The Role of Sensory Innervation in Homeostatic and Injury-Induced Corneal Epithelial Renewal.

The cornea is the window through which we see the world. Corneal clarity is required for vision, and blindness occurs when the cornea becomes opaque. The cornea is covered by unique transparent epithelial cells that serve as an outermost cellular barrier bordering between the cornea and the external environment. Corneal sensory nerves protect the cornea from injury by triggering tearing and blink reflexes, and are also thought to regulate corneal epithelial renewal via unknown mechanism(s). When protective corneal sensory innervation is absent due to infection, trauma, intracranial tumors, surgery, or congenital causes, permanent blindness results from repetitive epithelial microtraumas and failure to heal. The condition is termed neurotrophic keratopathy (NK), with an incidence of 5:10,000 people worldwide. In this report, we review the currently available therapeutic solutions for NK and discuss the progress in our understanding of how the sensory nerves induce corneal epithelial renewal.

Intranasal fentanyl for first-trimester uterine aspiration pain: A randomized controlled trial.

OBJECTIVE: To evaluate whether administration of intranasal fentanyl reduces reported pain during first-trimester uterine aspiration. STUDY DESIGN: We conducted a multicenter, randomized, double-blind, placebo-controlled trial of patients with pregnancies less than or equal to 14 weeks gestation seeking uterine aspiration for induced abortion, early pregnancy loss, or failed medication abortion. We randomized participants 1:1 to either intranasal fentanyl 100 mcg or intranasal placebo. All participants received ibuprofen and a standardized paracervical block. The primary outcome was pain indicated at the time of uterine aspiration on a 100 mm visual analog scale (VAS). We designed the study to detect a 15 mm difference in mean pain scores, which required 53 people in each arm for a total of 106 participants. Secondary outcomes included postprocedure pain and patient satisfaction with pain control. RESULTS: From March 2017 through June 2018, we screened 355 people for eligibility and enrolled 107 participants. Those who received intranasal fentanyl reported similar uterine aspiration pain to participants who received placebo (58.4 ± 28.0 fentanyl vs 58.6 ± 24.5 placebo, p = 0.97). Participants who received intranasal fentanyl also reported similar postprocedure pain scores compared to participants who received placebo (19.1 ± 19.4 fentanyl vs 17.2 ± 19 placebo, p = 0.63), and were equally satisfied with procedure pain control (66.8 ± 31.2 fentanyl vs 63.3 ± 29.2 placebo, p = 0.57). CONCLUSION: Intranasal fentanyl did not decrease reported pain with first-trimester uterine aspiration, nor did it decrease postprocedure pain compared to placebo. As an adjunct to ibuprofen and paracervical block, intranasal fentanyl did not improve patient satisfaction with pain control. IMPLICATIONS: Intranasal fentanyl does not reduce reported pain with first-trimester uterine aspiration, however abortion-seeking patients are amenable to receiving intranasal medications for pain management.

A metal-free aromative cascade for the synthesis of diverse heterocycles.

A metal-free aromative cascade has been developed for the synthesis of diverse heterocycles from readily accessible hydroxy/aminochalcones and acid/alkyl halides. The cascade being by a base-mediated intramolecular aldol cyclization/dehydration sequence to provide a triene, which sets the stage for a 6π-electrocyclization/oxidative aromatization to access diverse heterocyclic scaffolds.

Updating fetal foot length to gestational age references: a chart review of abortion cases from 2012 to 2014.

OBJECTIVES: We sought to develop an updated fetal foot length-to-gestational week reference range from patient-reported last menstrual period (LMP), ultrasound, and best-estimate for gestational age based on American College of Obstetricians and Gynecologists' (ACOG) pregnancy dating guidelines. Subsequently, we aimed to determine the impact, if any, of race/ethnicity on our findings and compare our measurements to commonly referenced ranges. METHODS: We performed a chart review of 610 dilation and evacuation records with gestational ages 14 weeks 0 days to 21 weeks 6 days from October 2012 to December 2014 in Honolulu, Hawaii. We analyzed records containing pathology-measured fetal foot length and three gestational age estimation methods using ANOVA tests, determined if race/ethnicity affected fetal foot length, and compared our measurements to previously published studies. RESULTS: Linear regression analysis demonstrated that ultrasound-derived gestational age dating provided the best-fit regression formula with an R-squared and adjusted R-squared value of 0.92. Patient body mass index (p=.15), parity (p=.15), and race (p=.99) did not affect the equation. Mean fetal foot length per gestational age differed from historically referenced ranges by 0.36-3.92 mm in either direction. CONCLUSIONS: Our population's fetal foot length per gestational age differed from ranges typically referenced by pathologists following abortion at all gestational ages, using all three methods of fetal gestational age estimation. As gestational age increased, the variability of fetal foot length measurements per gestational week increased. If post-abortion fetal foot length measurements are obtained, it is important to use an updated reference range. IMPLICATIONS: Reference ranges frequently used by pathologists to assess fetal foot length following abortion may be outdated, limiting their utility. If facilities routinely obtain these measurements to estimate gestational age, it is important to use an updated reference range.

Paracervical Block for Laminaria Insertion Before Second-Trimester Abortion: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the efficacy of a paracervical block to decrease pain during osmotic dilator insertion before second-trimester abortion. METHODS: In this double-blind, randomized trial, 41 women undergoing Laminaria insertion before a second-trimester abortion received either a paracervical block with 18 mL 1% lidocaine and 2 mL sodium bicarbonate or a sham block. Women were between 14 and 23 6/7 weeks of gestation. The primary outcome was pain immediately after insertion of Laminaria. Women assessed their pain on a 100-mm visual analog scale. Secondary outcomes included assessment of pain at other times during the insertion procedure and overall satisfaction with pain control. To detect a 25-mm difference in pain immediately after Laminaria insertion, at an α of 0.05 and 80% power, we aimed to enroll 20 patients in each arm. RESULTS: From May 2015 to December 2015, 20 women received a paracervical block and 21 received a sham block. Groups were similar in demographics, including parity, history of surgical abortion, and number of Laminaria placed. The paracervical block reduced pain after Laminaria insertion (median scores 13 mm [interquartile range 2-39] compared with 54 mm [interquartile range 27-61], P=.01, 95% CI -47.0 to -4.0). Women who received a paracervical block also reported higher satisfaction with overall pain control throughout the entire Laminaria insertion procedure (median scores 95 mm [interquartile range 78-100] compared with 70 mm [interquartile range 44-90], P=.05, 95% CI 0.0-37.0). CONCLUSION: Paracervical block is effective at reducing the pain of Laminaria insertion. Additionally, a paracervical block increases overall patient satisfaction with pain control during Laminaria placement. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02454296.

University Researcher and Law Enforcement Collaboration.

In 2012, heads of local law enforcement agencies in Benton County, Oregon, contacted researchers at Oregon State University to discuss a problem: a sharp rise in the number of contacts between police and suspects displaying symptoms of mental illness. This initial inquiry led to an ongoing collaborative examination of the nature, causes, and consequences of the rise in police contacts. In this article, the authors describe this collaboration between researchers and law enforcement officials from the perspective of both parties, situating it within the context of mental illness in the U.S. criminal justice system. The collaborators draw on firsthand experiences and prior collaborations to discuss the benefits of, challenges in, and recommendations for university-police research collaborations. Although such collaborations may pose challenges (related to relationship definition, data collection and analysis, outputs, and relationship maintenance), the potential benefits-for researchers and law enforcement agencies-are substantial.

Assessment of saccular function in children with sensorineural hearing loss.

OBJECTIVE: To investigate saccular function using vestibular evoked myogenic potentials in children with congenital or early acquired sensorineural hearing loss. DESIGN: Retrospective cohort study. SETTING: Pediatric tertiary referral center. PATIENTS: Twenty-three children with bilateral sensorineural hearing loss (severe to profound in 22 cases, moderate in 1 case) underwent evaluation of saccular function. Twelve pediatric subjects with normal hearing were included in the study as the control group. INTERVENTIONS: Otologic examination, computed tomography of the temporal bone, audiometry, tympanometry, and vestibular evoked myogenic potential testing. MAIN OUTCOME MEASURE: Differences in threshold, amplitude, and P1 and N1 latencies of vestibular evoked myogenic potentials between children with normal-hearing and hearing-impaired children. RESULTS: Abnormal vestibular evoked myogenic potentials were found in 21 of 23 children (91%) with sensorineural hearing loss. The thresholds of vestibular evoked myogenic potential were significantly higher (P <.001) and the amplitudes were lower in children with sensorineural hearing loss than those in children with normal hearing. There were no differences in the P1 and N1 latencies between the 2 groups. CONCLUSIONS: The impairment of saccular function, indicated by the abnormal findings in the vestibular evoked myogenic potential, is often associated with sensorineural hearing loss in the pediatric population. Although saccular dysfunction may create a vestibular deficit, its manifestations can vary and be easily overlooked in children. Considering the high percentage of abnormal findings in our study, we recommend that deaf and hard-of-hearing children undergo vestibular evaluation. Vestibular evoked myogenic potential testing is an easy and reliable procedure to evaluate saccular function in children.