52 diopter [D]), lowest median (0.245 D) and mean (0.413 D) absolute errors and highest percentage of eyes with a PE within ±0.25 D (54%), ±0.50 D (70%) and ±0.75 D (84%). The Barrett True-K No-History formula with predicted posterior corneal power yielded the worst refractive outcomes. When the 4 options were compared, statistically significant differences were detected in the standard deviation of the median absolute error (p = .0017) and the percentage of eyes with a PE within ±0.25 D (p less then .0001). CONCLUSIONS Using historical data and measured posterior corneal power improved the refractive accuracy of the Barrett True-K formula in eyes with previous myopic excimer laser surgery.OBJECTIVE Although ample evidence indicates that child health is compromised by early adversity (e.g., abuse and poverty), less is known about the contribution of parenting in low-stress contexts to child health, especially in infancy. This longitudinal study extends previous research on early adversity to ask the question Does quality of parental care predict infant health in a low-risk community sample? METHOD Participants were 187 healthy mothers and their full-term infants (86 girls) from the Netherlands, followed from birth to age 1. Home observations of mothers' behavior were conducted during a naturalistic task (bathing session) when infants were 5 weeks old. Trained researchers interviewed mothers about the infants' health and prescribed antibiotic use every month for 12 months. Infant health problems were categorized into 4 domains according to the International Classification of Primary Care to capture a range of outcomes respiratory, digestive, skin, and general illnesses and symptoms. RESULTS Controlling for health-related covariates (e.g., maternal smoking and breastfeeding), maternal sensitivity predicted reduced rates of infant respiratory symptoms and skin conditions and marginally lower prescribed antibiotic use over the first year. Maternal behavior was unrelated to infant digestive and general illnesses. CONCLUSION Even in the absence of adversity, quality of maternal care may have implications for the development of physical health, beginning as early as the first year of life. That such findings emerge in a low-risk sample helps rule out potential confounders and underscores the importance of parenting for physical and psychological health outcomes.OBJECTIVES Subjective tinnitus loudness has been measured using loudness matches, which compare tinnitus loudness with pure tones from an audiometer. When patients compare the sound pressure of certain noises with the tinnitus loudness, however, there may be remarkable differences from the measurements according to loudness matches. Subjective loudness (SubL) is an estimation of the sound pressure of tinnitus loudness by comparison of noises considered to be most similar to tinnitus loudness of patient. We examine whether SubL is inferior to loudness matches in measurement of subjective tinnitus loudness. DESIGN Single-group cross-sectional study. PATIENTS Included in this study were a clinical group of 111 patients with the chief complaint of subjective tinnitus. Seven of the 111 patients were excluded due to missing audiometry or questionnaire data. METHODS Patients assessed the tinnitus loudness and related distress using visual analogue scales (VAS-L and VAS-S) and answered the Tinnitus Handicap Inventory (THI). Hearing acuity, tinnitus pitch, and loudness were then measured using an audiometer. RESULTS VAS-L, VAS-S, and THI scores significantly correlated with loudness match using Goodwin's method (SL2) and SubL. Subgroup analysis based on patient ages indicated that all correlations of SL2 with VAS-L, VAS-S, and THI scores were no longer seen in patients more than 60 years of age. Meanwhile, SubL correlated with VAS-L, VAS-S, and THI scores in all subgroups. CONCLUSIONS SubL was a good reflection of self-reported loudness and distress of tinnitus. It may therefore be a simple and easy means of assessing tinnitus loudness and associated distress during pre-examination without an audiometer.OBJECTIVE To explore the usefulness of vestibular evoked myogenic potentials (VEMPs) in the diagnosis of Menière's disease (MD) and vestibular migraine (VM). STUDY DESIGN Retrospective cohort. SETTING Multidisciplinary neurotology clinic. PATIENTS Definite MD and definite VM patients between January, 2015 and May, 2017, as well as healthy volunteers. INTERVENTIONS Cervical and ocular VEMP (cVEMP and oVEMP) testing. MAIN OUTCOME MEASURES VEMP response, amplitude, and latency. RESULTS Twenty five definite MD, 34 definite VM, and 13 control subjects were analyzed. MD affected ears had significantly lower cVEMP (p = 0.007) and oVEMP (p  less then  0.001) amplitudes than control ears. VM ears had significantly lower oVEMP (p = 0.001), but not cVEMP (p = 0.198) amplitudes than control ears. MD affected ears, but not VM ears, had significantly more absent cVEMP (25.9% versus 0%, p = 0.005) and oVEMP responses (40.7% versus 0%, p  less then  0.001) than control ears. oVEMP latency was significantly shorter for both MD affected (p  less then  0.001) and VM ears (p  less then  0.001) than control ears. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated using a neurotology clinic MD prevalence of 7.9% in dizzy patients. A present cVEMP or oVEMP both have more than 93% chance of ruling MD out in the tested ear, while a cVEMP amplitude more than 54.9 μV or oVEMP amplitude more than 5.1 μV both have more than 94% of ruling out MD in the tested ear. CONCLUSIONS Despite some overlap in VEMP results between MD and VM, when the diagnosis is uncertain between the two disorders due to symptomatic overlap and nonspecific audiometric data, VEMPs can be helpful in guiding treatment toward one disease entity or the other until more evidence points to a definitive diagnosis.OBJECTIVE To report and discuss the effectiveness of stereotactic radiosurgery (SRS) or fractionated radiotherapy (FRT) for tumor control following surgical resection of endolymphatic sac tumors (ELST). STUDY DESIGN Retrospective case series. SETTING Multi-institutional academic referral centers. PATIENTS Patients undergoing surgical resection for ELST followed by SRS or FRT. INTERVENTION(S) Surgical resection followed by radiotherapy. MAIN OUTCOME MEASURES Local tumor control. RESULTS Two of the five patients experienced tumor recurrence after gross total microsurgical at 78 and 11 months, respectively. The former patient received salvage 3D conformal radiotherapy (3D-CRT) and while the latter patient underwent three courses of salvage SRS for recurrence, two of which were in-field and was disease-free at last follow up. Two additional patients underwent subtotal tumor resection (STR) followed by intensity-modulated radiation therapy (IMRT) and are currently without disease. One patient underwent STR followed by proton-beam therapy (PBT) and was free of disease at most recent follow-up. CONCLUSION SRS/FRT remains a useful adjuvant for treatment of residual or recurrent ELSTs, where the risk of revision microsurgical resection is high.BACKGROUND Cardiovascular morbidity and mortality are a major burden in patients with type 2 diabetic mellitus. https://www.selleckchem.com/products/l-histidine-monohydrochloride-monohydrate.html In a landmark study, semaglutide (an injectable glucagon like peptide-1 receptor agonist) has been shown to significantly reduce cardiovascular events, however, the mechanism of benefit is still unknown. The primary hypothesis of our current study is to assess the effect of semaglutide to reduce progression of noncalcified coronary atherosclerotic plaque volume as measured by serial coronary CTA as compared to placebo in persons with diabetes over 1 year. METHODS One hundred forty patients will be enrolled after signing informed consent and followed up for 12 months and with a phone call 30 days after medical discontinuation. All the participants will undergo coronary artery calcium scoring and coronary computed tomography angiography at our center at baseline and 12 months. Eligible participants will be randomly assigned to semaglutide 2 mg/1.5 ml (1.34 mg/ml) prefilled pen for subcutaneous (SC) injection or placebo 1.5 ml, pen-injector for SC injection in a 11 fashion as add-on to their standard of care. RESULTS As of July 2019, the study was approximately 30% enrolled with an estimated enrollment completion by first quarter of 2020 and end of study by first quarter 2021. Thirty patients were enrolled as of 23 July 2019. Preliminary data of demographics and clinical characteristics were summarized. CONCLUSION Our current study will provide important imaging-derived data that may add relevance to the clinically derived outcomes from liraglutide effect and action in diabetes evaluation of cardiovascular outcome results and semaglutide and cardiovascular outcomes in patients with type 2 diabetic mellitus 6 trials.The prevalence of pediatric hypertension is growing. Hypertension during childhood remains a major risk factor for adverse cardiovascular events later in life. NPs should be aware of current guidelines on screening, diagnosis, and treatment of hypertension in children to improve care for this patient population. Globally, the proportion of older people living with HIV (PLWH) is growing and the burden of noncommunicable diseases, including cardiac and renal disease, is increasing. There are few studies of renal disease and cardiac risk in older PLWH. This study investigates the relationship between albuminuria and cardiac risk as estimated by the Atherosclerotic Cardiovascular Disease 10-year risk calculator. We report that albuminuria is associated with a higher Atherosclerotic Cardiovascular Disease risk score in both diabetic and nondiabetic older PLWH.OBJECTIVE To investigate whether the switch from tenofovir disoproxil fumarate/emtricitabine/rilpivirine (TDF/FTC/RPV) to tenofovir alafenamide (TAF)/FTC/RPV is associated with weight gain in people living with HIV (PLWHIV). DESIGN Retrospective single-centre study. METHODS All PLWHIV on TDF/FTC/RPV who switched to TAF/FTC/RPV from January 2017 to December 2018 were considered if they had at least two weight measures in the year before and two after the switch. The weight trend across the study was evaluated by a generalized linear model for repeated measures, with pair comparison performed by Bonferroni adjustment. RESULTS Two hundred and fifty-two patients on TDF/FTC/RPV were included, 65% men, mean age 51.2 years (±9.6), history of 18 (±18.2) years of HIV infection and CD4 T-cell count of 744 (±329) cells/μl. All had HIV-RNA 25 kg/m), lower CD4 T-cell count (≤500 cells/μl) and history of previous drug abuse. The frequency of BMI greater than 25 kg/m rose from 122/252 patients (48.4%), to 133/252 (52.8%) (P  less then  0.0001). CONCLUSION TAF appears to have an impact on weight gain, similarly to what observed in naïve patients, also in experienced PLWHIV with good virologic control.OBJECTIVE The Rotterdam Healthy Aging Score (HAS) is a validated multidimensional index constructed from five health domains. We describe the HAS distribution in a cohort of HIV-positive adults and correlate it with health outcomes. DESIGN A cross-sectional pilot study of 101 adults aged at least 40 years, on suppressive antiretroviral therapy attending a tertiary HIV clinic in Toronto, Canada. METHODS Participants completed questionnaires to calculate their HAS (range 0-14). Demographics, HAS and sub-scores were compared by age and sex. The HAS was compared with results of the Fried Frailty Score, Short Performance Physical Battery score (SPPB) and measures of health utilization. Kruskal--Wallis Rank-Sum and Fisher's exact tests were used for all comparisons. RESULTS Median (IQR) age was 56 (50--62), 81 (80%) men and 50 (50%) born in Canada. Median (IQR) CD4 cell count was 574 (417--794) cells/μl. Median (IQR) HAS was 12 (10--13) with 39 (39%) achieving a score more than 12 (considered healthy aging). Younger participants experienced more depression, whereas women had greater pain.