Strategy for the management of diabetic macular edema: the European Vitreo-Retinal Society macular edema study

Objective. To compare the efficacy of different therapies in the treatment of diabetic macular edema (DME). Design. Nonrandomized, multicenter clinical study. Participants. 86 retina specialists from 29 countries provided clinical information on 2,603 patients with macular edema including 870 patients with DME. Methods. Reported data included the type and number of treatment(s) performed, the pre-and posttreatment visual acuities, and other clinical findings.The results were analyzed by the French INSEE (National Institute of Statistics and Economic Studies). Main Outcome Measures. Mean change of visual acuity and mean number of treatments performed. Results.The change in visual acuity over time in response to each treatment was plotted in second order polynomial regression trend lines. Intravitreal triamcinolone monotherapy resulted in some improvement in vision. Treatmentwith threshold or subthreshold grid laser also resulted in minimal vision gain. Anti-VEGF therapy resulted in more significant visual improvement. Treatment with pars plana vitrectomy and internal limiting membrane (ILM) peeling alone resulted in an improvement in vision greater than that observed with anti-VEGF injection alone. In our DME study, treatment with vitrectomy and ILM peeling alone resulted in the better visual improvement compared to other therapies

Hydraulics of flow over side weirs

This thesis reviews the present state of knowledge of the hydraulics of flow over side weirs, and describes an experimental investigation into the flow of water over side weirs using a laboratory flume. A detailed exeimination is made of the assumption conventionally used by many investigators that the total energy of the flow remaining in the channel does not vary along the length of the side weir (excluding friction loss), and following consideration of oarlier warke in this subject. Some new conclusions are suggested concerning the weir coefficient, the variation of the velocity sind pressure distribution coefficients and the end controls. The secondary flow observed along the side weirs in the experimental work and the changes it underwent on progressing along the side weir are described in detail. Some degree of confirmation of the analysis was achieved for the exact way in which the flow moves along the side weir as it leaves the channel section and enters the side weir section. The background of the side weir theory is given in detail, preceding an examination of the predictions of this theory in terms of the results of the present and other experimental</p

Dobutamine stress echocardiography in patients with chronic peripheral artery disease

Background: peripheral artery disease (PAD) whether symptomatic or asymptomatic, is a risk factor for non-fatal and fatal coronary disease and cerebrovascular events, screening tests for early diagnosis of coronary artery disease (CAD) may lead to early treatment and therefore improved outcomes. AIM OF THE STUDY: is to study the relation between severity of peripheral artery disease by ankle-brachial index and myocardial ischemia by dobutamine stress echocardiography in patients free from cardiac symptoms Patients and Methods: fifty patients diagnosed with peripheral arterial disease (case group) and another fifty individuals without PAD (control group). Full history taking, complete physical examination, ECG, Echocardiography, ankle brachial index and dobutamine stress echocardiography were done to all patients. Results: Our study showed that there was a statistically significant higher percentage of distal lesion in patients with DM and higher percentage of proximal lesion among cases with hypertension with p-value &lt;0.05. There was a statistically significant lower ABI level with p-value &lt;0.05 among diabetic patients treated by insulin and ex-smokers and there was statistically significant invers correlation with p-value &lt;0.05 between ABI level and smoking index.&nbsp

Multi-slice CT angiography versus duplex ultrasound in detection of stenosis of access arteriovenous fistulas and grafts in dysfunctional hemodialysis

Purpose: To assess the accuracy of MS-CTA for the detection and grading of stenosis in AVF and AVG in comparison with colored Duplex. Patients and methods: Prospective analysis of vascular access related data was obtained from 30 patients (10 Males, 20 Females and age range 18–62 years) referred from hemodialysis unit for CTA and CDUS examination in upper limbs. Results: There were no statistically significant differences between mean Stenosis%, mean Length of stenosis segment and mean Narrowest part as measured by the two modalities (P-values = 0.115, = 0.271 & = 0.233 respectively). Subclavian vein occlusion: detected in 7 cases (23.3%) by CTA and only 4 out of the 7 cases were detected by Doppler (13.3%). SVC occlusion: not detected by Doppler (0.0%) and detected in 4 cases (13.3%) by CTA. Chest wall venous collateralization: not detected by Doppler (0.0%) and detected in 10 cases (33.3%) by CTA. Innominate vein occlusion: not detected by Doppler (0.0%) and detected in 2 cases (6.7%) by CTA. Conclusions: CDUS by an experienced hand is an adequate diagnostic tool except for evaluation of central veins, whereas, the MSCTA plays an important role as a minimally invasive modality for evaluating the AVFs especially the central veins

Predictors of incomplete optical colonoscopy using computed tomographic colonography

Background/Aims: Optical colonoscopy (OC) is the primary modality for investigation of colonic pathology. Although there is data on demographic factors for incomplete OC, paucity of data exists for anatomic variables that are associated with an incomplete OC. These anatomic variables can be visualized using computed tomographic colonography (CTC). We aim to retrospectively identify variables associated with incomplete OC using CTC and develop a scoring method to predict the outcome of OC. Patients and Methods: In this case-control study, 70 cases ( with incomplete OC) and 70 controls (with complete OC) were identified. CTC images of cases and controls were independently reviewed by a single CTC radiologist. Demographic and anatomical parameters were recorded. Data was examined using descriptive linear statistics and multivariate logistic regression model. Results: On analysis, female gender (80% vs 58.6% P = 0.007), prior abdominal/pelvic surgeries (51.4% vs 14.3% P < 0.001), colonic length (187.6 ± 30.0 cm vs 163.8 ± 27.2 cm P < 0.001), and number of flexures (11.4 ± 3.1 vs 8.4 ± 2.9 P < 0.001) increased the risk for incomplete OC. No significant association was observed for increasing age (P = 0.881) and history of severe diverticulosis (P = 0.867) with incomplete OC. A scoring system to predict the outcome of OC is proposed based on CTC findings. Conclusion: Female gender, prior surgery, and increasing colonic length and tortuosity were associated with incomplete OC, whereas increasing age and history of severe diverticulosis were not. These factors may be used in the future to predict those patients who are at risk of incomplete OC

A Survey to Identify the Current Management of Cow’s Milk Disorders and the Role of Goat Milk-Based Formulas in the Middle East and North Africa Region

Background: Cow’s milk allergy (CMA) and cow’s milk intolerance (CMI) are the major cow’s milk disorders observed in infants and young children. This study investigates, for the first time, physician knowledge regarding CMA and CMI prevalence, diagnosis, and management in the Middle East and North Africa (MENA) region. In addition, we explore the role of goat milk-based formula as an alternative in infants suffering from CMI. Method: This cross-sectional survey was conducted from December 2020 to February 2021. A convenience sample of 2500 MENA-based physicians received the questionnaire, developed by a working group of pediatric experts. Results: 1868 physicians completed the questionnaire, including pediatric specialists (80.8%), training physicians (0.2%), dermatologists (0.1%), family/general physicians (12.9%), neonatologists (3.6%), neurosurgeons (0.2%), allergy nurse specialists (0.3%), pharmacists (2.1%), and public health workers (0.1%). Differentiation between CMA and CMI was recognized by the majority of respondents (80.7%), for which the majority of respondents (35.4%) identified that the elimination and challenge test was the best test to differentiate CMA from CMI, whereas 30.7% and 5.4% preferred the immunoglobulin E (IgE) test and skin prick test, respectively. In addition, 28.5% of respondents reported that there is no confirmatory test to differentiate CMA from CMI. The majority of respondents (47.3%) reported that amino acid-based formula (AAF)/ extensively hydrolyzed formula (EHF) is the cornerstone for the management of CMA. However, most respondents (33.7%) reported that lactose avoidance was best for the management of CMI. Overall, 65% of the respondents were aware of nutritionally adapted goat’s milk formula as an alternative to cow’s milk products and 37% would recommend its routine use in infants (≤2 years of age). Conclusion: The results of this survey demonstrate that the majority of physicians are aware of the underlying pathophysiology and management of CMA and CMI. However, a significant proportion of physicians do not follow the clinical guidelines concerning CMA/CMI diagnosis and management. Notably, this survey identified that goat’s milk formulas may offer a suitable alternative to AAF/EHF in infants with CMI as they contain β-casein protein which is easily digestible. In addition, goat’s milk formulas contain higher levels of oligosaccharides and medium-chained fatty acids compared with standard cow’s milk formulas, yet further clinical trials are warranted to support the inclusion of goat’s milk formulas in clinical guidelines

MicroRNA-141-regulated KLK10 and TNFSF-15 gene expression in hepatoblastoma cells as a novel mechanism in liver carcinogenesis

Abstract Liver cancer is one of the most pivotal global health problems, leading hepatocellular carcinoma (HCC) with a significant increase in cases worldwide. The role of non-coding-RNA in cancer proliferation and carcinogenesis has attracted much attention in the last decade; however, microRNAs (miRNAs), as non-coding RNA, are considered master mediators in various cancer progressions. Yet the role of miR-141 as a modulator for specific cellular processes in liver cancer cell proliferation is still unclear. This study identified the role of miR-141 and its potential functions in liver carcinogenesis. The level of miR-141 in HepG2 and HuH7 cells was assessed using quantitative real-time PCR (qRT-PCR) and compared with its expression in normal hepatocytes. A new miR-141 construct has been performed in a CMV promoter vector tagged with GFP. Using microarray analysis, we identified the potentially regulated genes by miR-141 in transfected HepG2 cells. The protein profile of the kallikrein-related peptidase 10 (KLK10) and tumor necrosis factor TNFSF-15 was investigated in HepG2 cells transfected with either an inhibitor, antagonist miR-141, or miR-141 overexpression vector using immunoblotting and flow cytometry assay. Finally, ELISA assay has been used to monitor the produced inflammatory cytokines from transfected HepG2 cells. Our findings showed that the expression of miR-141 significantly increased in HepG2 and HuH7 cells compared to the normal hepatocytes. Transfection of HepG2 cells with an inhibitor, antagonist miR-141, showed a significant reduction of HepG2 cell viability, unlike the transfection of miR-141 overexpression vector. The microarray data of HepG2 cells overexpressed miR-141 provided a hundred downregulated genes, including KLK10 and TNFSF-15. Furthermore, the expression profile of KLK10 and TNFSF-15 markedly depleted in HepG2 cells transfected with miR-141 overexpression accompanied by a decreasing level of interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α), indicating the role of miR-141 in HepG2 cell proliferation and programmed cell death. Interestingly, the experimental rats with liver cancer induced by Diethylnitrosamine injection further confirmed the upregulation of miR-141 level, IL-10, and TNF-α and the disturbance in KLK10 and TNFSF-15 gene expression compared with their expression in normal rats. The in-silico online tools, IntaRNA and miRWalk were used to confirm the direct interaction and potential binding sites between miR-141 and identified genes. Thus, the seeding regions of potential targeted sequences was cloned upstream of luciferase reporter gene in pGL3 control vector. Interestingly, the luciferase activities of constructed vectors were significantly decreased in HepG2 cells pre-transfected with miR-141 overexpression vector, while increasing in cells pre-transfected with miR-141 specific inhibitor. In summary, these data suggest the crucial role of miR-141 in liver cancer development via targeting KLK10 and TNFSF-15 and provide miR-141 as an attractive candidate in liver cancer treatment and protection