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Introduction: Proton beam therapy has been utilised for the treatment of uveal melanoma in the UK for over 30 years, undertaken under a single centre. In the UK, all ocular tumours are treated at one of four centres. We aimed to understand the variation in referral patterns to the UK proton service, capturing all uveal melanoma patients treated with this modality. Methods: Retrospective analysis of data regarding all patients treated at the Clatterbridge Proton service between January 2004 and December 2014. Results: A total of 1084 patients with uveal melanoma were treated. The mean age was 57 years (range 9–90 years), basal diameter of 11.5 mm (range 2.0–23.4 mm) and tumour thickness of 3.9 mm (range 0.1–15.4 mm). The majority were TNM stage I (39%) or II (36%). The distance to the optic nerve varied from 0 to 24.5 mm with 148 (14%) of patients having ciliary body involvement. There were variations in the phenotypic characteristic of the tumours treated with protons from different centres, with London referring predominantly small tumours at the posterior pole, Glasgow referring large tumours often at the ciliary body and Liverpool sending a mix of these groups. Discussion: In the UK, common indications for the use of proton treatment in uveal melanoma include small tumours in the posterior pole poorly accessible for plaque treatment (adjacent to the disc), tumours at the posterior pole affecting the fovea and large anterior tumours traditionally too large for brachytherapy. This is the first UK-wide audit enabling the capture of all patients treated at the single proton centre.

Background: Despite evidence-based guidelines advocating for the provision of oral health care throughout pregnancy, dentists remain hesitant to provide dental treatment for pregnant women. However, little is known about attitudes toward treating pregnant women among dental school faculty, who may transmit their attitudes and treatment preferences to their students.Methods: We collected cross-sectional survey data at the New York University College of Dentistry, which produces 10% of all US dentists and is the largest US dental school, to understand faculty attitudes and knowledge regarding providing dental treatment to pregnant women. This study was part of an educational effort to improve dental care access by pregnant women and to examine what factors influence willingness to treat pregnant patients among dental faculty members.Results: We found that concerns about professional liability outweighed inadequate knowledge regarding treatment of pregnant patients in determining dental faculty’s willingness to treat pregnant women.Conclusions: Educational interventions delivered to dental faculty regarding current dental treatment guidelines for pregnant women may not be sufficient to increase faculty’s provision of dental care to women during pregnancy. Future work to design effective interventions to increase dental treatment of pregnant women among dental faculty should address liability concerns.Knowledge Transfer Statement Interventions addressing dental clinician and faculty knowledge about dental treatment for pregnant women may be insufficient to increase dental treatment among pregnant women. Instead, policy makers should consider designing, implementing, and evaluating interventions addressing malpractice and liability concerns.

La infección congénita por citomegalovirus (cCMV) es la causa más frecuente de infección neonatal en el mundo. La infección congénita por este virus puede causar numerosos trastornos entre ellos, alteraciones sensorioneurales auditivas de diverso grado, hasta llegar a la sordera profunda, en una proporción signifcativa de los niños infectados, en que, desafortunadamente, la mayoría es asintomática. En los últimos años se han registrado grandes progresos en el diagnóstico y tratamiento de la infección congénita por este agente. El objetivo de este artículo es mostrar estos avances y comentar nuestra experiencia en Clínica Las Condes.

PurposeThe purpose of the study was to investigate the outcomes of primary photodynamic therapy (PDT) for small pigmented posterior pole choroidal melanoma.Patients and methodsProspective interventional consecutive case series of 15 patients with small pigmented posterior pole choroidal melanoma, who were treated with three sessions of PDT and followed-up thereafter. Risk factors for failure were assessed and outcome measures at presentation were compared to those at last follow-up visit.ResultsTumor control was achieved in 12 (80%) patients in a median follow-up time of 15 months (mean 14, range 8–18). Three patients failed treatment, diagnosed in a median time of 5 months (mean 4, range 3–6), after first PDT. In all failed cases, lesions were 100% pigmented; de novo melanoma rather than transformed nevi and showed a radial growth pattern rather than increased thickness. All failed cases were subsequently successfully treated with radiotherapy. In this cohort, subretinal fluid (SRF) was significantly reduced (P<0.001), vision did not deteriorate (P=0.11) and even improved in patients with subfoveal SRF at presentation (P=0.018), tumor height significantly decreased (P=0.037) and no complications were recorded.ConclusionPrimary PDT was found to be a safe and efficient treatment modality for small pigmented posterior pole choroidal melanoma, achieving short-term tumor control in 80% of patients. PDT offers patients the opportunity to preserve vision by avoiding the retinopathy associated with conventional radiation treatments for choroidal melanoma. However, the long-term local control of these tumors remains uncertain.

PurposeThe purpose of this study is to present the outcomes of a series of patients with choroidal neovascular membrane (choroidal neovascularisation (CNV)) secondary to a choroidal osteoma undergoing anti-VEGF monotherapy.Patients and methodsRetrospective series of patients with choroidal neovascularization secondary to choroidal osteoma. All patients underwent clinical and imaging assessment (fundus photo, B-scan ultrasonography, fluorescein angiography, and optical coherence tomography—where available), and were managed with intravitreal anti-VEGF injections (Bevacizumab). Visual acuity and central retinal thickness were recorded pre treatment and at the end of the follow-up period.ResultsEight patients were included in this study. Of this, 6/8 had predominantly classic or classic and 2/8 patients had minimally classic or occult CNV. Each patient received 3–10 injections of bevacizumab. Median follow-up was 9 months (3–15 months). Visual acuity improved in 5 patients, by 2–6 Snellen lines. CNV completely regressed in 5 cases and partially regressed in 3 cases. Mean CRT reduction was 122 μm (6 to −230 μm).ConclusionIntravitreal bevacizumab can be an effective treatment modality in the management of vision threatening CNV secondary to choroidal osteoma.

En nuestra práctica nos resultan muy cercanos y familiares los programas estructurados de inmunizaciones para lactantes, preescolares y escolares (PNI=Programa Nacional de Inmunizaciones). Sin embargo, para la población adolescente y adultos jóvenes, no existe conciencia, ni menos un programa estatal de inmunizaciones para esta población. Por ello, están desprovistos de prestaciones organizadas y estructuradas en relación a vacunas.

. Purpose:
To determine whether metastasis-free survival following stereotactic radiosurgery is comparable with that following enucleation in a cohort of patients with choroidal and ciliary body melanoma. Methods:
This was a non-randomized, retrospective study of 196 patients with uveal melanoma treated between 1990 and 2000. A total of 118 eyes were enucleated and 78 eyes were treated with stereotactic radiosurgery. The following variables were recorded: age and sex of patient; tumour location, volume and height; the presence of retinal detachment, and extrascleral extension. Tumour location was divided into three categories: within the posterior pole; beyond the limits of the posterior pole but not including the ciliary body, and ciliary body location. Analysis of survival time was performed using Kaplan−Meier estimation of survival curves and Cox's proportional hazards regression modelling. Results:
The 5-year cumulative metastasis-free survival rate was 51% in the enucleation treatment group compared to 74% in the stereotactic treatment group. However, in the multivariate analysis there was no statistical difference in survival rates between the two treatment groups. The only variables that influenced survival rates were tumour location (p = 0.002), ciliary body tumours with the worst prognosis, and tumour volume (p = 0.001). Conclusions:
Tumour size and location at presentation determined metastasis-free survival. Large ciliary body tumours had the highest risk of metastasis. Metastasis-free survival after stereotactic radiosurgery was comparable to that after enucleation.

Symptoms of pain and weakness are nearly ubiquitous after carpal tunnel release. This study investigates the length of time before restoration of grip and pinch strength after open carpal tunnel release, in a population of patients without workers' compensation-related injuries. Two different forms of carpal ligament reconstruction were carried out in 2 groups of patients, and a third group underwent no ligament reconstruction. Grip and pinch strengths were measured for participants in each group both preoperatively and at set postoperative intervals. Mean changes in strength were calculated and analysis of variance used to determine statistical significance of the changes. Grip strength at 6 weeks after surgery in the group that underwent transposition flap repair exceeded preoperative grip strength values and all 3 groups surpassed preoperative grip strength measurements at 12 weeks. By 6 weeks after surgery, all pinch measurements for 3 groups equaled or exceeded preoperative pinch measurements. The transposition flap repair group recovered faster than did the other 2 groups and surpassed those groups in maximum grip and pinch strength at 12 weeks. These results suggest that transverse carpal ligament reconstruction, particularly the transposition flap technique, after open carpal tunnel release confers a mechanical advantage and that the transverse carpal ligament is an important pulley in flexor tendon excursion.

Donkeys were exposed to trichlorofluoromethane (FC11), dichlorodifluoromethane (FC12) and an equivolume mixture of the two to determine their effects on tracheobronchial particle deposition and mucociliary clearance. There was no statistically significant evidence of changes beyond those variations observed in corresponding air control tests.

Alzheimer's disease (AD) involves selective loss of muscarinic m2, but not m1, subtype neuroreceptors in cortical and hippocampal regions of the human brain. Emission tomographic study of the loss of m2 receptors in AD is limited by the fact that there is currently no available m2-selective radioligand which can penetrate the blood-brain barrier. We have previously reported the results of in vivo dissection studies, using both carrier-free and low specific activity [³H]QNB, which show that [³H]QNB exhibits a substantial in vivo m2 selectivity. Because of the expense of the radioligand and the long exposure time required for the X-ray film, performing a large number of direct in vivo autoradiographic studies using [³H]QNB is precluded. Therefore, we now confirm these results autoradiographically by studying the in vivo inhibition of radio-iodinated (R)-3-quinuclidinyl (S)-4-iodobenzilate ((R,S)-[¹²⁵I]IQNB) binding by unlabeled QNB. In the absence of QNB, (R,S)-[¹²⁵I]IQNB labels brain regions in proportion to the total muscarinic receptor concentration; in the presence of 15 nmol QNB, (R,S,)-[¹²⁵I]IQNB labeling in those brain regions containing predominantly m2 subtype is reduced to background levels. We conclude that QNB is m2-selective in vivo and that a suitably radiolabeled derivative of QNB, possibly labeled with ¹⁸F, may be of potential use in positron emission tomographic study of the loss of m2 receptors in AD. Copyright 1995, 1999 Academic Press

Alzheimer's disease (AD) involves selective loss of muscarinic m2, but not m1, subtype neuroreceptors in cortical and hippocampal regions of the human brain. Emission tomographic study of the loss of m2 receptors in AD is limited by the fact that there is currently no available m2-selective radioligand which can penetrate the blood-brain barrier. We now demonstrate the in vivo m2 selectivity of an analogue of QNB, 4-(bromophenyl)-2-thienylglycolate (QBPTG), by studying autoradiographically the in vivo inhibition of radioiodinated (R)-3-quinuclidinyl (S)-4-iodobenzilate ((R,S)-[¹²⁵I]IQNB) binding by unlabeled QBPTG in rat brain. In the absence of QBPTG, (R,S)-[¹²⁵I]IQNB labels brain regions in proportion to the total muscarinic receptor concentration; in the presence of 37.5 nmol of racemic QBPTG, (R,S)-[¹²⁵I]IQNB labeling in those brain regions containing predominantly the m2 subtype is reduced to background levels. We conclude that QBPTG is m2-selective in vivo and that [⁷⁶Br]QBPTG, or a radiofluorinated analogue, may be of potential use in positron emission tomographic study of the loss of m2 receptors in AD. In addition, a radioiodinated analogue may be of potential use in single photon emission tomographic studies. Copyright 1995, 1999 Academic Press

The nuclear spin and magnetic moment of argon 39 have been determined by high-resolution optical spectroscopy, using a pressure-swept Fabry–Perot interferometer, photoelectric detection, and digital data processing. The ^39Ar was produced through the ^39K(n,p)^39Ar reaction by pile neutron irradiation of KF. The spectrum of ^39Ar was excited in a miniature hollow cathode cooled by liquid nitrogen. Helium was used as a carrier gas. By application of the intensity rules, the nuclear spin was determined to be 72, in agreement with the shell model. Anomalous spin values which were measured from some lines were shown to be caused by self-absorption from excited states. Using the A value of −23.76 ± 0.04 mK (1 mK = 10^−3 cm^−1) measured for the 1s_2 level and the previous result for ^37Ar the nuclear magnetic moment has been determined to be −1.3 ± 0.3 nuclear magnetons. The measured B value for the 1s_2 level is B = +2.80 ± 0.02 mK. Several level structures and isotope shifts are reported.

The nuclear spin and magnetic moment of argon 39 have been determined by high-resolution optical spectroscopy, using a pressure-swept Fabry-Perot interferometer, photoelectric detection, and digital data processing. The ^39Ar was produced through the ^39K(n,p)^39Ar reaction by pile neutron irradiation of KF. The spectrum of ^39Ar was excited in a miniature hollow cathode cooled by liquid nitrogen. Helium was used as a carrier gas. By application of the intensity rules, the nuclear spin was determined to be 7/2, in agreement with the shell model. Anomalous spin values which were measured from some lines were shown to be caused by self-absorption from excited states. Using the A value of -23.76±0.04 mK (1 mK=10^-3 cm^-1) measured for the 1s_2 level and the previous result for ^37Ar the nuclear magnetic moment has been determined to be -1.3±0.3 nuclear magnetons. The measured B value for the 1s_2 level is B=+2.80±0.02 mK. Several level structures and isotope shifts are reported.

The problem of minimizing both the in-flight bending moments as well as the terminal drift of a flexible vehicle is considered. The performance criterion V(T)=12y2(T)+k¯2∫tTM2(ξ)dξ, where y(T) is the drift, and M is the in-flight bending moment, is selected to achieve a compromise between excessive drift and excessive structural loading. The two-point boundary value problem for the design of the rigid-body control system is solved analytically for the linear, time-varying optimum control law. The flexibility of the vehicle is then accounted for, in a model consisting of two rigid sections hinged together with a torsional spring, by augmenting the rigid-body optimum control law with feedback terms proportional to the vehicle flexure and its rate. The results of a digital computer simulation indicate that the quasi-optimum control law obtained by this technique results in satisfactory performance, while the rigid-body control law is inadequate for a vehicle of moderate flexibility.

Choroidal metastases from follicular thyroid carcinoma are uncommon and usually present as an amelanotic lesion against a background of known systemic disease. We present the case of a 56-year-old woman with a thyroid metastatic focus with unusual clinical presentation, systemic involvement, and early response to systemic treatment. A review of the literature accompanies this case presentation.

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