Faculty Bibliography

PURPOSE/OBJECTIVE:To compare renal function in patients with age-related macular degeneration (AMD) with and without concurrent reticular macular disease (RMD). DESIGN/METHODS:Retrospective cohort study. PARTICIPANTS/METHODS:Patients with documented AMD with and without RMD. METHODS:Via our electronic health record system, we retrospectively identified patients assigned an International Classification of Diseases, Ninth Edition, code associated with AMD between January 2012 and January 2016. Patients met inclusion criteria if they had at least 1 macular spectral-domain optical coherence tomography volume scan, 1 provider note, and 1 glomerular filtration rate (GFR) value in the electronic medical record. We evaluated images for the presence or absence of RMD; we defined RMD as the presence of at least 1 subretinal drusenoid deposit in at least 1 macular slice. Patients with RMD in at least 1 eye were deemed RMD positive. Patients with bilateral choroidal neovascularization were excluded from analysis. MAIN OUTCOME MEASURE/METHODS:Observation of renal function in RMD patients. RESULTS:(144 vs. 219 μm; P = 0.0008). CONCLUSIONS:Our analysis showed an association between RMD and renal dysfunction. Larger cross-sectional and longitudinal studies of the association of RMD with kidney function are warranted to better understand the nature and biological basis of this observed connection.

OBJECTIVE: The aim of this study was to describe the clinical phenotype of a limited group of responders and survivors of the World Trade Center (WTC) disaster who were referred for the evaluation of neuropathic symptoms. METHODS: Sixteen patients with WTC exposure were referred to a neurologist for evaluation. All had a neurologic examination. Most had electromyogram and nerve conduction testing/nerve conduction studies as well as appropriate imaging and blood tests. RESULTS: There was a higher probability of a neuropathy diagnosis in WTC-exposed patients than other patients referred for EMG testing. Two WTC-exposed patients had motor neuron disease and not neuropathy. CONCLUSION: This study provides objective evidence of neuropathy in a relatively high fraction of WTC-exposed patients with neuropathic symptoms. It also emphasizes that the scope of neurologic problems following WTC exposure may include other diagnoses such as motor neuron disease.

INTRODUCTION: Small airway dysfunction occurs following WTC dust exposure, but its role in producing symptoms is unclear. METHODS: Methacholine challenge (MCT) was used to assess the relationship between onset of respiratory symptoms and small airway abnormalities in 166 symptomatic WTC dust-exposed patients. Forced oscillation testing (FOT) and respiratory symptoms were assessed during MCT. FOT parameters included resistance at 5 and 20 Hz (R5 and R20 ) and the R5 minus R20 (R5-20 ). RESULTS: Baseline spirometry was normal in all (mean FEV1 100 + 13% predicted, mean FEV1 /FVC 80 + 4%). MCT revealed bronchial hyperreactivity by spirometry in 67 patients. An additional 24 patients became symptomatic despite minimal FEV1 change (<5%); symptom onset coincided with increased R5 and R5-20 (P > 0.001 vs. baseline). The dose-response of FOT (reactivity) was greater compared with subjects that remained asymptomatic (P < 0.05). CONCLUSIONS: FOT during MCT uncovered reactivity in small airways as a mechanism for respiratory symptoms in subjects with inhalational lung injury. Am. J. Ind. Med. 59:767-776, 2016. (c) 2016 Wiley Periodicals, Inc.

OBJECTIVE: Longitudinal assessment of lower respiratory symptoms (LRS) in community members with World Trade Center (WTC) exposures. METHODS: Adult members of a treatment program with complete standardized visits were evaluated (n = 798). Association of demographic characteristics, mental health symptoms and lung function with trajectory of LRS between initial and monitoring visit was evaluated. RESULTS: Severe LRS were present in 70% at initial and 63% at monitoring visit. Initial severe LRS were associated with WTC dust cloud exposure and mental health symptoms. Spirometry measures were not associated with LRS severity or trajectory; improvement in LRS was associated with improved lung function measured with forced oscillometry techniques. CONCLUSION: Many community patients in a WTC treatment program had severe LRS associated with exposures and mental health symptoms. Improvement in LRS was associated with improvement in measures of small airway function. Am. J. Ind. Med. 59:777-787, 2016. (c) 2016 Wiley Periodicals, Inc.

The World Trade Center (WTC) destruction released dust and fumes into the environment. Although many community members developed respiratory symptoms, screening spirometry was usually normal. We hypothesised that forced oscillation testing would identify functional abnormalities undetected by spirometry and that symptom severity would relate to magnitude of abnormalities measured by oscillometry. A symptomatic cohort (n=848) from the Bellevue Hospital WTC Environmental Health Center was evaluated and compared to an asymptomatic cohort (n=475) from the New York City Department of Health WTC Health Registry. Spirometry and oscillometry were performed. Oscillometry measurements included resistance (R5) and frequency dependence of resistance (R5-20). Spirometry was normal for the majority of subjects (73.2% symptomatic versus 87.6% asymptomatic, p<0.0001). In subjects with normal spirometry, R5 and R5-20 were higher in symptomatic versus asymptomatic subjects (median (interquartile range) R5 0.436 (0.206) versus 0.314 (0.129) kPa.L-1.s-1, p<0.001; R5-20 0.075 (0.085) versus 0.004 (0.042) kPa.L-1.s-1, p<0.0001). In symptomatic subjects, R5 and R5-20 increased with increasing severity and frequency of wheeze (p<0.05). Measurement of R5-20 correlated with the presence and severity of symptoms even when spirometry was within normal limits. These findings are in accord with small airway abnormalities as a potential explanation of the respiratory symptoms.

BACKGROUND: Destruction of the World Trade Center (WTC) towers on September 11, 2001, released massive dust, gas, and fumes with environmental exposures for community members. Many community members have lower respiratory symptoms (LRSs) that began after September 11, 2001, and remain persistent. We evaluated whether systemic inflammation measured by C-reactive protein was associated with WTC dust exposures, persistent LRS, and lung function. METHODS: Community members self-referred for the treatment of symptoms related to September 11, 2001. C-reactive protein and lung function measurements, including spirometry and forced oscillation tests (impulse oscillometry system), were included as routine analyses in patients (2007 to 2012). RESULTS: Increased C-reactive protein levels were associated with the type of WTC dust exposure, LRS, reduced spirometry, and increased forced oscillation measurements (n = 724). CONCLUSIONS: Ongoing systemic inflammation measured years after the event was associated with WTC dust exposures, persistent LRS, and abnormal lung function in a community cohort. These findings have implications for treatment and surveillance.

Higher levels of .outness. . a fundamental experience of people who experience same-sex attraction or engage in same-sex relationships . have been associated with increased community engagement, improved self-worth and relationship satisfaction. Pornography viewing is common among men who have sex with men (MSM), and may be associated with outness. Current literature lacks analyses of outness and pornography viewing among MSM. In data taken from a 2009 online survey 1995 MSM participants reported accessing pornography via the Internet (58.8%), video/digital versatile disc (32.3%) and magazines (10.4%). Viewing of pornography portraying only safer sex encounters (oral sex, mutual masturbation and/or anal sex with condoms) was reported by 49.4%; 4.5% reported exclusively viewing high-risk sex (anal sex without condoms with/without oral sex or mutual masturbation); and 46.1% reported viewing both safer sex and high-risk pornography. In multivariable modelling . compared to the other two groups . men who watched only safer sex pornography were more likely to report being single, HIV negative, a lower degree of outness and to indicate their sex life resembled pornography. Self-identifying as gay was not associated with type of pornography watched. These findings highlight the need to incorporate level of outness when analysing pornography-viewing behaviours among MSM, as outness may be associated with different viewing habits

AIM: To investigate the risk characteristics of the combined geographic atrophy (GA) and choroidal neovascularisation (CNV) phenotype of age-related macular degeneration (AMD) compared to GA or CNV. METHODS: Patients with advanced AMD were identified and divided into three groups using multimodal imaging: patients with GA in at least one eye, patients with CNV in at least one eye, and patients with simultaneous GA and CNV in at least one eye. Epidemiologic and clinical factors were gathered from patient questionnaires. Genotypes for age-related maculopathy susceptibility 2 (ARMS2) and complement factor H (CFH) were determined. RESULTS: 42 patients with GA or CNV, and 16 patients with combined GA/CNV were identified. Patients with the combined phenotype were older (86.4 vs 81.8 years, p=0.049), and had a higher prevalence of advanced AMD in the fellow eye (81.3% vs 31.0%, p<0.001). CFH and ARMS2 risk alleles were not associated with the combined phenotype. CONCLUSIONS: The combined GA/CNV phenotype has similar epidemiologic, clinical, and genetic features as GA and CNV, but occurs at an older age and is more associated with advanced AMD in the fellow eye, suggesting that all these phenotypes are part of the same spectrum of disease and that the combined phenotype represents an even more advanced form of AMD than either GA or CNV.

PURPOSE: To investigate genetic, environmental, and systemic risk factors in prospectively identified subjects with the age-related macular degeneration (AMD) phenotypes of (a) reticular pseudodrusen without large soft drusen and (b) large soft drusen without reticular pseudodrusen. DESIGN: Prospective case-case comparison. METHODS: In a clinical practice setting, patients with AMD were sequentially screened using clinical examination and scanning laser ophthalmoscopy imaging to prospectively identify subjects (n=73) with the phenotypes of (a) reticular pseudodrusen without large soft drusen (n=30) or (b) large soft drusen without reticular pseudodrusen (n=43). Subjects were genotyped for two alleles associated with AMD, age-related maculopathy susceptibility 2 (ARMS2) and complement factor H (CFH). A questionnaire was administered to collect history of smoking, hypertension, diabetes, and hyperlipidemia, as well as personal and family history of AMD. RESULTS: The reticular pseudodrusen group was older (median age 87 vs. 81 years, P=0.04) and had more females (83.3% vs. 48.8%, P=0.003), later ages of AMD onset (83 vs. 70 years, P=0.0005), and a greater frequency of hypertension (76.7% vs. 55.8%, P=0.08). No significant differences were found in the distribution of the ARMS2 risk allele (P=0.4) between the reticular pseudodrusen (homozygous=20.0%; heterozygous=56.7%) and large soft drusen (homozygous=19.0%; heterozygous=42.9%) phenotypes, or in the distribution of the CHF risk allele (P=0.7) between the reticular pseudodrusen (homozygous=26.7%; heterozygous=56.7%) and large soft drusen (homozygous=21.4%; heterozygous=66.7%) phenotypes. CONCLUSIONS: The reticular pseudodrusen phenotype was associated with increased age, later age of AMD onset, and female gender.