1-week period in July 2007 who all responded.

Do the vastus medialis obliquus and vastus medialis longus really exist? A systematic review.

There remains controversy over whether the vastus medialis (VM) is a single anatomical structure or whether it is composed of two separate portions, the vastus medialis longus (VML) proximally and the vastus medialis obliquus (VMO) distally. The objective of this study was to assess the evidence base of investigations into muscle fiber orientation, presence of a fibrofascial plane, and the innervation of the VM in human cadaver specimens and subjects. In addition to a hand search of specialist journals, an electronic search of AMED, British Nursing Index, CINAHL, the Cochrane database, EMBASE, ovid Medline, Pubmed, and Zetoc were performed from their inception to September 2008.

The content of optometric eye examinations for a young myope with headaches.

Background: A recent review found standardised patient (SP) methodology to be the gold standard methodology for evaluating clinical care. We used this to investigate the content of optometric eye care for a young myopic patient with headaches suggestive of migraine.

Methods: We recruited 100 community optometrists who consented to be visited by an unannounced actor for an eye examination and to have that eye examination recorded.

Technical Note: A comparison of a novel direct ophthalmoscope, the Optyse, to conventional direct ophthalmoscopes.

Despite the current popularity of binocular indirect ophthalmoscopy, direct ophthalmoscopes are still commonly used by clinicians for fundus examination. They are considered to be expensive, however, and it has been suggested that this cost can prevent their use by healthcare professionals in developing countries. The Optyse Lens Free Ophthalmoscope is a novel direct ophthalmoscope, without a lens focus system, that allows for comparatively inexpensive manufacture and supply.

Subtle binocular vision anomalies in migraine.

A literature review reveals old references to an association between migraine headache and binocular vision anomalies, but a lack of scientific evidence evaluating these claims. In a masked case control study, we investigated binocular vision using standard clinical tests in people with migraine and in controls. Some test results suggest that heterophoria and fixation disparity are more common in the migraine group.

Visual stimuli are common triggers of migraine and are associated with pattern glare.

Objective: To investigate the associations between interictal pattern glare, visual stress, and visual triggers of migraine.

Background: There has been relatively little research on the visual stimuli that can trigger migraine episodes. This is surprising, since if practitioners can obviate such triggers, then some attacks may be prevented.

The correlation between migraine headache and refractive errors.

Purpose: A literature review reveals historical references to an association between migraine headache and refractive errors, but a lack of scientific evidence relating to these claims.

Methods: In a masked case-controlled study, we investigated the four aspects of refractive errors that have been implicated in the literature as correlated with migraine: spherical refractive error, astigmatic refractive error, anisometropia, and uncorrected ametropia. We also compared the calculated scalar value of refractive error, aided and unaided visual acuity, and spectacle use in migraine and control groups.

The pupillary light reflex in migraine.

The literature suggests that there may be pupil size and response abnormalities in migraine headache sufferers. We used an infra-red pupillometer to measure dynamic pupil responses to light in 20 migraine sufferers (during non-headache periods) and 16 non-migraine age and gender matched controls. There was a significant increase in the absolute inter-ocular difference of the latency of the pupil light response in the migraine group compared with the controls (0.

Frequency doubling technology perimetry and standard automated perimetry in migraine.

The literature suggests that visual field defects may be more common in people who experience migraine. The Humphrey frequency doubling (FDT) visual field instrument selectively examines the magnocellular visual pathway, but has not previously been used to investigate visual function in migraine. In a masked controlled study we compared Humphrey FDT and Humphrey Swedish Interactive Threshold Algorithm fields of 25 migraine sufferers with 25 age- and gender-matched controls.

The optometric correlates of migraine.

Migraine is a common, chronic, multi-factorial, neuro-vascular disorder typically characterised by recurrent attacks of unilateral, pulsating headache and autonomic nervous system dysfunction. Migraine may additionally be associated with aura; those focal neurological symptoms that may precede or sometimes accompany the headache. This review describes the optometric aspects of migraine headache.

Acute posterior vitreous detachment: the predictive value of vitreous pigment and symptomatology.

Aim: To establish whether the presence of a retinal break can be predicted either by the presence of a positive Shafer's sign (pigment granules in the anterior vitreous) or symptomatology in patients presenting with an acute posterior vitreous detachment (PVD).

Methods: 200 eyes of 200 phakic patients with a symptomatic PVD of less than 1 month's duration underwent documentation of symptomatology and examination of the anterior vitreous for the presence of pigment granules. Indentation ophthalmoscopy was then carried out by an experienced vitreoretinal surgeon with no knowledge of the symptomatology or anterior vitreous gel examination findings.