Surgical outcomes of macular buckling techniques for macular retinoschisis in highly myopic eyes

Purpose

To report the anatomic and visual results following macular buckling for patients with macular retinoschisis related to high myopia.

Methods

Thirty-nine highly myopic eyes (mean refractive error −16.7 D; range, −9 to −24 D) of 36 patients (mean age 59 years; range, 35–79 years) presenting with macular retinoschisis associated with a posterior staphyloma, who underwent combined vitrectomy and macular buckling were evaluated. Main outcome measures included best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) findings. Three cases were excluded due to short follow-up (less than 3 months). The mean follow-up was 16 months.

Results

The mean BCVA increased from 0.76 to 0.43 LogMAR (p = 0.001). Visual acuity improved in 30 eyes (83.3%), remained stable in three eyes (8.3%) and decreased in three eyes (8.3%). OCT showed resolution of foveoschisis with foveal reattachment in all eyes. None of the evaluated patients developed a macular hole during follow-up.

Conclusion

Macular buckling associated with vitrectomy results in good anatomic and visual outcomes in patients with myopic foveoschisis.     

Heart rate as a predictor of development of sustained hypertension in subjects screened for stage 1 hypertension: the HARVEST Study

OBJECTIVE: Whether heart rate predicts the development of sustained hypertension in individuals with hypertension is not well known. We carried out a prospective study to investigate whether clinic and ambulatory heart rates assessed at baseline and changes in clinic heart rate during 6 months of follow-up were independent predictors of subsequent blood pressure (BP). METHODS: The study was conducted in a cohort of 1103 white, stage 1 hypertensive individuals from the HARVEST study, never treated for hypertension and followed-up for an average of 6.4 years. Data were adjusted for baseline BP, age, sex, body fatness, physical activity habits, parental hypertension, duration of hypertension, cigarette smoking, alcohol consumption, and change of body weight from baseline. RESULTS: Clinic heart rate and heart rate changes during the first 6 months of follow-up were independent predictors of subsequent systolic blood pressure (SBP) and diastolic blood pressure (DBP) regardless of initial BP and other confounders (all P < 0.01). A significant interaction was found between sex (male) and baseline resting heart rate on final SBP (P = 0.017) and DBP (P < 0.001). The ambulatory heart rate and the heart rate white-coat effect did not add prognostic information to that provided by the clinic heart rate. Patients whose heart rate was persistently elevated during the study had a doubled fully adjusted risk (95% confidence interval 1.4-2.9) of developing sustained hypertension in comparison with subjects with a normal heart rate. CONCLUSIONS: Baseline clinic heart rate and heart rate changes during the first few months of follow-up are independent predictors of the development of sustained hypertension in young persons screened for stage 1 hypertension.     

Ultrasonometric evaluation of bone healing: Experimental study using a model of diaphyseal transverse osteotomy of sheep tibiae

Noninvasive ionizing-radiation-free methods of evaluation, such as ultrasonometry, are desirable in any medical situation. An in vitro ultrasonometric study was undertaken to evaluate the bone healing process of sheep tibiae submitted to a diaphyseal transverse osteotomy at different times after the procedure. Fifteen sheep weighing an average of 37 kg had surgery for a transverse mid-diaphyseal osteotomy of the right tibia; they were divided postoperatively into three groups of five for periods of observation at 30, 45 and 60 days. The intact left tibiae of the 15 animals were used for control. The healing process was monitored with conventional radiographs taken at two-week intervals, and the animals were killed at the end of the period of observation of each group. Both surgical and intact tibiae were removed, their diameters were measured and they were submitted to measurement of underwater ultrasound propagation velocities (USPV) at the osteotomy sites in both the sagittal and frontal planes. The diameters of the surgical tibiae decreased with time in both planes (from 26.9 mm to 22.0 mm and to 20.9 mm in the sagittal plane, and from 29.3 mm to 23.9 mm and to 23 mm in the frontal plane), with significant differences between the periods of observation (p < or = 0.018 and p < or = 0.003 between 30 and 45 days and 30 and 60 days, respectively, for the sagittal plane and p < or = 0.006 and p < or = 0.003 between 30 and 45 days and 30 and 60 days, respectively, for the frontal plane) and between surgical and intact tibiae at all time points (p < or = 0.0005 for each comparison). USPV increased with time from 2290 m/s to 2399 m/s and to 2382 m/s in the sagittal plane, and from 2376 m/s to 2472 m/s and to 2466 m/s in the frontal plane, accounting for an approximate 5% difference between 30 and 60 days Differences between the surgical and intact tibiae were significant at all time points (p < or = 0.0005 for both sagittal and frontal planes) but not between periods for either plane. There was a strong negative correlation between diameter and USPV (Pearson's correlation coefficient of -0.8998 for the sagittal plane and -0.9192 for the frontal plane). It was concluded that ultrasonometric evaluation of the bone healing process is feasible, yielding precise and reliable results, with a potential for clinical application.     

Cistaceae aqueous extracts containing ellagitannins show antioxidant and antimicrobial capacity,and cytotoxic activity against human cancer cells

Roots and aerial parts of Cistaceae have been used since ancient times in the Mediterranean cultures for its medicinal properties. In this study, phenolic and tannin content of C. ladanifer and C. populifolius leaves aqueous extracts were determined and their antioxidant and antimicrobial activity were fully studied by several in vitro assays. Their major compounds were identified and quantitated by high-performance liquid chromatography with diode array detection coupled to electrospray ion-trap mass spectrometry. Cytotoxicity on a panel of human cancer cells was also determined. C. populifolius extract was stronger antioxidant than C. ladanifer extract in electron transfer reaction based assays but C. ladanifer extract was more effective to inhibit peroxyl radicals. The major compounds in both extracts were ellagitannins, especially punicalagins derivatives, showing C. populifolius a higher content. C. ladanifer showed noteworthy antibacterial activity against Staphylococcus aureus, whereas C. populifolius was effective against Escherichia coli, with MICs values of 154 and 123 μg/mL, respectively. Last, both extracts showed a notorious capacity to inhibit the proliferation of M220 pancreatic cancer cells and MCF7/HER2 and JIMT-1 breast cancer cells. The leaves of these plants suppose a source for water-soluble ellagitannins-enriched polyphenolic extracts with antioxidant and antimicrobial activities. Their cytotoxic activity against several cancer cells may deserve further attention.     

Pregnancy and autoimmunity: maternal treatment and maternal disease influence on pregnancy outcome

If a woman suffers from autoimmune disease (AD), several factors can affect pregnancy or neonatal outcome: repeated spontaneous pregnancy losses (frequently related to antiphospholipid antibodies (aPL)), neonatal lupus with complete congenital heart block (CHB) (linked to transplacental passage of IgG anti Ro/SS-A antibodies) and the disease activity itself that can affect the mother, the pregnancy and fetal outcome. If appropriately managed, the antiphospholipid syndrome (APS) is "one of the few tractable causes of pregnancy losses." A recent case control study, on babies from APS-mothers and healthy mothers, did not show any difference in the occurrence of neonatal complications. There are few data about the long-term outcome of babies born to patients with AD. We recently reported increased occurrence of learning disabilities in children born to aPL positive mothers with systemic lupus erythematosus (SLE). The modern management of pregnancy in patients with AD includes the treatment of disease flares, using drugs effective but safe for fetus. Corticosteroids and some immunosuppressive drugs can be used in pregnancy to control maternal disease. A prolonged fetal exposure to dexamethasone was reported to impair cerebral development, but we recently studied 6 children, born to patients treated with dexamathasone because of CHB, showing a normal intelligence quotient. The last 10-year experience shows that fetal exposure to antimalarial drugs should not be regarded as an important risk factor for gestational nor neonatal complications. However, information about long-term outcome of children exposed to immunosuppressive drugs "in utero" are still lacking and more efforts are needed in this research area.     

Two Innovative Pharmaceutical Forms of Leuprorelin: Results from 818 Patients with Advanced Prostate Cancer

Objectives

This study set out to examine the efficacy and tolerability of two innovative implant forms of leuprorelin acetate in men with advanced hormone-dependent prostate cancer in everyday clinical practice.

Methods

Data were collected from 818 patients (from 273 centers across Germany) who were pretreated with slow-release luteinizing hormone-releasing hormone (LHRH) agonist formulations and who were about to be switched to the leuprorelin implants. Patients received three injections of 1- or 3-month leuprorelin implant and physicians were asked to complete a case report form specific to each of the three clinic visits. Documented parameters included laboratory measurements, such as testosterone and prostate-specific antigen (PSA) levels, adverse events, and patient- and physician-rated assessments of the therapy.

Results

Compared with baseline, a significant decrease in both testosterone and PSA levels were measured after the first and second injections of leuprorelin implant. These results were confirmed for both the 1-month and 3-month implants in separate analyses. Switching, without treatment interruption, from Trenantone® (Takeda Pharma GmBH, Aachen, Germany) to the leuprorelin implant resulted in a significant decrease in the mean serum testosterone concentrations (P < 0.05) and a nonsignificant increase in the proportion of patients reaching castrate testosterone levels, while the number of patients with PSA values ≤4 ng/mL significantly increased (P = 0.045). Similar results were obtained for patients previously treated with goserelin who switched to leuprorelin implant. For 94% of patients, treating physicians rated the efficacy of leuprorelin implant as “very good” or “good.” Treatment with leuprorelin implant was well tolerated, with only 61 adverse events reported in 42 (5.1%) patients. Patients and physicians rated the tolerability of leuprorelin implant as “very good” or “good” in 95% and 91% of cases, respectively.

Conclusions

These results confirm the efficacy, tolerability, and ease of use of the leuprorelin implants among a large population of men with advanced, hormone-dependent prostate cancer treated in a clinical practice setting.     

The place of race and racism in cultural competence: what can we learn from the English experience about the narratives of evidence and argument?

This paper outlines the history of workforce strategies for providing mental health care to "black and ethnic minorities" in England. Universal mental health policies failed to deliver equity in care, and thus specific policies were launched to address ethnic inequalities in care experiences and outcomes. The emphasis on race equality rather than cultural complexity led to widespread acceptance of the need for change. The policy implementation was delivered in accord with multiple regional and national narratives of how to reduce inequalities. As changes in clinical practice and services were encouraged, resistance emerged in various forms from clinicians and policy leaders. In the absence of commitment and then dispute about forms of evidence, divergent policy and clinical narratives fuelled a shift of attention away from services to silence issues of race equality. The process itself represents a defence against the pain of acknowledging systemic inequities whilst rebutting perceived criticism. We draw on historical, psychoanalytic, and learning theory in order to understand these processes and the multiple narratives that compete for dominance. The place of race, ethnicity, and culture in history and their representation in unconscious and conscious thought are investigated to reveal why cultural competence training is not simply an educational intervention. Tackling inequities requires personal development and the emergence and containment of primitive anxieties, hostilities, and fears. In this paper we describe the experience in England of moving from narratives of cultural sensitivity and cultural competence, to race equality and cultural capability, and ultimately to cultural consultation as a process. Given the need to apprehend narratives in care practice, especially at times of disputed evidence, cultural consultation processes may be an appropriate paradigm to address intersectional inequalities.