In diabetic retinopathy, high glucose (HG)-mediated breakdown in cell-cell communication promotes disruption of retinal homeostasis. Several studies indicate that HG condition alters expression of connexin genes and subsequent gap junction intercellular communication (GJIC) in retinal vascular cells and non-vascular cells. A serious consequence of disrupted cell-cell communication is apoptosis and breakdown of the blood-retinal barrier (BRB). More recently, studies suggest adverse effects from HG on retinal Müller cells. This article focuses on HG-mediated changes in connexin expression and GJIC and their subsequent effects on the breakdown of retinal homeostasis, cell death, compromised vascular permeability, and interactions between endothelial cells, pericytes and retinal Müller cells in the pathogenesis of diabetic retinopathy. Additionally, options for rectifying disrupted homeostasis under HG condition associated with diabetic retinopathy are reviewed.
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ImportanceApical pelvic organ prolapse is a common condition that affects women. Currently, sacrocolpopexy is considered the criterion standard surgical treatment, with an increasing preference for minimally invasive techniques.ObjectiveIn this study, the content and readability of select internet pages describing robotic and laparoscopic sacrocolpopexy were evaluated.Study DesignUsing an online key word planner, the phrases “robotic sacrocolpopexy” and “laparoscopic sacrocolpopexy” were determined to be the most popular search terms. These terms were systematically browsed in incognito mode in 3 of the most popular web search engines: Google, Yahoo, and Bing. Links that were nontext primary, duplicate, irrelevant, and non-English were excluded. The Flesch-Kincaid Grade Level and Flesch-Kincaid Reading Ease indices were used to assess readability.ResultsThe average readability of all sites was 12.9, requiring at least a 12th-grade reading level, which is significantly higher than the recommended American Medical Association/National Institutes of Health (AMA/NIH) level of sixth-grade or below. One hundred percent of all analyzed sites were above this recommended sixth-grade reading level. There was no significant difference between mean grade level or reading ease score from the type of web source (P = 0.32 and 0.34, respectively), approach of surgery (P = 0.91, 0.70), or specialty (P = 0.48, 0.36).ConclusionsAlmost all websites require at least a high school education to properly comprehend, regardless of source or specialty. It is important that health care providers be aware of available information, so they may direct patients to specific resources that are personally validated or provide in-office materials at an appropriate reading level.
INTRODUCTION AND OBJECTIVE: Rising antibiotic resistance has driven antibiotic stewardship to minimize antibiotic use while maintaining low peri-procedural infectious complications. Our objective was to assess if appropriately augmented antibiotic regimen during transrectal prostate biopsies would reduce infectious complications in high-risk patients based on our departmental antibiotic stewardship protocol METHODS: A retrospective review of 413 patients undergoing transrectal prostate biopsies were done from January 1 st to December 31 st , 2020 during the implementation of our antibiotic stewardship protocol. We implemented a survey in clinic designed to identify high risk patients pre-prostate biopsy. High-risk patients received augmented antibiotics with either ceftriaxone or gentamicin in addition to one standard dose of a fluoroquinolone. We fit multivariable logistic regression models to assess the relationship between antibiotic regimen and infectious complications.RESULTS: Of the 413 patients who underwent transrectal prostate biopsies, 22 (5%) had 30-day infectious complications. The majority of patients, 338 (82%) received appropriate antibiotics as dictated by our protocol. Of the 22 patients with infectious complications, 9 (41%) received augmented antibiotics as indicated, 2 (10%) did not receive augmented antibiotics as indicated, 1 (4%) received augmented antibiotics when not indicated, 9 (41%) did not receive augmented antibiotics as indicated and 1(4%) was unknown. Inappropriate antibiotic regimen received was not an independent predictor of increased infectious complications (odds ratio [OR] 1.37, 95% CI 0.28-6.78) CONCLUSIONS: The majority of our patients received appropriate antibiotics during our intervention. Despite augmented antibiotics, over 40% of infections occurred in this group. Further intervention beyond antimicrobial augmentation should be considered for these high-risk patients such as rectal swab cultures, longer duration of antibiotics or change to perineal prostate biopsy.
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