Efficacia di una terapia senza bendaggio con gel a base di trealosio ialuronato sodico carbomero, nella riparazione del danno corneale epiteliale di tipo meccanico vs terapia a base di pomata antibiotica oftalmica con bendaggio

Introduzione: la superficie oculare è una complessa unità funzionale, il cui normale funzionamento è regolato dal sistema nervoso, particolarmente espresso a livello corneale. Diverse patologie possono portare ad una alterazione della superficie oculare e tra queste le patologie traumatiche della superficie oculare. In caso di trauma lo scopo principale della terapia della superficie oculare è di riparare il danno epiteliale. L’effetto protettivo e riparativo di una formulazione in gel a base di trealosio/ialuronato sodico/carbomero può trovare una valida applicazione nei processi di riparazione di danno epiteliale. Scopo: valutare l’efficacia riparativa nei confronti del danno epiteliale di tipo meccanico, di una formulazione in gel a base di trealosio/ialuronato sodico/carbomero, senza bendaggio oculare in confronto ad una terapia topica antibiotica con bendaggio oculare. Materiali e metodi: studio osservazionale condotto su 262 pazienti afferiti presso la clinica Oculistica di Roma nel periodo maggio 2014 – giugno 2017 per una lesione corneale e/o corneo-congiuntivale di natura da corpo estraneo o per abrasione corneale traumatica. È stata ottenuta l’approvazione del Comitato Etico ed il consenso informato dei pazienti. Il primo gruppo era costituito da 158 pazienti sottoposti a rimozione di corpo estraneo corneale e trattati per 7 giorni con le seguenti modalità: 83 pazienti con una formulazione in gel a base di trealosio/ialuronato sodico/carbomero quattro volte al giorno senza bendaggio oculare; 75 pazienti con una terapia topica antibiotica quattro volte al giorno con bendaggio oculare. Il secondo gruppo costituito da 104 pazienti con abrasione corneale e trattati con le stesse modalità descritte nel primo gruppo di pazienti (50 vs 54 rispettivamente). Risultati: dopo 4 giorni di trattamento la percentuale di guarigione dei pazienti trattati con la formulazione in gel a base di trealosio/ialuronato sodico/carbomero rispetto ai pazienti trattati con terapia topica antibiotica era significativamente superiore in entrambi i gruppi (73% vs 32%; p<0,01 Gruppo 1) (78% vs 29%; p<0,01 Gruppo 2). La differenza si è mantenuta anche dopo 7 giorni di trattamento (98% vs 91%; p<0,01 Gruppo 1) (100% vs 87% Gruppo 2; p<0,01). Una differenza statisticamente significativa dopo 4 giorni di trattamento è stata riscontrata per i parametri soggettivi come dolore (0,22 vs 0,47; p<0,01 Gruppo 1) (0.1 vs 0.5; p<0,01 Gruppo 2), bruciore (0,23 vs 0,79; p<0,01 Gruppo 1) (0.1 vs 0.8; p<0,01 Gruppo 2) e sensazione di corpo estraneo (0,51 vs 1,37; p<0,01 Gruppo 1) (0.4 vs 1.8; p<0,01 gruppo 2). Conclusioni: la terapia con una formulazione in gel a base di trealosio/ialuronato sodico/carbomero senza bendaggio sembra una valida alternativa all’applicazione di pomata oftalmica antibiotica con bendaggio.Introduction: The ocular surface is a complex functional unit whose normal functions are regulated by the nervous system, particularly expressed at the corneal level. Various diseases, and also traumatic injuries, can lead to the alteration of the ocular surface. In case of trauma, the main purpose of ocular surface therapy is to repair the epithelial damage. A gel formulation based on trehalose/sodium hyaluronate/carbomer may represent a valid strategy to help the epithelial repair processes, thanks to its protective and repairing action. Aim: To evaluate the effect of a gel formulation based on trehalose/sodium hyaluronate/carbomer without eye patching compared to topical antibiotic therapy with eye patching, in recovering epithelial damage caused by mechanical injury. Materials and methods: An observational study involving 262 patients referred to the Ophthalmology Clinic in Rome between May 2014 and June 2017 for corneal and/or cornealconjunctival lesion caused by a foreign body or by traumatic corneal abrasion. Ethical approval was obtained , and only consenting subjects were involved. The first group involved 158 patients who underwent corneal foreign body removal and were treated for 7 days as follows: 83 patients received a gel formulation based on trehalose/sodium hyaluronate/carbomer four times a day, without occlusive eye patch; 75 patients were treated with topical antibiotic therapy four times a day and occlusive eye patch. The second group included 104 patients with corneal abrasion who underwent the same treatments described for the first group of patients (50 vs 54 patients, respectively). Results: After 4 days of treatment, the recovery rate was significantly higher in both groups of patients treated with the gel formulation based on trehalose/sodium hyaluronate/carbomer, compared to patients treated with topical antibiotic therapy (73% vs 32%, p<0.01; Group 1) (78% vs 29%, p<0.01; Group 2). The difference was maintained even after 7 days of treatment (98% vs 91%, p<0.01; Group 1) (100% vs 87%, p<0.01; Group 2). A statistically significant difference was found after 4 days of treatment in subjective parameters such as pain (0.22 vs 0.47, p<0.01; Group 1) (0.1 vs 0.5, p<0.01; Group 2), burning sensation (0.23 vs 0.79, p<0.01; Group 1) (0.1 vs 0.8, p<0.01; Group 2) and foreign body sensation (0.51 vs 1.37, p<0.01; Group 1) (0.4 vs 1.8, p<0.01; Group 2). Conclusions: Treatment with a gel formulation based on trehalose/sodium hyaluronate/carbomer without occlusive patch seems a valid alternative to the application of an antibiotic ophthalmic ointment and occlusive eye patching

Pseudo-ductile Failure of Adhesively Joined GFRP Beam-Column Connections:An Experimental and Numerical Investigation

Glass Fiber Reinforced Polymer (GFRP) I-beam-column adhesively bonded connections are tested under combined bending and shear. The special feature of the novel connection is the wrapping of the seat angles at the connection by a carbonfiber reinforced polymer (CFRP) fabric wrap. The wrap is primarily intended to alter the connection failure mode from brittle to pseudo-ductile, thus providing adequate warning of impending failure. Four moment resisting connection configurations are tested, including the reference configuration without the wrap. It is observed that the connection failure is initiated by the fracture of the adhesive, but the provision of the wrap, together with a steelseat angle, alters the failure mode from brittle to pseudoductile. The post-peak load deformation is achieved without a large drop in the resistance of the connection. On other hand, the connection with the wrapping and a GFRP seat angle can also change the failure mode to pseudo-ductile, but it could not be done without a large reduction in theconnectionresistanceafterthepeakload

A pilot telephone intervention to increase uptake of breast cancer screening in socially deprived areas in Scotland (TELBRECS):study protocol for a randomised controlled trial

BACKGROUND Breast cancer accounts for almost 30% of all cancers and is the second leading cause of cancer deaths in women in Scotland. Screening is key to early detection. The Scottish Breast Screening Programme is a nationwide, free at point of delivery screening service, to which all women aged between 50 and 70 years are invited to attend every 3 years. Currently over three-quarters of invited women regularly attend screening. However, women from more deprived areas are much less likely to attend: for example in the 3 years from 2010-2012 only 63% of women in the most deprived area attended the East of Scotland Breast Screening programme versus 81% in the least deprived. Research has suggested that reminders (telephone or letter) and brief, personalised interventions addressing barriers to attendance may be helpful in increasing uptake in low-income women. METHODS/DESIGN We will employ a brief telephone reminder and support intervention, whose purpose is to elicit and address any mistaken beliefs women have about breast screening, with the aim that the perceived benefits of screening come to outweigh any perceived barriers for individuals. We will test whether this intervention, plus a simple anticipated regret manipulation, will lead to an increase in the uptake of breast cancer screening amongst low-income women who have failed to attend a first appointment, in a randomised controlled trial with 600 women. Participants will be randomly allocated to one of four treatment arms i.e. 1) Letter reminder (i.e. Treatment as usual: CONTROL); 2) Telephone reminder (TEL), 3) Telephone reminder plus telephone support (TEL-SUPP) and 4) Telephone reminder plus support plus AR (TEL-SUPP-AR). The primary outcome will be attendance at breast screening within 3 months of the reminder letter. DISCUSSION If this simple telephone support intervention (with or without AR intervention) leads to a significant increase in breast screening attendance, this would represent a rare example of a theoretically-driven, relatively simple psychological intervention that could result in earlier detection of breast cancer amongst an under-served group of lower socio-economic women. TRIAL REGISTRATION Current Controlled trials: ISRCTN06039270. Registered 16th January 2014

Development of new FRP reinforcement for optimized concrete structures

With the goal of achieving sustainable design, being able to combine optimized geometries with durable construction materials is a major challenge for Civil Engineering. Recent research at the University of Bath has demonstrated that fibre-reinforced polymers (FRP) can be woven into geometrically appropriate cages for the reinforcement of optimised concrete beams. This innovative construction method enables the replacement of conventional steel with non-corrosive reinforcement that can provide the required strength exactly where needed. The manufacturing of the reinforcement is achieved by means of an automated process based on a filament winding technique. Being extremely lightweight, the wound-FRP (WFRP) cages are well suited to speeding up construction processes, as they can be delivered on site ready to be cast. In this paper, the results of flexural tests on optimised full-scale flexibly formed concrete elements are reported and discussed. Two different case studies are taken in consideration: A structurally optimized joist supporting a lightweight floor;A structurally optimized beam with an in-situ casting of a concrete floor. The optimization objective is to obtain the minimal mass of concrete required to achieve the structural capacity design requirements from widely recognized design codes. The experimental results demonstrate the reliability of the technical solution proposed and provide the basis of a new concept for sustainable and durable reinforced concrete structures

Filament winding fabrication of FRP reinforcement cages

This project has made progress towards the development of a novel alternative reinforcement technique for concrete structures with complex geometries, which are difficult to reinforce with conventional steel. Fibre-reinforced polymers (FRP) are woven into geometrically appropriate reinforcement cages to provide the required strength exactly where it is needed. Automated fabrication of the reinforcement utilises a modification of the filament winding technique. Being extremely lightweight, the resulting wound- FRP (W-FRP) cages are well suited to automation of the construction process, as they can be delivered ready for casting in optimized concrete elements. This is a key advance in research progress towards achieving minimum embodied energy, optimised, concrete structures. Experimental tests conducted on full-size W-FRP reinforced concrete beams demonstrate the reliability of the solution proposed, showing a new frontier for sustainable and durable reinforced concrete structures

FRP-RC/PC members subjected to combined actions

The capacity provisions of conventional Reinforced Concrete (RC) and Prestressed Concrete (PC) beams subjected to combined action of torsion, shear and flexure are well known and stated by international/national codes. Similar provisions lack for concrete members containing Fibre Reinforced Polymer (FRP) reinforcements. In general, there is paucity of research on the treatment of torsion combined with other stress resultants for FRP-RC/PC members. In this paper the theoretical method proposed by the Canadian standard CSA S806 for FRP-RC/PC structures is presented. The critical issues, related to this topic, such as the appropriate strength and inclination of the diagonal struts and failure criteria are critically analyzed and addressed. In order to assess the reliability of this study a comparison between available experimental data regarding FRP-RC/PC beams subjected to combined actions and their corresponding theoretical provisions derived by the CSA S806 standard is shown. Furthermore, another approach, available in literature, which is based on the space truss model, is examined and used for comparison in order to evaluate the theoretical provisions offered by this model against the tests value of the set of the beams analyzed in this study. Based on the critical analysis of the results, it can be highlighted that the CSA method is able to conservatively predict the capacity of these beams

GFRP hollow column to built-up beam adhesive connection:Mechanical behaviour under quasi-static, cyclic and fatigue loading

A new adhesive beam-column connection is tested which possess the highest strength and stiffness compared to any other similar adhesive or bolted connection tested in the past. A square GFRP hollow section, acting as a column, was connected to a built-up beam made of two GFRP U-profiles by means of either epoxy or steel bolts. The beam-column assembly formed an L-shaped frame which was tested by applying a point load at the beam free end while the column was fixed at its base. Five bolted and five adhesive replicate connections were subjected to quasi-static loading up to failure. Another three adhesive connections were subjected to 400, 800 or 1200 cycles of loading and unloading with the maximum load being equal to 0.50 Pu,avg, where Pu,avg is the average static strength of the replicate adhesive specimens. At the end of the cyclic loading, the latter specimens were loaded quasi-statically to failure. Finally, another two adhesive connections were subjected to fatigue type loading. They were successively subjected to at least 196 cycles of loading and unloading with the load amplitude being 0.50 Pu,avg in the first 60 cycles, 0.75 Pu,avg in the next 60 cycles, 0.85 Pu,avg in the following 60 cycles and 0.95 Pu,avg after the 180th cycle. The test results show that the proposed adhesive connection can achieve on average 82% higher strength and 380% higher rotational stiffness than the companion bolted connection. Furthermore, the above cyclic loading has negligible effect on either the strength or the stiffness of the connection. Finally, the connection can sustain the foregoing fatigue load up to almost 180 cycles without significant damage but it will not be able to withstand the full 60 cycles of the load with 0.95 Pu,avg amplitude. The current results demonstrate the superior strength and stiffness of the new adhesive connection compared to a similar bolted connection

Text-message reminders increase uptake of routine breast screening appointments : a randomised controlled trial in a hard-to-reach population

Background: There is a need for interventions to promote uptake of breast screening throughout Europe. Methods: We performed a single-blind randomised controlled trial to test whether text-message reminders were effective. Two thousand two hundred and forty women receiving their first breast screening invitation were included in the study and randomly assigned in a 1 : 1 ratio to receive either a normal invitation only (n=1118) or a normal invitation plus a text-message reminder 48 h before their appointment (n=1122). Findings: In the intention-to-treat analysis, uptake of breast screening was 59.1% among women in the normal invitation group and 64.4% in the text-message reminder group (χ2=6.47, odds ratio (OR): 1.26, 95% confidence intervals (CI): 1.05–1.48, P=0.01). Of the 1122 women assigned to the text-message reminder group, only 456 (41%) had a mobile number recorded by their GP and were thereby sent a text. In the per-protocol analysis, uptake by those in the control group who had a mobile number recorded on the GP system was 59.77% and by those in the intervention group who were sent a reminder 71.7% (χ2=14.12, OR=1.71, 95% CI=1.29–2.26, P<0.01). Interpretation: Sending women a text-message reminder before their first routine breast screening appointment significantly increased attendance. This information can be used to allocate resources efficiently to improve uptake without exacerbating social inequalities

Acute and cumulative effects of rTMS on behavioural and EMG parameters in Focal Hand Dystonia

Previous studies suggest that low-frequency repetitive Transcranial Magnetic Stimulation (rTMS) over contralateral premotor cortex (PMC) might ameliorate Focal Hand Dystonia (FHD) symptoms. In the present study behavioral and muscle activity outcomes were explored in a patient with FHD following a single and multiple sessions of rTMS. The patient's behavior was assessed on handwriting tasks, while surface EMG signals were recorded. In Experiment 1 evaluations were performed before and after one session of active and sham 1Hz rTMS over contralateral PMC. In Experiment 2, evaluations were performed before and after six sessions of the same treatment. In Experiment 1 active rTMS improved the patient's performance, although the EMG amplitude did not change. In Experiment 2, the patient showed an improvement of performance along with a decrease of 20% in the EMG amplitude. These results demonstrated that a single session of rTMS ameliorated the patient's performance, while multiple sessions were necessary to reduce muscles activity

Recent Developments in Gene Therapy for Neovascular Age-Related Macular Degeneration: A Review

Age-related macular degeneration (AMD) is a complex and multifactorial disease and a leading cause of irreversible blindness in the elderly population. The anti-vascular endothelial growth factor (anti-VEGF) therapy has revolutionized the management and prognosis of neovascular AMD (nAMD) and is currently the standard of care for this disease. However, patients are required to receive repeated injections, imposing substantial social and economic burdens. The implementation of gene therapy methods to achieve sustained delivery of various therapeutic proteins holds the promise of a single treatment that could ameliorate the treatment challenges associated with chronic intravitreal therapy, and potentially improve visual outcomes. Several early-phase trials are currently underway, evaluating the safety and efficacy of gene therapy for nAMD; however, areas of controversy persist, including the therapeutic target, route of administration, and potential safety issues. In this review, we assess the evolution of gene therapy for nAMD and summarize several preclinical and early-stage clinical trials, exploring challenges and future directions