Improvement In Subjective Assessment Research Articles

Combining visual cues with relaxing music, perfume and ventilation to reduce passenger car sickness: An experimental study

The autonomous, digital, and electric transformation of passenger vehicles is projected to elevate the incidence of motion sickness among occupants. This study investigates the effectiveness of an “anti-motion sickness” system that features dynamic light stimuli to support visual perception of longitudinal motion, combined with relaxing music, perfume and ventilation pulses to enhance user wellbeing. In an experimental design aimed at replicating a realistic passenger drive, fifty-three subjects were tested as front passengers engaged in a gaming activity. Subjective motion sickness ratings were collected throughout the drive, and the development of symptoms was monitored through in-ear physiological measurements, including RR-intervals, core temperature, and oxygen saturation. Post hoc analyses indicated non-significant improvement in subjective assessments of motion sickness. Similarly, physiological measurements did not demonstrate any significant difference across conditions. The tested system was however more effective in mitigating car sickness for low susceptible than for mid-to-high susceptible individuals.

Investigating the Efficacy of Modified Lipoaspirate Grafting to Improve the Appearance of Atrophic Acne Scars: A Pilot Study.

Processed lipoaspirate grafting describes several techniques theorized to leverage the inflammatory and regenerative capacities of mechanically processed adipocytes to rejuvenate and correct skin pathology. Although lipoaspirate grafting is typically leveraged to fill visible defects such as depressed scars and dermal lines, additional fat processing allows grafts to stimulate mechanisms of wound healing, including the promotion of fibroblast activation, neovascularization, and neocollagenesis. This study intends to assess the efficacy and tolerability of processed lipoaspirate grafting monotherapy to improve the clinical appearance of atrophic acne scars. Patients underwent a single autologous processed lipoaspirate grafting procedure at the site of atrophic acne scars. Objective and subjective scar analysis was performed at 3 and 6 months posttreatment. Scars were assessed with standard photography, topographic analysis, and noninvasive skin measurements. In addition, microbiopsies were obtained before and after treatment to assess histological or genetic changes. Clinical improvement was assessed with patient and clinician Global Aesthetic Improvement Scales (GAIS) and blinded photographic evaluation. Ten patients between ages 18 and 60 completed the study. Clinical evaluation demonstrated that fat grafting improved the appearance of atrophic acne scars. Clinician GAIS and patient GAIS scores showed clinical improvement at both 3- and 6-month follow-up compared with baseline (P < .05). Blinded clinician GAIS scores also showed statistically significant improvement when clinicians compared clinical photographs taken at 6-month follow-up to baseline (P < .0001). The attenuation coefficient increased at 6-month follow-up, suggesting collagen remodeling and reorganization over the study period. Patients experienced anticipated posttreatment symptoms including transient erythema and edema; however, no unexpected adverse events were reported. Micronized lipoaspirate injection is a viable and effective option to improve the appearance of facial acne scarring. Favorable improvements in atrophic acne scarring were captured by objective analysis of skin ultrastructure as well as improvement in subjective assessments of scarring.

Combined procedure of the transcervical radiofrequency ablation (TRFA) system and surgical hysteroscopy. Increased risk or safe procedure?

IntroductionThe advantage of transcervical radiofrequency ablation (TRFA) is that it is minimally invasive, incision-free, and treats a wide spectrum of fibroids, including those that are not accessible by surgical hysteroscopy (FIGO 3, 4, 5, 6, and 2-5). However, there are no publications describing a combined procedure of operative hysteroscopy and TRFA yet, so it was still unknown whether a combined procedure is associated with additional risks.AimTo report the combined technique of transcervical intrauterine radiofrequency ablation of fibroids and surgical hysteroscopy.Material and methodsOur study was designed to show the results of our case series with 21 patients. The retrospective study included only patients who were treated with the combined procedure of surgical hysteroscopy with fibroid and/or endometrial resection and fibroid ablation using the Sonata System.ResultsThe combined procedure was performed without any complications in all cases. Two days after surgery, no increased morbidity was observed compared to only conventional surgical hysteroscopy and/or therapy with the TRFA. All patients were satisfied with the procedure. No late complications were observed within the first 6 months postoperatively. Seventeen patients with bleeding symptoms were asked about their subjective assessment of improvement. Fifteen patients reported significant improvement in symptoms and 1 patient reported only minimal improvement. Only 1 patient, who underwent TRFA and endometrial resection, did not report any improvement. No increase in symptoms was observed.ConclusionsAlthough TRFA is an approved method, it is not yet widely used worldwide. The combined procedure has been rarely used. The aim of our work is to show through our case series that transcervical radiofrequency ablation can be combined with surgical hysteroscopy for fibroid and/or endometrial resection without any additional risk.

The effect of room sound absorption on a teleconference system and the differences in subjective assessments between elderly and young people

In recent years, the rapid development of information and communication technology (ICT) and the influence of the novel coronavirus (COVID-19) have affected our lives and work in various fields such as medical and welfare, construction and manufacturing and education, etc. With this global background, teleconference systems have received attention and become a new trend. However, the acoustics of rooms using teleconference system often overlap the acoustic characteristics from multiple rooms on both the speaker and listener sides. Therefore, it can sometimes be difficult to listen to each other. A prior study suggested that the installation of sound-absorbing panels improves intelligibility and reduces the listening difficulty for young people. However, elderly people must be included in the target owing to the effects of aging. This study aimed to clarify improvements in the subjective assessments of elderly people in a room where a teleconference system is used. In addition, the differences in subjective assessments between young people and elderly people were also investigated. The results of an experiment indicate that, first, a room using a teleconference system demonstrated a greater improvement in subjective assessments after the acoustic improvements compared to the same room where face-to-face meetings. Second, the subjective assessments and improvements of them for elderly people differed greatly since older user had listening habits and experiences that varied from those of young people.

Patient education on nasal spray technique for allergic rhinitis

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Allergic rhinitis (AR) is a common condition worldwide. Intranasal corticosteroid spray (INCS) is the mainstream and effective first line monotherapy treatment of AR. However, the efficacy of INCS may be dependent on factors such as the patient’s compliance and delivery technique of the nasal spray. The correct delivery technique of INCS depends on the adequacy of patient education. Hence, our study was conducted to assess the benefit of the different methods of patient education and the best method of patient education on INCS usage technique. Objectives of the study were to determine if proper education in the usage of ICNS affected the treatment of AR and to determine the best teaching method of nasal spray technique using both subjective and objective methods of assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a prospective study that was performed over 2 years duration from the year 2017 until 2019. A total of 96 patients were recruited based on our inclusion and exclusion criteria. The effectiveness of the different methods of teaching were determined both subjectively by total nasal symptom score (TNSS) and objectively using Rhinomanometry test. The teachings method became increasingly more comprehensive as compared to the previous visit. Assessment was done every six weeklies for 4 times after each teaching methods of nasal spray usage on each visit. All Rhinometry test and patients follow up of was done by the same surgeon.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: There was statistically significant improvement (p&amp;lt;0.05) in patients symptoms based on the nasal resistance and TNSS with more comprehensive method of teaching nasal spray.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study showed the importance of educating patient regarding the use of INCS. Both objective and subjective assessment of improvement after each method of patient education showed statistically significant outcome.&lt;/p&gt;

Ayurveda interventions in management of chronic plaque psoriasis (Ekakushtha)

Psoriasis is a chronic inflammatory disease skin disease that is associated with different clinical phenotypes and that may show a variety of clinical manifestations such as interaction of genetic, and immunological and environmental factors. Plaque-type psoriasis (PP) is the most common form of psoriasis, occurring in 85%–90% of all cases. The classical symptoms of PP correspond to Ekakushtha in ayurveda, which is explained under Kushtha (skin) disease. The clinical sign and symptoms, dermatological examination, and previous history confirmed the case as “Plaque psoriasis.” According to classics, the case was diagnosed as Ekakushtha. Internal administration of decoction of drugs Punarnava, Manjistha, and Ushira, and Arogyavardhini Vati along with local application of 777 oil and Jivantyadi Yamaka was suggested to the patient initially for 1 month. After 1 month of treatment, there was a significant improvement in subjective assessment of itching, scaling, dryness, and erythema and PASI score, which was initially 43.6, was reduced to 5.2. Then along with above medication Mahatikta Ghrita was prescribed for 6 months. After 6 months of treatment, there was complete regression of all the symptoms and PASI score was found to be 0. In follow-up period even 10 months without medication, there were no signs of relapse. This case proved efficacy of ayurveda interventions in treating such cases where other systems of medicines have their own limitation.

Autologous Serum in Dry Eye Disease

Background: The tear film overlays the ocular surface and provides the interface between the eye and the external environment. The tear film is essential for the nutrition and protection of the ocular surface and for clear vision as the tear film is the first refractive surface of the eye. Aim of the Work: the purpose of this study was to review the efficacy, complications and safety of using autologous serum in dry eye. Patients and Methods: thirty patients of moderate to severe dry eye selected from Ophthalmology Out-Patient Clinics, Al-Hussein University Hospitals. All patients were subjected to Schirmer 1 test, Tear break – up time (TBUT), and Fluorescein clearance test Results: The mean value of Schirmer 1 test before the use of autologous serum was 2.83 mm ± 0.83 SD while after use of autologous serum was 5.33 mm ± 9.99 SD. The mean value of TBUT test before the use of autologous serum was 9.50 sec ± 1.20 SD while after use of autologous serum was 9.433 sec ± 1.52 SD. The mean value of FCT before the use of autologous serum was 100 % positive while after use of autologous serum was 76.7 % positive. The difference between before and after use of autologous is statistically significant as P-value < 0.001. Conclusion: this study revealed that autologous serum eye drops were found effective and safe in treatment of severe dry eye disease, as evidenced by improvement in subjective assessment of symptoms, Schirmer’s 1teast, tear film break-up time (TBUT) and fluorescein clearance test (FCT).

Autologous Serum in Dry Eye Disease

Background: The tear film overlays the ocular surface and provides the interface between the eye and the external environment. The tear film is essential for the nutrition and protection of the ocular surface and for clear vision as the tear film is the first refractive surface of the eye. Aim of the Work: the purpose of this study was to review the efficacy, complications and safety of using autologous serum in dry eye. Patients and Methods: thirty patients of moderate to severe dry eye selected from Ophthalmology Out-Patient Clinics, Al-Hussein University Hospitals. All patients were subjected to Schirmer 1 test, Tear break – up time (TBUT), and Fluorescein clearance test Results: The mean value of Schirmer 1 test before the use of autologous serum was 2.83 mm ± 0.83 SD while after use of autologous serum was 5.33 mm ± 9.99 SD. The mean value of TBUT test before the use of autologous serum was 9.50 sec ± 1.20 SD while after use of autologous serum was 9.433 sec ± 1.52 SD. The mean value of FCT before the use of autologous serum was 100 % positive while after use of autologous serum was 76.7 % positive. The difference between before and after use of autologous is statistically significant as P-value < 0.001. Conclusion: this study revealed that autologous serum eye drops were found effective and safe in treatment of severe dry eye disease, as evidenced by improvement in subjective assessment of symptoms, Schirmer’s 1teast, tear film break-up time (TBUT) and fluorescein clearance test (FCT).

Efficacy and Safety of Autologous Serum Eye Drops in Treatment of Severe Dry Eye

* Deptt of Ophthalmology. V.C.S.G.G.M.S.&R.I., Srinagar Garhwal, Uttarakhand, India. Abstract: Aim: To evaluate the efficacy and safety of autologous serum eye drops in treatment of severe dry eye. Material and methods: Twenty six eyes of thirteen severe dry eye patients were enrolled in this study. All patients were refractory to treatment with conventional artificial tears. Autologous serum eye drops were applied eight times a day per eye. Patients were evaluated subjectively and objectively with Schirmer's test, TBUT, Fluorescein stain at start of treatment, at two weeks, and six weeks after start of treatment. Results: Clinically and statistically significant improvement was seen both objectively and subjectively in patients of severe dry eye treated with autologous serum. Conclusion: Autologous serum eyedrops were found effective and safe in treatment of severe dry eye disease, as evidenced by improvement in subjective assessment of symptoms, Schirmer's score, tear film break-up time

Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV)

Benign paroxsymal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo associated with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology (ENT) clinics. BPPV of the posterior canal is a specific type of BPPV for which the Epley (canalith repositioning) manoeuvre is a verified treatment. A range of modifications of the Epley manoeuvre are used in clinical practice, including post-Epley vestibular exercises and post-Epley postural restrictions. To assess whether the various modifications of the Epley manoeuvre for posterior canal BPPV enhance its efficacy in clinical practice. We searched the Cochrane ENT Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 15 December 2011. Randomised controlled trials of modifications of the Epley manoeuvre versus a standard Epley manoeuvre as a control in adults with posterior canal BPPV diagnosed with a positive Dix-Hallpike test. Specific modifications sought were: application of vibration/oscillation to the mastoid region, vestibular rehabilitation exercises, additional steps in the Epley manoeuvre and post-treatment instructions relating to movement restriction. Two authors independently selected studies from the search results and the third author reviewed and resolved any disagreement. Two authors independently extracted data from the studies using standardised data forms. All authors independently assessed the trials for risk of bias. The review includes 11 trials involving 855 participants. A total of nine studies used post-Epley postural restrictions as their modification of the Epley manoeuvre. There was no evidence of a difference in the results for post-treatment vertigo intensity or subjective assessment of improvement in individual or pooled data. All nine trials included the conversion of a positive to a negative Dix-Hallpike test as an outcome measure. Pooled data identified a significant difference from the addition of postural restrictions in the frequency of Dix-Hallpike conversion when compared to the Epley manoeuvre alone. In the experimental group 88.7% (220 out of 248) patients versus 78.2% (219 out of 280) in the control group converted from a positive to negative Dix-Hallpike test (risk ratio (RR) 1.13, 95% confidence interval (CI) 1.05 to 1.22, P = 0.002). No serious adverse effects were reported, however three studies reported minor complications such as neck stiffness, horizontal BPPV, dizziness and disequilibrium in some patients.There was no evidence of benefit of mastoid oscillation applied during the Epley manoeuvre, or of additional steps in the Epley manoeuvre. No adverse effects were reported. There is evidence supporting a statistically significant effect of post-Epley postural restrictions in comparison to the Epley manoeuvre alone. However, it important to note that this statistically significant effect only highlights a small improvement in treatment efficacy. An Epley manoeuvre alone is effective in just under 80% of patients with typical BPPV. The additional intervention of postural restrictions has a number needed to treat (NNT) of 10. The addition of postural restrictions does not expose the majority of patients to risk of harm, does not pose a major inconvenience, and can be routinely discussed and advised. Specific patients who experience discomfort due to wearing a cervical collar and inconvenience in sleeping upright may be treated with the Epley manoeuvre alone and still expect to be cured in most instances.There is insufficient evidence to support the routine application of mastoid oscillation during the Epley manoeuvre, or additional steps in an 'augmented' Epley manoeuvre. Neither treatment is associated with adverse outcomes. Further studies should employ a rigorous randomisation technique, blinded outcome assessment, a post-treatment Dix-Hallpike test as an outcome measure and longer-term follow-up of patients.

Is non‐ablative 1550‐nm fractional photothermolysis an effective modality to treat melasma? Results from a prospective controlled single‐blinded trial in 51 patients

Melasma is a common benign pigmentary disease and can pose a substantial therapeutic challenge. Although the use of non-ablative fractional photothermolysis (NFP) has gained much popularity, there are still very few evidence-based data supporting NFP in the treatment of melasma. To assess the efficacy and safety of NFP for the treatment of melasma in a controlled observer-blinded parallel-group study. Fifty-one patients [90.2% women, 9.8% men; mean age 40.3±6.1 (control group) and 41.7±11.4 (treatment group)] received a broad-spectrum sunscreen either alone (n=25; 49.0%) or in combination with a 1550-nm NFP treatment (n=26; 51.0%) [energy: 15 mJ/microthermal zone (MTZ); total density: 1048 MTZs/cm(2); density per pass: 131 MTZs/cm(2); number of passes: 8; total coverage: 20%]. Four sessions of NFP treatment were performed at 3-week intervals on each subject in the treatment group. Patients were evaluated at baseline and 12 weeks after final treatment. The primary efficacy variables were the Melasma Area and Severity Index (MASI) and the physician's global assessment (PGA); secondary efficacy variables were the patients' subjective assessment of improvement and patient satisfaction. Safety was evaluated through the reporting of adverse events. The percentage of subjective improvement was virtually identical in both groups: one-third of the patients reported a 'marked improvement' and another half reported 'some improvement'. Twenty-three patients in each group declared that they were 'satisfied' with the treatment result. The MASI corroborated the patients' subjective estimate, both in terms of the degree of improvement and the lack of a group difference. In both groups, the MASI score and the PGA were reduced significantly after therapy, and the reduction was also clinically relevant. No serious side-effects were reported in either group. Our findings do not support the hypothesis of NFP providing a substantial benefit in treating melasma when compared with the lone application of a broad-spectrum sunscreen.

Do Cannabinoids Reduce Multiple Sclerosis-Related Spasticity?

The plant Cannabis sativa contains numerous cannabinoids, which are aromatic hydrocarbons that have central nervous system effects mediated through specific cannabinoid receptors. Some patients with multiple sclerosis (MS) report symptomatic relief from spasticity, pain, and other symptoms when using smoked cannabis, and small trials have suggested some symptomatic benefit. Do cannabinoids improve spasticity in patients with MS? We addressed the question through the development of a structured, critically appraised topic. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarian, and clinical content experts in the field of MS. Participants started with a clinical scenario and a structured question, devised search strategies, located and compiled the best evidence, performed a critical appraisal, synthesized the results, summarized the evidence, provided commentary, and declared bottom-line conclusions. The largest randomized, placebo-controlled trial of oral cannabinoid therapy detected no improvement for MS-related spasticity as measured by the Ashworth scale. However, subjective participant reports indicated improvement in spasticity (P = 0.01), spasms (P = 0.038), sleep quality (P = 0.025), and pain (P = 0.002) without detriment to depression, fatigue, irritability, or walk time. A second randomized controlled trial, which used subjective participant report as the primary outcome, revealed the same discrepancy between subjective and objective spasticity outcome measures. Randomized controlled trials have failed to confirm objective evidence for a beneficial effect of cannabinoids on MS-related spasticity. However, improvement in subjective assessments of spasticity and other related symptoms have been consistently noted, raising questions about the sensitivity and validity of current objective outcome instruments. Further research is warranted with regards to both outcome instrument development and the effects of cannabinoids on MS-related spasticity.

A new pelvic muscle trainer for the treatment of urinary incontinence

Objective To describe a new device for home treatment of urinary incontinence (UI) by comparing 3 conservative techniques and monitoring compliance and performance. Methods Thirty-two patients with UI were allocated to 1 of 3 intervention groups: pelvic floor muscle exercises (PFME; n = 11) alone; PFME combined with biofeedback (n = 10); or PFME combined with electrical stimulation (n = 11). The outcomes assessed were: changes in quality of life score (QLS), urodynamic and perineometric parameters, episodes of urine loss, subjective assessment of improvement, and actual compliance and performance with treatment. Results Increased pelvic muscle contraction strength ( P < 0.05), improvement in QLS ( P < 0.02), and fewer episodes of urine leakage were observed in all 3 groups ( P < 0.05). Compliance was similar among the groups ( P = 0.201). Conclusion All 3 techniques were effective for home treatment of UI, with significant control of symptoms and improved quality of life. The device effectively monitored compliance and performance of exercises.

Relationship between rapid maxillary expansion and nasal cavity size and airway resistance: Short- and long-term effects

The availability of new, reliable, objective, and 3-dimensional techniques to assess the effects of rapid maxillary expansion on the morphology of the maxillary dental arch, nasal cavity dimensions, and nasal airway resistance led to the development of this research. Thirty-eight subjects participated in this study (mean age, 13 years). Data were collected before expansion, when the expander was stabilized, when the expander was removed, and 9 to 12 months after the expander was removed. Subjective assessment of improvement in nasal respiration was obtained when the expander was stabilized. Three-dimensional imaging and acoustic rhinometry were used to assess the virtual cast and the nasal cavity, respectively. The statistically significant short-term effects of RME were (1) mean increases in palatal area, volume, and intermolar distance; (2) a mean reduction of nasal airway resistance; and (3) mean increases in total nasal volume and nasal valve area. Our long-term findings were the following: (1) mean palatal area and intermolar distance were reduced, while palatal volume was stable, and (2) nasal airway resistance was stable, whereas mean nasal cavity volume and minimal cross-sectional area increased. Additionally, 61.3% of our subjects reported subjective improvement in nasal respiration. Weak correlations were found between all variables analyzed.

Zastosowanie implantu ucha środkowego u pacjenta z odbiorczym, wysokoczęstotliwościowym ubytkiem słuchu – studium przypadku

People who suffer from hearing impairment complain mainly of a problem with communication. Wearing hearing aids can often compensate some problems related with moderate to serve sensorineural hearing loss. Many of hearing aids users complain of some problems associated with plugging the ear canal, such as feedback, unpleasant sound while eating, unnatural sound of their own voice, physical discomfort. The alternative method for some group of patients with sensorineural loss is the middle ear implant. In the middle ear implant the sound is converted into mechanical vibrations that directly drive the ossicular chain inside the middle ear. It leaves the ear canal open and ear drum undisturbed. The sound quality is improved and residual hearing is preserved. Additionally feedback is reduced while comfort improved. 53-year-old man with bilateral sensorineural hearing loss (mild at low frequencies up to 1000 Hz in combination with serve degree at high frequencies) was implanted with Vibrant Soundbridge system. Tests of speech comprehension in quiet were performed using monosyllabic word lists. Improvement in patienfs score was observed while testing with Vibrant Soundbridge. Patient also reports significant improvement in subjective assessment. Application of the Floating Mass Transducer for sound processing results in significant improvement in sound quality. Results obtained indicate a high level of benefits with the Yibrant Soundbridge.

Objective Versus Subjective Assessment of Methylphenidate Response

Subjective improvement-assessment in attention deficit/hyperactivity disorder (ADHD), following a single dose of methylphenidate (MPH) was compared to performance on the Test-of-Variables-of-Attention (TOVA). Self-perception was assessed with the clinical-global-impression-of-change (CGI-C). Participants included 165 ADHD subjects (M:F ratio 67%:33%) aged 5-18 (11.09 +/- 3.43) years. TOVA was administered before and after MPH challenge (0.3 mg/kg). Self-perception CGI-C scores were compared to the TOVA scores. An inverse correlation was found only between CGI-C and the TOVA-Commission-scores (r = -0.326, p < 0.001). We thus conclude that subjective reports are too unreliable to be used in order to assess MPH benefit in ADHD pediatric populations.

Extended-Wear Silicone Hydrogel Soft Contact Lenses in the Management of Moderate to Severe Dry Eye Signs and Symptoms Secondary to Graft-Versus-Host Disease

To determine the safety and efficacy of the Focus NIGHT & DAY (CIBA Vision, Duluth, GA) silicone hydrogel contact lens in the management of refractory, moderate to severe dry eye signs and symptoms secondary to graft-versus-host disease (GVHD). Seven patients with GVHD and moderate to severe dry eye disease as determined by the Ocular Surface Disease Index (OSDI) questionnaire were fitted with a near plano Focus NIGHT & DAY soft contact lens (SCL) used on a 7-night continuous-wear basis. Visual acuity, objective measures of dry eye disease (i.e., Schirmer I, tear breakup time, and corneal fluorescein staining), and OSDI scores were compared before SCL wear and after 1 week and 1 month of SCL wear. There was significant improvement in subjective assessment of dry eye symptoms (initial vs. 1-month OSDI score, 76.8 +/- 13.6 vs. 31.2 +/- 17.8, P<0.0005, paired t test). In addition, patients had significant improvement in best-corrected visual acuity after 1 month of SCL wear (initial vs. 1-month logMAR visual acuity for the right eye, 0.23 +/- 0.050 vs. 0.04 +/- 0.027, P<0.007; initial vs. 1-month logMAR visual acuity for the left eye, 0.22 +/- 0.049 vs. 0.04 +/- 0.020, P<0.007, analysis of variance, Dunnett post hoc). There were no significant changes in results of Schirmer I testing, corneal fluorescein staining, or tear breakup time. No adverse events or complications of SCL wear were observed. The Focus NIGHT & DAY contact lens can improve subjective dry eye symptoms and visual acuity in patients with refractory dry eye disease secondary to GVHD.

Endoscopic Dacryocystorhinostomy with Adjunctive Mitomycin C for Canalicular Obstruction

Purpose to report our experience in treating distal and common canalicular obstruction by trephination followed by topical low-dose mitomycin C (0.03%) and silicone intubation during endoscopic dacryocystorhinostomy (DCR). Methods Noncomparative interventional case series of five eyes of five patients with epiphora and clinical evidence of distal or common canalicular obstruction. Only patients with canalicular obstruction at a distance of at least 7 mm distance from the punctum were offered this treatment. Treatment consisted of DCR and trephination under transnasal endoscopic view followed by topical mitomycin C. The major outcome was defined by the patients' subjective assessment of improvement and by objective evaluation of patency by endoscopic examination of the internal ostium, and the passage of fluorescein to the nose (Jones 1). Results Four patients were symptom free, and Jones 1 positive after a mean follow-up period of 15.4 months. One patient had recurrence of her distal canalicular narrowing and needed a Jones tube. No adverse reactions or complaints were reported during and following mitomycin C use. Conclusions Trephination of distal or common canalicular obstruction under endoscopic vision and adjunctive topical Mitomycin C should be considered as a possible viable approach to an external approach canaliculodacryocystorhinostomy.

Gastro‐oesophageal reflux disease in ‘difficult‐to‐control’ asthma: prevalence and response to treatment with acid suppressive therapy

The causal association between gastro-oesophageal reflux disease (GERD) and difficult-to-control asthma is unclear. To determine the prevalence of GERD and response to proton pump inhibitor therapy in patients with difficult-to-control asthma. Consecutive patients with difficult-to-control asthma as defined by persistent and recurrent symptoms despite on optimal asthmatic medications were recruited for the study. GERD was diagnosed by symptoms, gastroscopy and 24-h oesophageal pH monitoring. All patients were prescribed a course of lansoprazole 30 mg daily for 8 weeks. Improvement to treatment was assessed by a change in pulmonary symptom score and also by patient's subjective assessment of improvement. Seventeen of 30 (56.7%) patients with difficult-to-control asthma were diagnosed with GERD. Pulmonary symptom score improved significantly only in patients with GERD (35.0 to 21.0; P = 0.002). Twelve of 16 (75%) patients with GERD reported an improvement in asthma symptoms; 1 of 11 (9.1%) without GERD reported mild symptom improvement. There was no significant change in peak expiratory flow rate and forced expiratory volume. More than half of patients with difficult-to-control asthma were diagnosed with GERD. In these patients the severity of asthma improved significantly with potent acid suppression therapy. This underlines the critical role of acid reflux in this subset of patients with difficult-to-control asthma.

Topography-guided Custom Retreatments in 27 Symptomatic Eyes

To evaluate the use of topography-guided ablations for refractive irregularities induced by previous surgery. This prospective, non-comparative trial comprised 27 symptomatic eyes with a history of LASIK for myopia that underwent topography-guided treatment with the ALLEGRETTO WAVE system. Pre- and postoperative refraction, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal asphericity (Q value), low contrast sensitivity, and patient's subjective assessment of improvement were measured. Preoperative data were sphere -0.84 +/- 1.37 diopters (D), cylinder -1.55 +/- 0.78 D, UCVA 20/49 +/- 0.22, BSCVA 20/32 +/- 0.15, and Q value 1.46 +/- 0.79. Postoperative data at mean 6-month follow-up were: sphere -0.61 +/- 0.81 D, cylinder -0.53 +/- 0.58 D, UCVA 20/25 +/- 0.21 (P < .01), BSCVA 20/21 +/- 0.14 (P < .001), and Q value 1.07 +/- 0.89. Contrast sensitivity scores improved by 70%. No loss of BSCVA occurred in any patient. Topography-guided treatments may be effective in correcting the quality of vision. It should be viewed as a possible two-step procedure due to spherical adjustment that may change refraction unpredictably.