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To help researchers in multiple sclerosis (MS) take advantage of the measurement properties of the PROMIS Pain Interference instrument while maintaining continuity with previous research, we developed and tested a crosswalk table to transform Brief Pain Inventory pain interference scale (BPI-PI) scores to PROMIS-PI short form (PROMIS-PI SF) scores. The BPI-PI and the PROMIS-PI SF were administered in two studies that included persons with MS. One sample of 369 participants served as a developmental calibration sample, and a separate sample of 360 served as a validation sample. The crosswalk development included dimensionality assessment, item-level parameter estimation, and assessment of accuracy. BPI-PI and PROMIS-PI T scores were obtained from participants’ item responses, and using the crosswalk table, PROMIS-PI T scores were derived from responses to the BPI-PI items. Differences between observed and crosswalked T scores were compared in both samples. For BPI-PI summary scores ranging from 0 to 10, corresponding T scores ranged from 38.6 to 81.2. The mean difference between observed and crosswalked T scores was 0.51 (SD = 3.9) in the calibration sample and −1.47 (SD = 4.2) in the validation sample. Approximately 80 % of crosswalked scores in the calibration sample were within four score points of the observed PROMIS-PI SF scores, and 70 % were within four points in the validation sample. In both samples, the largest differences were at lower levels of the pain interference continuum. Crosswalked pain interference scores adequately approximated observed PROMIS-PI SF scores in both the calibration and validation samples. MS researchers and clinicians interested in adopting the PROMIS instruments can use this table to transform BPI-PI scores to enable comparisons with other studies and to maintain continuity with previous research.

In this study, we compared panel designs applied with various routing methods in the multistage test (MST) based on the partial credit model in the context of classification testing. Simulations were performed to compare three routing methods and four panel structures. Conditions of two test lengths and three passing rates were also included. The results showed that, regardless of the routing method used, the same panel structure performed similarly in terms of the precision of the classification decision with the same test length condition. The longer test length produced higher accuracy, whereas the 50 % passing rate yielded the lowest accuracy. Finally, all MST conditions performed well in terms of test security.

A novel necrosis inhibitor, LC28-0126, is expected to have a cellular protective effect from ischaemic reperfusion injury in acute myocardial infarction. The objective of this study was to investigate the safety, tolerability and pharmacokinetics of LC28-0126 after a single intravenous administration in healthy male subjects.The study was a dose-block-randomized, double-blind, placebo-controlled, single ascending dose, first-in-human trial. Subjects were randomly assigned to receive 0.3, 1, 3, 10, 25, 50, 100 or 200 mg of LC28-0126. LC28-0126 was infused for 30 min and 5 min in cohorts 1 and 2, respectively. An interim analysis to assess the tolerability and pharmacokinetics was conducted in each dose group. Blood samples were taken to determine plasma LC28-0126 concentrations from predose to 48 or 144 h postdose, and urine samples were taken from predose to 48 or 72 h postdose.Overall, 89 subjects were randomly assigned to the dose groups of the two cohorts. LC28-0126 was well tolerated, and no serious adverse events were reported. LC28-0126 showed rapid disposition in the distribution phase. Overall, the fraction of unchanged LC28-0126 excreted during the 48 or 72 h after administration was below 5%. The systemic exposure of LC28-0126 tends to be increased in a dose-proportional manner in the dose range of 0.3-200 mg.A single intravenous dose of LC28-0126 was safe and well tolerated up to 200 mg. Furthermore, LC28-0126 demonstrated a predictable pharmacokinetic profile after a single intravenous infusion of doses ranging from 0.3 to 200 mg.

Individuals with multiple sclerosis (MS) report fatigue, pain, depression, cognitive difficulties, and other symptoms. It is often difficult to compare symptoms across studies and populations because scales used to measure individual symptoms or quality of life indicators (QOLI) use different metrics and often do not provide norms. PROMIS and Neuro-QOL measures, developed with modern psychometric methods, use a common metric and provide population norms.To create symptom profiles and compare symptoms and QOLIs of people living with MS to a US general population sample.Data from observational cross-sectional survey studies of 1544 community dwelling individuals with MS were analyzed. T-tests and non-parametric tests were used to examine whether symptoms or QOLIs of people with MS differed from the general US population. Regression analyses were used to adjust differences for age and sex. Measures included PROMIS or NeuroQoL anxiety, depression, fatigue, sleep disturbance and related impairment, pain interference, physical function, satisfaction with social roles, and applied cognition. Symptom levels were also compared by age, gender, and disability level.Scores on all health domains were statistically significantly (all p 0.001) worse than the general US population and six domains had scores worse by half standard deviation or more. These differences remained significant after adjusting for age and sex.Individuals with MS report clinically meaningful worse health compared to the general population across multiple health related domains. Symptom profiles utilizing PROMIS or NeuroQoL measures can be used to quickly assess symptom levels in an individual or group.

Dagmar Amtmann,1 Jiseon Kim,1 Hyewon Chung,2 Robert L Askew,3 Ryoungsun Park,4 Karon F Cook5 1Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; 2Department of Education, Chungnam National University, Daejeon, Republic of Korea; 3Department of Psychology, Stetson University, Deland, FL, USA; 4Theoretical and Behavioral Foundations Division, Wayne State University, Detroit, MI, USA; 5Department of Medical Social Science, Northwestern University, Chicago, IL, USA Background: The minimally important difference (MID) refers to the smallest change that is sufficiently meaningful to carry implications for patients' care. MIDs are necessary to guide the interpretation of scores. This study estimated MID for the Patient Reported Outcomes Measurement Information System (PROMIS) pain interference (PI). Methods: Study instruments were administered to 414 people who participated in two studies that included treatment with low back pain (LBP; n=218) or depression (n=196). Participants with LBP received epidural steroid injections and participants with depression received antidepressants, psychotherapy, or both. MIDs were estimated for the changes in LBP. MIDs were included only if a priori criteria were met (ie, sample size ≥10, Spearman correlation ≥0.3 between anchor measures and PROMIS-PI scores, and effect size range =0.2–0.8). The interquartile range (IQR) of MID estimates was calculated. Results: The IQR ranged from 3.5 to 5.5 points. The lower bound estimate of the IQR (3.5) was greater than mean of standard error of measurement (SEM) both at time 1 (SEM =2.3) and at time 2 (SEM =2.5), indicating that the estimate of MID exceeded measurement error. Conclusion: Based on our results, researchers and clinicians using PROMIS-PI can assume that change of 3.5 to 5.5 points in comparisons of mean PROMIS-PI scores of people with LBP can be considered meaningful. Keywords: minimally important differences, pain interference, back pain, Patient Reported Outcomes Measurement Information System, responsiveness, PROMIS

The University of Washington Self-Efficacy Scale (UW-SES) was originally developed for people with multiple sclerosis (MS) and spinal cord injury (SCI). This study evaluates the measurement invariance of the 6-item short form of the UW-SES across four disability subgroups. Evidence of measurement invariance would extend the UW-SES for use in two additional diagnostic groups: muscular dystrophy (MD) and post-polio syndrome (PPS).Multi-group confirmatory factor analysis was used to evaluate successive levels of measurement invariance of the 6-item short form, the UW-SES: (a) configural invariance, i.e., equivalent item-factor structures between groups; (b) metric invariance, i.e., equivalent unstandardized factor loadings between groups; and (c) scalar invariance, i.e., equivalent item intercepts between groups. Responses from the four groups with different diagnostic disorders were compared: MD (n = 172), MS (n = 868), PPS (n = 225), and SCI (n = 242).The results of this study support that the most rigorous form of invariance (i.e., scalar) holds for the 6-item short form of the UW-SES across the four diagnostic subgroups.The current study suggests that the 6-item short form of the UW-SES has the same meaning across the four diagnostic subgroups. Thus, the 6-item short form is validated for people with MD, MS, PPS, and SCI.

This study evaluates the role that religious and cultural values have on individual opinions toward suicide worldwide. Using multilevel modeling with data from the fourth wave of the World Values Survey (42,299 individuals in 43 countries), the current study is designed to analyze the effect of individual (i.e., micro-level), and country (i.e., macro-level) characteristics on opinions toward suicide. Specifically, cultural values, religious affiliation, religious importance, and church attendance are analyzed at both the individual and country levels to evaluate the impact of individual and country level effects on opinions toward suicide. The results show that individual opinions toward suicide are influenced by individual belief as well as by the cultural and religious characteristics of their country. The results suggest that evaluation of individual opinions toward controversial behavior should account for the unique and cross-interaction effects of micro- and macro-level effects.

Common stereotypes of virtual game or community users are often portrayed as young and socially inept male addicts. Recent studies, however, defy many of the common prejudices about game or community users. As an extension of recent research, this study looks at gender differences in Virtual Worlds and finds that female users are actually a driving force behind the recent success of online communities. The study results indicate that female users more actively participate in social life, information seeking, and building activities in Virtual Worlds than their male counterparts. Similarly, female users have greater appreciation for the value of Virtual Worlds, although both male and female users recognize Virtual Worlds as a highly useful entertainment tool.

Informed by achievement goal orientation and self-determination theories, we explored the role of cultural/contextual factors on Korean students' achievement motivation. Specifically, we examined the role of the Korean middle school students' family orientation as a mediator between their perceptions of parent goals or motivating styles and their achievement motivations in learning math, when their perceptions of classroom goal structures were controlled. We also investigated gender differences in the role of the students' family orientation and of their perceptions of their parents and classroom variables in predicting their own achievement motivations. Multi-sample path analyses indicated that both Korean boys' and girls' family orientation mediated between their perceptions of parent variables and their own achievement motivations. Korean students' family orientation predicted mainly controlled forms of motivation and ego-focused goals. In addition, the relationships between students' perceptions of parent variables and their achievement motivations statistically varied across gender.

This study compared the use of the conventional multilevel model (MM) with that of the multiple membership multilevel model (MMMM) for handling multiple membership data structures. Multiple membership data structures are commonly encountered in longitudinal educational data sets in which, for example, mobile students are members of more than one higher-level unit (e.g., school). While the conventional MM requires the user either to delete mobile students' data or to ignore prior schools attended, MMMM permits inclusion of mobile students' data and models the effect of all schools attended on student outcomes. The simulation study identified underestimation of the school-level predictor coefficient, as well as underestimation of the level-two variance component with corresponding overestimation of the level-one variance when multiple membership data structures were ignored. Results are discussed along with limitations and ideas for future MMMM methodological research as well as implications for applied researchers.

The current study describes modification of change in R 2 (ΔR 2) indices used to describe a treatment's effect on the level and linear growth in outcome measures in single-subject experimental designs. A description of how to calculate each index, its standard error and associated test statistic is provided. A small simulation study was conducted to evaluate the Type I error rates of the ΔR 2 indices under various manipulated conditions, including sample size and ratio, autocorrelation, and the magnitude of the baseline phase's trend. Results are discussed and recommendations provided for researchers interested in using indices to aggregate single-subject experimental designs. Source of funding: Preparation of this article was supported by a grant from the Institute of Eduction Sciences, U.S. Department of Education. However, the opinions expressed do not express the opinions of this agency.

This study examined the accuracy of depression cross-walk tables in a sample of people with multiple sclerosis (MS). The tables link scores of two commonly used depression measures to the Patient Reported Outcome Measurement Information System Depression (PROMIS-D) scale metric. We administered the 8-item PROMIS-D (Short-Form 8b; PROMIS-D-8), the 20-item Center for Epidemiologic Studies Depression Scale (CESD-20), and the 9-item Patient Health Questionnaire (PHQ-9) to 459 survey participants with MS. We examined correlations between actual PROMIS-D-8 scores and the scores predicted by cross-walks based on PHQ-9 and CESD-20 scores. Intraclass correlation coefficients were used to assess correspondence. Consistency in severity classification was also calculated. Finally, we used Bland–Altman plots to graphically examine the levels of agreement. The correlations between actual and cross-walked PROMIS-D-8 scores were strong (CESD-20 = .82; PHQ-9 = .74). The intraclass correlation was moderate (.77). Participants were consistently classified as having or not having at least moderate depressive symptoms by both actual and cross-walked scores derived from the CESD-20 (90%) and PHQ-9 (85%). Bland–Altman plots suggested the smaller differences between actual and cross-walked scores with greater-than-average depression severity. PROMIS cross-walk tables can be used to translate depression scores of people with MS to the PROMIS-D metric, promoting continuity with previous research.

Age-related physiological changes are known to alter the pharmacokinetics (PK) and pharmacodynamics (PD) of drugs. Metformin is commonly used as first-line medication for management of diabetes in elderly patients. However, the PK and PD of metformin have not been sufficiently studied in elderly subjects. Here, 12 elderly subjects, aged 65 to 85 years, and 20 younger healthy volunteers were orally administered 750 mg of metformin 2 hours after dinner, followed by administration of a second dose (500 mg) 12 hours later. An oral glucose tolerance test (OGTT) was performed 2 hours after the second dose, with 75 g of glucose administered. Blood samples were collected at specific time points after the second metformin dose for the assessment of PK and the glucose-lowering effect of metformin. Elderly subjects exhibited 1.7 and 2.0 times higher average Cmax and AUC∞ than the younger subjects, respectively (P = .007 and .001, respectively), and t1/2 was comparable between the elderly and younger subjects. However, relative glucose level changes from baseline after metformin administration tended to be lower in elderly subjects. Systemic exposure to metformin was elevated by 50% or more in elderly subjects, whereas the glucose-lowering effect was similar compared to younger subjects after 2 doses of metformin.

As part of the ongoing CRISP project (Communicating Risk in Internet Security and Privacy), we conducted a user study in a marginalized community to better understand community members' interactions with computers and the Internet in terms of security and privacy. We used the Health Belief Model to understand what factors affect members' behavior when a potential attack is present. In particular, we focused on two factors, perceived risk and self-efficacy, and interviewed 44 participants about them. In this paper, we report our preliminary quantitative and qualitative findings.

Objective Over a quarter million individuals in the United States have multiple sclerosis (MS). Chronic pain and depression are disproportionately high in this population. The purpose of this study was to examine the relationship between chronic pain and depression in MS and to examine potentially meditational effects of anxiety, fatigue, and sleep. Method We used cross-sectional data from self-reported instruments measuring multiple symptoms and quality of life indicators in this study. We used structural equation modeling to model direct and indirect effects of pain on depression in a sample of 1,245 community-dwelling individuals with MS. Pain interference, depression, fatigue, and sleep disturbance were modeled as latent variables with 2 to 3 indicators each. The model controlled for age, sex, disability status (Expanded Disability Status Scale), and social support. Results A model with indirect effects of pain on depression had adequate fit and accounted for nearly 80% of the variance in depression. The effects of chronic pain on depression were almost completely mediated by fatigue, anxiety, and sleep disturbance. Higher pain was associated with greater fatigue, anxiety, and sleep disturbance, which in turn were associated with higher levels of depression. The largest mediating effect was through fatigue. Additional analyses excluded items with common content and suggested that the meditational effects observed were not attributable to content overlap across scales. Conclusion Individuals living with MS who report high levels of chronic pain and depressive symptoms may benefit from treatment approaches that can address sleep, fatigue, and anxiety.

Objective The aim of our study is to compare the overall survival (OS), progression-free survival (PFS), and treatment-related morbidities between primary concurrent chemoradiation therapy (CCRT) vs. radical hysterectomy (RH) with or without tailored adjuvant therapy in patients with stages IB2 and IIA cervical cancer. Methods This was a retrospective study of 113 patients with IB2 or IIA cervical cancer treated with either primary CCRT (n=49) or RH (n=64) with or without tailored adjuvant therapy between 2002 and 2011 at Keimyung University Dongsan Medical Center. Patients in RH group was divided into those undergoing surgery alone (n=26) and those undergoing surgery with adjuvant therapy (n=38). Results The median follow up period was 66 months. The 5-year OS by treatment modality was 88.7% for the 64 patients in the RH group and 72.8% for 49 patients in the CCRT group (P=0.044). The 5-year PFS was 82.3% and 65.6% after RH group and CCRT group (P=0.048), respectively. Grade 3-4 complication was less frequent after RH alone (7.7%) than RH with adjuvant therapy (34.2%) or CCRT group (28.6%) (P=0.047). Conclusion The RH group seems to be superior to the CCRT group in oncologic outcomes. However, considering the selection bias including tumor size, lymph node meta, and parametrial invasion in pretreatment magnetic resonance imaging, both treatment modalities are reasonable and feasible in cervical cancer IB2 and IIA. It is important to choose the appropriate treatment modality considering the age and general condition of the patient. Randomized controlled study is needed to confirm the result of our study and determine the optimal treatment.

In order to test the difference between group means, the construct measured must have the same meaning for all groups under investigation. This study examined the measurement invariance of responses to the patient-reported outcomes measurement information system (PROMIS) pain behavior (PB) item bank in two samples: the PROMIS calibration sample (Wave 1, N = 426) and a sample recruited from the American Chronic Pain Association (ACPA, N = 750). The ACPA data were collected to increase the number of participants with higher levels of pain.Multi-group confirmatory factor analysis (MG-CFA) and two item response theory (IRT)-based differential item functioning (DIF) approaches were employed to evaluate the existence of measurement invariance.MG-CFA results supported metric invariance of the PROMIS-PB, indicating unstandardized factor loadings with equal across samples. DIF analyses revealed that impact of 6 DIF items was negligible.Based on the results of both MG-CFA and IRT-based DIF approaches, we recommend retaining the original parameter estimates obtained from the combined samples based on the results of MG-CFA.

Purpose The purpose of this study was to calibrate the items for the Communicative Participation Item Bank (CPIB; Baylor, Yorkston, Eadie, Miller, & Amtmann, 2009; Yorkston et al., 2008) using item response theory (IRT). One overriding objective was to examine whether the IRT item parameters would be consistent across different diagnostic groups, thereby allowing creation of a disorder-generic instrument. The intended outcomes were the final item bank and a short form ready for clinical and research applications. Method Self-report data were collected from 701 individuals representing 4 diagnoses: multiple sclerosis, Parkinson's disease, amyotrophic lateral sclerosis, and head and neck cancer. Participants completed the CPIB and additional self-report questionnaires. CPIB data were analyzed using the IRT graded response model. Results The initial set of 94 candidate CPIB items were reduced to an item bank of 46 items demonstrating unidimensionality, local independence, good item fit, and good measurement precision. Differential item functioning analyses detected no meaningful differences across diagnostic groups. A 10-item, disorder-generic short form was generated. Conclusions The CPIB provides speech-language pathologists with a unidimensional, self-report outcomes measurement instrument dedicated to the construct of communicative participation. This instrument may be useful to clinicians and researchers wanting to implement measures of communicative participation in their work.

Background There are several studies about the relationship between serum homocysteine levels and bone mineral density (BMD), but the results are varied, and the studies are limited in Korea. In our study, the relationship between serum homocysteine levels and BMD by part according to age and sex is investigated. Methods From March 2012 to July 2015, the 3,337 healthy adults who took a medical examination were recruited. Subjects filled in the self-recording type questionnaire and physical examination, blood test, BMD of lumbar spine and femur were measured. After sorting by aging (≤49 year old, 50-59 year old, ≥60 year old) and sex, the results were adjusted with age and body mass index (BMI) and the relationship between serum homocysteine levels and BMD by lumbar spine and femur was analyzed by multiple regression analysis. Results As results of analysis, with the adjustment with age and BMI, all age groups of men had no significant relationship between log-converted serum homocysteine levels and BMD. In women aged under 50, there were significantly negative relationships at lumbar spine (β=-0.028, P=0.038), femur neck (β=-0.062, P=0.001), and total hip (β=-0.076, P

Objective The identification of cancer stem-like cells is a recent development in ovarian cancer. Compared to other cancer cells, cancer stem-like cells present more chemo-resistance and more aggressive characteristics. They play an important role in the recurrence and drug resistance of cancer. Therefore, the target therapy of cancer stem-like cell may become a promising and effective approach for ovarian cancer treatment. It may also help to provide novel diagnostic and therapeutic strategies. Methods The OVCAR3 cell line was cultured under serum-free conditions to produce floating spheres. The CD44(+)CD117(+) cell line was isolated from the human ovarian cancer cell line OVCAR3 by using immune magnetic-activated cell sorting system. The expression of stemness genes such as OCT3/4, NANOG and SOX2 mRNA were determined by reverse transcription polymerase chain reaction. OVCAR3 parental and OVCAR3 CD44(+)CD117(+) cells were grown in different doses of paclitaxel and salinomycin to evaluate the effect of salinomycin. And growth inhibition of OVCAR3 CD44(+)CD117(+) cells by paclitaxel combined with salinomycin was determined by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. Results Tumor spheroids generated from the OVCAR3 cell line are shown to have highly enriched CD44 and CD117 expression. Treatment with a combination of paclitaxel and salinomycin demonstrated growth inhibition of OVCAR3 CD44(+)CD117(+) cells. Conclusion The present study is a detailed investigation on the expression of CD44 and CD117 in cancer stem cells and evaluates their specific tumorigenic characteristics in ovarian cancer. This study also demonstrates significant growth inhibition of cancer stem-like cells by paclitaxel combined with salinomycin. Identification of these cancer stem-like cell markers and growth inhibition effect of salinomycin may be the next step to the development of novel target therapy in ovarian cancer.

Pain behaviors that are maintained beyond the acute stage post-injury can contribute to subsequent psychosocial and physical disability. Critical to the study of pain behaviors is the availability of psychometrically sound pain behavior measures. In this study we developed a self-report measure of pain behaviors, the Pain Behaviors Self Report (PaB-SR). PaB-SR scores were developed using item response theory and evaluated using a rigorous, multiple-witness approach to validity testing. Participants included: a) 661 survey participants with chronic pain and with multiple sclerosis (MS), back pain, or arthritis; b) 618 survey participants who were significant others of a chronic pain participant; and c) 86 participants in a videotaped pain behavior observation protocol. Scores on the PaB-SR were found to be measurement invariant with respect to clinical condition. PaB-SR scores, observer-reports, and the video-taped protocol yielded distinct, but convergent views of pain behavior, supporting the validity of the new measure. The PaB-SR is expected to be of substantial utility to researchers wishing to explore the relationship between pain behaviors and constructs such as pain intensity, pain interference, and disability.

This study examined the measurement invariance of responses to the patient-reported outcomes measurement information system (PROMIS) pain interference (PI) item bank. The original PROMIS calibration sample (Wave I) was augmented with a sample of persons recruited from the American Chronic Pain Association (ACPA) to increase the number of participants reporting higher levels of pain. Establishing measurement invariance of an item bank is essential for the valid interpretation of group differences in the latent concept being measured. Multi-group confirmatory factor analysis (MG-CFA) was used to evaluate successive levels of measurement invariance: configural, metric, and scalar invariance. Support was found for configural and metric invariance of the PROMIS-PI, but not for scalar invariance. Based on our results of MG-CFA, we recommend retaining the original parameter estimates obtained by combining the community sample of Wave I and ACPA participants. Future studies should extend this study by examining measurement equivalence in an item response theory framework such as differential item functioning analysis.

Objectives To identify interaction structures (i.e., patterns of reciprocal interaction) that characterize the treatments of patients with borderline personality disorder (BPD) in crisis. Design A 6-month naturalistic psychotherapy process and outcome study in which interaction structures were correlated with outcome data. Methods Five BPD patients in crisis participated in 6 months of three-times-per-week psychodynamic therapy. Patients completed a measure of psychological distress every week. One hundred and twenty-seven sessions were audiotaped and coded using the Psychotherapy Process Q-Set. Results Four interaction structures were identified: (1) collaborative relationship with supportive, reassuring therapist (IS1), (2) therapist empathic attunement (IS2), (3) erotized therapeutic relationship (IS3) and (4) directive therapist with compliant patient (IS4). The magnitude of these four interaction structures varied within and between the five therapist–patient dyads over time. Interaction structures correlations with time were inversely proportional to interaction structures correlations with distress levels. IS2 was correlated with two different outcomes in patient 3's and patient 5's treatments – a positive outcome for patient 3's treatment and a negative outcome for patient 5's treatment. Conclusions An effective treatment model for BPD patients in crisis needs to promote the emergence of empathically attuned interactions as well as supportive and directive interventions as dictated by the patient's individual needs. These treatments require flexibility to accommodate the patient's unique presentation in crisis. The therapeutic dyad senses which interaction structures to increase or decrease over time to reduce the patient's distress. Practitioner Points Unique constellations of four different interaction structures characterized the treatments of five BPD patients in crisis, which provide practitioners with a finite range of expectations in their therapeutic interactions with such patients. Practitioners need to implement intervention strategies with BPD patients in crisis tailored to the unique characteristics of each patient rather than strategies designed for all patients. Being empathic attuned, supportive or directive in treatment with BPD patients in crisis depends on the nature of the therapeutic dyad at any given moment in time. Practitioners need to be flexible enough to change intervention strategies when they seem to be increasing distress in BPD patients in crisis.

To investigate the correlation between integrity of foveal photoreceptor layer and initial as well as final visual acuity (VA) after successful resolution of macular oedema (ME) associated with retinal vein occlusion (RVO).We retrospectively studied 31 eyes of 31 patients with resolved ME secondary to RVO. The integrity of foveal photoreceptor layer was studied using the junction between photoreceptor inner and outer segment (IS/OS) on spectral domain optical coherence tomography (SD OCT). The study eyes were categorized into three groups at final visit; V group with completely visible IS/OS, P group with partially detected IS/OS and I group with invisible IS/OS. Disrupted length of IS/OS and external limiting membrane (ELM) were measured.Final VA (logMAR) was closely associated with the IS/OS integrity at final visit; final VA in V group (0.03 ± 0.05) was better than that in P group (0.21 ± 0.23) (p = 0.027) and final VA in P group was better than that in I group (0.70 ± 0.36) (p = 0.004). Better initial VA (logMAR) and shorter length of disrupted IS/OS at initial visit were closely associated with better final VA (logMAR). In addition, final VA (logMAR) was closely associated with the length of disrupted IS/OS and ELM at final visit. After resolution of ME associated with RVO, the final VA is associated with the integrity of foveal photoreceptor layer. Better VA and the smaller length of disrupted IS/OS on SD OCT at initial visit are indicators of better visual outcome in patients with RVO.

Choriocarcinoma is a rapidly growing tumor that characteristically outgrows its blood supply. We report a rare case of metastatic choriocarcinoma presenting with acute right flank pain due to kidney rupture secondary to renal metastasis. The renal metastasis was embolised to stanch blood for control of hemorrhage. A brief review of the imaging features and therapeutic options for the ruptured renal metastases is discussed along with the case.