Modulatory Effect of Fenofibrate on Endothelial Production of Neutrophil Chemokines IL-8 and ENA-78

Purpose  

The PPAR-alpha agonists (fibrates) are commonly used in the treatment of dyslipidemia. It has been hypothesized that the cardio-protective effects of fibrates are partially due to immunomodulatory effects. However, there is a paucity of data regarding the effect of fibrates on neutrophilic chemokines such as epithelial neutrophil activating protein (ENA-78) and interleukin (IL)-8. We investigated the influence of fenofibrate on IL-1β-stimulated production of ENA-78 and IL-8 from human endothelial cells (HUVECs).     

Thrombolytic Evacuation of Intracerebral and Intraventricular Hemorrhage

Intracranial hemorrhage (ICH) accounts for 10-15?% of all strokes, however it causes 30-50?% of stroke related mortality, disability and cost. The prevalence increases with age with only two cases/100,000/year for age less than 40?years to almost 350 cases/100,000/year for age more than 80?years. Several trials of open surgical evacuation of ICH have failed to show clear benefit over medical management. However, some small trials of minimal invasive hematoma evacuation in combination with thrombolytics have shown encouraging results. Based on these findings larger clinical trials are being undertaken to optimize and define therapeutic benefit of minimally invasive surgery in combination with thrombolytic clearance of hematoma. In this article we will review some of the background of minimally invasive surgery and the use of thrombolytics in the setting of ICH and intraventricular hemorrhage (IVH) and will highlight the early findings of MISTIE and CLEAR trials for these two entities respectively.     

Two-year efficacy after first transscleral controlled cyclophotocoagulation in patients with and without pseudoexfoliation

Purpose

Transscleral controlled cyclophotocoagulation (COCO) is a transscleral 810-nm diode laser cyclophotocoagulation that automatically adjusts the applied laser energy utilizing an optical feedback loop. The present study investigates the influence of pseudoexfoliation (PEX) on the efficacy of COCO in a Caucasian study population.

Methods

Retrospective data from 130 consecutive eyes were analyzed during a 2-year follow-up. Baseline characteristics, intraocular pressure (IOP), number of IOP-lowering medications, visual field, best-corrected visual acuity (BCVA), and secondary surgical interventions (SSI) were analyzed. The primary endpoint was IOP reduction at M24 compared to baseline, and the secondary endpoints were IOP course, reduction of IOP-lowering medications, surgical success, and IOP-lowering SSIs stratified by PEX and baseline IOP.

Results

IOP reductions of −35, −39, −25, −25, −23, −34, and −36% could be achieved from baseline to D1, W1, M1, M3, M6, M12, and M24 (all p < 0.001), respectively, while there was a significant overall reduction over time (p < 0.001) in the number of topical IOP-lowering medications postoperatively. The proportion of eyes requiring additional systemic IOP-lowering medication reduced from 31 to 0% at M24 (p = 0.025). Eyes without PEX and IOP < 30 mmHg at baseline had the lowest risk for IOP-lowering SSIs (p < 0.03). BCVA dropped at M12 (0.25 [95% CI: 0.12–0.38]), and the drop persisted during the following 12 months.

Conclusion

The present study demonstrates a midterm IOP-lowering effect after COCO while reducing the burden for topical and systemic IOP-lowering medications. Patients without PEX and IOP < 30 mmHg have a lower risk of SSI. The procedure per se cannot be excluded as causative for the decreased postoperative BCVA. Further prospective investigations are suggested.

     

Total joint replacement and blood loss: what is the best equation?

With the population aging, total joint replacements which are an effective method to restore patient’s mobility are an increasing necessity. However, such operations are known to entail serious blood loss, which may have dramatic consequences in patients with chronic diseases or when the prosthesis is revised, a situation where the blood loss is even higher. Therefore, formulas to better estimate the blood loss are available. These formulas may also be used for clinical studies to compare blood loss between different joint replacement techniques. The aim of this review is to provide a clear understanding of the formulas and to help physicians to further improve their blood loss estimation. Moreover, surgeons will then be able to choose the most accurate and user-friendly formula for more comparable data between clinical studies.