Ranibizumab For Diabetic Macular Edema Refractory To Multiple Prior Treatments

Purpose: Diabetic macular edema can be refractory to multiple treatment modalities. Although there have been anecdotal reports of ranibizumab showing efficacy when other modalities provided limited benefit, little has been published on treatment for refractory diabetic macular edema. This study sought to investigate this observation further. Methods: Retrospective chart review. Results: Thirty-three eyes of 22 patients with refractory diabetic macular edema were treated with 0.3 mg intravitreal ranibizumab. This group of eyes received an average of 5.1 prior treatments (macular laser, intravitreal bevacizumab, triamcinolone acetonide, or dexamethasone implant). The mean best corrected visual acuity before the initial ranibizumab injection was 20/110 and the mean central subfield thickness was 384 μm. After 7 visits over an average of 48 weeks, during which an average of 6 ranibizumab injections were administered, the mean visual acuity improved to 20/90 and the mean central subfield thickness improved to 335 μm. Both central subfield thickness and best corrected visual acuity improved with number of days of follow-up in a statistically significant fashion (P < 0.01). Similarly, both central subfield thickness and visual acuity improved with number of ranibizumab injections in a linear fashion, but this was not statistically significant. Conclusion: Ranibizumab can improve diabetic macular edema refractory to prior treatments of laser photocoagulation, intravitreal triamcinolone acetonide, and bevacizumab

Treatment Strategies for Refractory Diabetic Macular Edema: Switching Anti-VEGF Treatments, adopting corticosteroid-based treatments, and combination therapy

Introduction: The pathophysiology of diabetic macular edema (DME) is complex, involving vascular endothelial growth factor (VEGF) and other inflammatory mediators. DME is currently treated first-line with intravitreal anti-VEGF treatments, though some cases are refractory to multiple anti-VEGF treatments. Areas covered: This article examines the evolution of treatment practices for DME, with discussion of the recent studies that guide treatment for refractory cases of DME. A literature search was performed using the following terms: anti-VEGF, DME, aflibercept, bevacizumab, ranibizumab, refractory macular edema, and VEGF. Expert opinion: Focal extrafoveal DME may be treated first-line with laser. In patients with center-involving DME and only mild vision loss, consider starting treatment with bevacizumab, especially when cost is an issue, whereas aflibercept may be considered more strongly in patients with moderate visual loss or worse. There are no standard protocols that define ‘treatment failure,’ but several studies have reported that switching from bevacizumab to either ranibizumab or aflibercept will result in further reduction of CSFT and improvement in BCVA. Further study with prospective randomized trials is warranted to validate these findings. Switching to intravitreal corticosteroids may be of particular benefit to pseudophakic patients. Anti-VEGF combination with sustained-release corticosteroids also appears promising for refractory DME

Whose Turn Is It? Problems of Reconciling Family and Work in Dual-Career Couples.

The work-family life conflict affects various aspects of dual-career families. Parenthood and the work-family life balance lead to an overload of responsibility and disparity at the expense of women, on a private as well as on a social level. In our research, we examined WIF (work to family) and FIW (family to work) conflicts in a sample of 483 dual-career couples. The main results underline an increase in familiar duties concerning child birth and childcare, as associated with the traditional work-family life balance strategy. The data seems to reflect differences in traditional roles between public-male- breadwinner and private-female-homemaker

DILATION TREATMENT OF BENIGN STRICTURED OF COLOCOLONIC ANASTOMOSES

SCOPO DI QUESTO ARTICOLO E' DI METTERE IN LUCE LA COMPLIANCE, I BENEFICI ED IL MIGLIORAMENTO DELLA QUALITA' DELLA VITA, NEI SOGGETTI AFFETTI DA STENOSI BENIGNA POST-ANASTOMOTICA COLO-COLICA E COLO-RETTALE E TRATTATI CON DILATAZIONE ENDOSCOPICA DEL TRATTO STENOTICO. LA DILATAZION PER VIA ENDOSCOPICA RISULTA ESSERE SICURA E DI SEMPLICE ESECUZIONE E PERMETTE DI OTTENERE RISULTATI SODDISFACENTI ANCHE PER PERIODI PROLUNGATI. I CRITERI STANDARD PER UNA EFFICACE DILATAZIONE VARIANO TRA 1 10 E 13 MM

L'IMMAGINE FILMICA NELLA FORMAZIONE: LE NARRAZIONI SULLA VIOLENZA ALL'INFANZIA

Il presente contributo rivolge l’attenzione alle risonanze emotive, alla soggettività di chi affronta il tema della violenza all’infanzia. Lo studio si propone di esplorare i processi attraverso i quali i soggetti, posti all’interno di un gruppo impegnato in attività formativa, organizzano informazioni e costruiscono rappresentazioni sull’abuso sui minori. Il gruppo dei partecipanti all’indagine è composto da 163 soggetti (122 studenti universitari, e 41 professionisti tra cui N = 12 agenti delle Forze dell’ordine e N = 29 operatori sociosanitari) ai quali è stata proposta la visione del film documentario Una storia americana (Capturing the Friedmans, USA 2003). I contenuti delle riflessioni sono stati analizzati attraverso l’analisi delle frequenze ed i test statistici del Chi2 . Lo studio conferma l’importanza dell’utilizzo, nella formazione, dei laboratori cinematografici che rendono possibile anche la narrazione interiore permessa dalla relazione, e dalla protezione, che si crea all’interno del gruppo per mezzo del quale si dà pensabilità all’accaduto ed una motivazione agli eventi e al loro senso.This paper directs its attention towards the emotional repercussions and the subjectivity of whoever is tackling the subject of child abuse. This study intends to explore the processes through which individuals placed within a group involved in educational activity organise their information and build up representations regarding child abuse. The group of participants in the study was made up of 163 individuals (122 university students and 41 professional persons, of whom N = 12 police officers and N = 29 social-medical workers), who were shown a documentary film, Capturing the Friedmans, (USA 2003). The results of the subsequent deliberations were examined via an analysis of frequency and the Chi-square statistical tests. The study confirms the importance of the utilisation, in education, of cinematographic laboratories; they also provide an opportunity for interior narration, which is permitted by the relationship (and the protection) created within the group. Through these the conceivable aspects of the event can emerge, along with the meaning and motivation behind the events

The acute and chronic effects of intravitreal anti-vascular endothelial growth factor injections on intraocular pressure: A review

The acute and chronic effects of repeated intravitreal antivascular endothelial growth factor (VEGF) injections on intraocular pressure have not been fully characterized, and the development of sustained ocular hypertension could adversely affect patients who are at risk of glaucomatous optic neuropathy. As expected, volume-driven, acute ocular hypertension immediately follows intravitreal injection, but this pressure elevation is generally transient and well tolerated. Several medications have been investigated to limit acute ocular hypertension following anti-VEGF therapy, but the benefits of pretreatment are not conclusive. Chronic, sustained ocular hypertension, distinct from the short-term acute ocular hypertension after each injection, has also been associated with repeated intravitreal anti-VEGF injections. Risk factors for chronic ocular hypertension include the total number of injections, a greater frequency of injection, and preexisting glaucoma. Proposed mechanisms for chronic ocular hypertension include microparticle obstruction, toxic or inflammatory effects on trabecular meshwork, as well as alterations in outflow facility by anti-VEGF agents. Although limiting anti-VEGF therapy could minimize the risk of both acute and chronic ocular hypertension, foregoing anti-VEGF therapy risks progression of various macular diseases with resulting permanent central vision loss. While definitive evidence of damage to the retinal nerve fiber layer is lacking, patients receiving repeated injections should be monitored for ocular hypertension and patients in whom sustained ocular hypertension subsequently developed should be periodically monitored for glaucomatous changes with optic nerve optical coherence tomography and static visual fields

UN MODELLO ALLE DIFFERENZE FINITE DI UN PANNELLO FOTOVOLTAICO ACCOPPIATO A MATERIALE A CAMBIAMENTO DI FASE

La diffusione commerciale dei dispositivi fotovoltaici presenta negli ultimi anni un trend di crescita significativa a livello internazionale. Numerose ricerche sono state svolte al fine di incrementare l\u2019efficienza di conversione elettrica dei pannelli fotovoltaici e tra le soluzioni indagate \ue8 stato sperimentato l\u2019impiego di materiali a cambiamento di fase (MCF) per ridurre i picchi di temperatura di funzionamento. Nel lavoro \ue8 stato sviluppato un algoritmo di calcolo in grado di fornire l\u2019andamento temporale della temperatura di un pannello fotovoltaico accoppiato a materiale a cambiamento di fase (Sistema PV-MCF). La determinazione della distribuzione di temperature che interessano un sistema PV-MCF \ue8 stata affrontata con il metodo delle differenze finite in geometria monodimensionale. Sono state definite le equazioni di conservazione dell\u2019energia per ogni punto nodale in cui \ue8 stato discretizzato il sistema fisico, differenziandole per i nodi \u201cinterni\u201d e per i nodi \u201csuperficiali\u201d. Le equazioni alle differenze finite sono state formulate esplicitamente rispetto alla variabile temporale e sono state codificate in un apposito software. Il confronto con alcune soluzioni analitiche largamente impiegate nella bibliografia di settore ha permesso di verificare la correttezza e la validit\ue0 dell\u2019approccio sviluppato

Beating the news using social media: the case study of American Idol

We present a contribution to the debate on the predictability of social events using big data analytics. We focus on the elimination of contestants in the American Idol TV shows as an example of a well defined electoral phenomenon that each week draws millions of votes in the USA. This event can be considered as basic test in a simplified environment to assess the predictive power of Twitter signals. We provide evidence that Twitter activity during the time span defined by the TV show airing and the voting period following it correlates with the contestants ranking and allows the anticipation of the voting outcome. Twitter data from the show and the voting period of the season finale have been analyzed to attempt the winner prediction ahead of the airing of the official result. We also show that the fraction of tweets that contain geolocation information allows us to map the fanbase of each contestant, both within the US and abroad, showing that strong regional polarizations occur. The geolocalized data are crucial for the correct prediction of the final outcome of the show, pointing out the importance of considering information beyond the aggregated Twitter signal. Although American Idol voting is just a minimal and simplified version of complex societal phenomena such as political elections, this work shows that the volume of information available in online systems permits the real time gathering of quantitative indicators that may be able to anticipate the future unfolding of opinion formation events

Evaluation of equilibrium moisture content in ligno-cellulosic residues of olive culture

The use of ligno-cellulosic residuals from agriculture as means for renewable energy production is well known; nonetheless significant problems still exist on development of bioenergy value chains. Moisture content and hygroscopicity are among these problems. Higher moisture content of the biomass means lower calorific value and higher perishability, hence storage difficulties. For this reason it is important to evaluate how the moisture content of the material varies while it is stored and how the calorific value of the feedstock is affected by it. The purpose of this study is to determine the variation of moisture content and its influence on lower calorific value (LCV) of four types of solid residual biomass: oven dried chipped olive tree trimmings, milled olive pomace; oven dried olive tree trimmings and fresh olive tree trimmings. Moisture content of the samples is calculated by means of thermogravimetric analysis (TGA) according to standard CEN/TS 14774-2:2004, while the LCVs are calculated by means of a calorimeter, following standard UNI EN 14918:2010. All the biomass samples were left to reach equilibrium moisture content (EMC) in a temperature and humidity controlled environment. Two different phases were analyzed with respect to moisture uptake rates: 1) fast moisture uptake rate phase (first four hours of exposure) and 2) slow moisture uptake rate, (the days following the first four hours of exposure). Samples experiencing fast moisture uptake rate, during the first four hours of exposure, were kept in a monitored ambient at T=22 \ub1 1oC and RH=59 \ub1 2%, while samples exposed to slow moisture uptake rate were kept in a climatic chamber at three different set of temperature and humidity controlled environment simulating the climatic conditions in different periods of the year in Enna province: 10oC - 80% RH (winter), 15oC - 70% RH (spring/autumn) and 20oC - 55% RH, (summer). The results obtained show that the olive pruning chips (0.425 mm to 1.00 mm and 1.00 mm to 2.00 mm particle size ranges) stored in a heap in a controlled climatic chamber require approximately 20 days to reach EMC. Depending on the particle size range EMCs reach the values of 6.2 and 7.5% by weight in the "summer" condition, 14.3% and 16.9% in "spring/autumn" condition, 24.1% and 28.2% in "winter" condition. Moisture is absorbed gradually over time and results show that in the first four hours, the dry sample exposed to ambient condition (T=22 \ub1 1 oC and RH=59 \ub1 2%) reaches a moisture content between 0.75 and 0.96% of its weight; the LCV at equilibrium is evaluated between 18, 576 J\u2022odg-1 and 18, 793 J\u2022odg-1, the higher value related to the bigger particle size range examined. Pomace heap under the same experimental set up and time period, reaches an equilibrium moisture content of 8.5% and 9.7% (summer conditions), 19.2% and 22.0% (spring/autumn condition) and between 30.9% and 34.1% (winter condition). Olive pomace accumulates moisture relatively faster than olive trimmings as dry sample recovers about 1.61% to 1.97% of moisture in the first four hours of exposure. The LCV at equilibrium is determined between 20, 145 J\u2022odg-1 and 20, 436 J\u2022odg-1. Pruning dried samples reach an EMC equal to 6.1% in approximately 25 days, with a LCV equal to18, 921 J\u2022odg-1 \ub1 1.9%. Heaps of fresh prunings reach an EMC of 8.2% in approximately 20 days; LCV of the feedstock is 19, 356 J\u2022odg-1\ub1 1.6%.\ua92006-2014 Asian Research Publishing Network (ARPN). All rights reserved

Relating the metatranscriptome and metagenome of the human gut

Although the composition of the human microbiome is now wellstudied, the microbiota’s \u3e8 million genes and their regulation remain largely uncharacterized. This knowledge gap is in part because of the difficulty of acquiring large numbers of samples amenable to functional studies of the microbiota. We conducted what is, to our knowledge, one of the first human microbiome studies in a well-phenotyped prospective cohort incorporating taxonomic, metagenomic, and metatranscriptomic profiling at multiple body sites using self-collected samples. Stool and saliva were provided by eight healthy subjects, with the former preserved by three different methods (freezing, ethanol, and RNAlater) to validate self-collection. Within-subject microbial species, gene, and transcript abundances were highly concordant across sampling methods, with only a small fraction of transcripts (\u3c5%) displaying between-method variation. Next, we investigated relationships between the oral and gut microbial communities, identifying a subset of abundant oral microbes that routinely survive transit to the gut, but with minimal transcriptional activity there. Finally, systematic comparison of the gut metagenome and metatranscriptome revealed that a substantial fraction (41%) of microbial transcripts were not differentially regulated relative to their genomic abundances. Of the remainder, consistently underexpressed pathways included sporulation and amino acid biosynthesis, whereas up-regulated pathways included ribosome biogenesis and methanogenesis. Across subjects, metatranscriptional profiles were significantly more individualized than DNA-level functional profiles, but less variable than microbial composition, indicative of subject-specific whole-community regulation. The results thus detail relationships between community genomic potential and gene expression in the gut, and establish the feasibility of metatranscriptomic investigations in subject-collected and shipped samples