Long-term follow-up of patients treated with multiple fluocinolone acetonide implants for noninfectious uveitis.

PURPOSE: To evaluate long-term outcomes in eyes undergoing exchange of fluocinolone acetonide intravitreal implants for noninfectious uveitis. METHODS: In this retrospective case series, chart review was conducted of all patients treated for noninfectious uveitis with fluocinolone acetonide implants. All patients were seen at a single center between 2007 and 2010.We studied eight eyes of eight patients who received second implants in exchange for previously placed implants and received follow-up care after the implant was exchanged. Main outcome measures were visual acuity (VA), recurrence of inflammation, need for adjunctive systemic anti-inflammatory treatment and adverse events. RESULTS: We studied eight eyes of eight patients. Average length of follow-up after the second implant was 32.3 months. Of the eight patients, five experienced improvement or stabilization of VA when acuity prior to the initial implant was compared to acuity on long-term follow-up. After their first implant, five patients experienced disease recurrence. Including all eight patients, the estimated median time to recurrence was 35.7 months after the first implant. The mean time to reimplantation was 42.7 months. After the second implant, three patients experienced recurrence. Including all eight patients, the estimated median time to recurrence was 30.1 months after the second implant. Adverse events included perioperative complications, elevated intraocular pressure (IOP) and cataracts. CONCLUSIONS: Exchanging FA intravitreal implants used to treat noninfectious uveitis may be useful in preventing vision loss and recurrence of inflammation. Development of elevated IOP and cataract is a potentially serious complication. The risks and benefits of implant exchange must be carefully considered with this intervention.

Risk determinants for catheter-associated blood stream infections in children and young adults with cancer.

BACKGROUND: Catheter-associated blood stream infections (CABSI) are frequent complications encountered with cancer treatment. In order to understand which factors might predispose to CABSIs in children and young adults, we evaluated risk for infection in association with tumor type, catheter type, and setting of occurrence. METHODS: All pediatric oncology patients having a central venous catheter (CVC) with a tunneled external (TE) or totally implantable design (TID) were prospectively followed for the occurrence of a CABSI for 12 months. CABSIs were defined in accordance with the guidelines published by the Centers for Disease Control, and were quantified as the number of occurrences per 1,000 device days. Rates of CABSIs were stratified by tumor histology, type of catheter design, and setting of occurrence. Statistical comparisons were made using the Mantel-Haenzel statistic and the Cox proportional hazard model. RESULTS: A total of 58 CABSIs were identified in 139 patients over a period of 35,935 CVC days. The overall CABSI rate was 1.6 infections per 1,000 CVC days (95% CI 1.2, 2.1). Stratified analysis demonstrated increased risk for CABSIs in hospitalized patients having TEs, and while patients with solid tumors were also at higher risk; this association was not supported by the Cox proportional hazard model. CONCLUSION: While our baseline CABSI rate was comparatively lower than for other institutions, subset analyses identified that hospitalized cancer patients having TEs are at the highest risk for developing CABSIs. Our findings may help to guide improved methods of anticipating and controlling infections in immunocompromised patients.

An immuno-PCR method for detecting Bacillus thuringiensis Cry1Ac toxin.

The Cry1Ac toxin is an insecticidal protein produced by Bacillus thuringiensis var. kurstaki. Recently, the gene encoding the toxin was genetically transformed into crop plants. A specific and sensitive method for detecting the Cry1Ac toxin would facilitate monitoring for this protein in crop and non-crop plants and also in foods. The purpose of this study was to develop an immuno-PCR technique for detecting this toxin. Immuno-PCR combines the specificity of an ELISA reaction with the sensitivity of assays that use a PCR-amplification step. In our assay, anti-Cry1Ac antibodies were covalently bound to reporter DNA via a linker molecule, succinimidyl-4-[N-maleimidomethyl]-cyclohexane-1-carboxylate (SMCC). Antigen was coated onto the surfaces of polyvinyl chloride microtiter plates or onto streptavidin-coated beads. Each of these solid-surface platforms was tested in immuno-PCR reactions. Both the microtiter plate- and bead-based assays showed a high degree of specificity and sensitivity, with minimum detection limits of 21.6 and 432 ng of toxin, respectively. This sensitive immuno-PCR method could be modified for detecting a variety of other protein toxins.