Macular Hole Surgery

Macular hole surgery is one of the most rapidly changing fields in vitreoretinal surgery, the authors discuss the recent acknowledgments and surgical options. Macular holes are classified, and surgical techniques are described in order to have the most successful procedure. Diagnostic tools and surgical instruments improvement allow surgeons to face difficult cases with a variety of surgical options unknown until a few years ago and is mandatory nowadays to approach the different patients with a broad mind

Molecular determinants of ER-Golgi contacts identified through a new FRET-FLIM system

ER-TGN contact sites (ERTGoCS) have been visualized by electron microscopy, but their location in the crowded perinuclear area has hampered their analysis via optical microscopy as well as their mechanistic study. To overcome these limits we developed a FRET-based approach and screened several candidates to search for molecular determinants of the ERTGoCS. These included the ER membrane proteins VAPA and VAPB and lipid transfer proteins possessing dual (ER and TGN) targeting motifs that have been hypothesized to contribute to the maintenance of ERTGoCS, such as the ceramide transfer protein CERT and several members of the oxysterol binding proteins. We found that VAP proteins, OSBP1, ORP9, and ORP10 are required, with OSBP1 playing a redundant role with ORP9, which does not involve its lipid transfer activity, and ORP10 being required due to its ability to transfer phosphatidylserine to the TGN. Our results indicate that both structural tethers and a proper lipid composition are needed for ERTGoCS integrity.Peer reviewe

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Influence of low stress handling during clinical visit on physiological and behavioural indicators in adult dogs: a preliminary study

Low stress handling techniques or “Fear Free principles” in veterinary clinics are becoming an important research area aimed at improving small animal welfare, considering that the majority of dogs who undergo clinical examinations exhibit fear or anxiety signs. Objective of this study was to compare a number of physiological and behavioural indicators using low stress handling (LSH) and traditional (TT) techniques in order to assess whether the LSH approach had a positive impact on the dog’s welfare. Eight adult dogs were filmed while undergoing both LSH and TT visits (separated by a distance of seven weeks). The same usual sequence of events was followed for both visits (e. g. muzzle wearing, heart and lungs stethoscope examination, etc.) except that 1) during the LSH visit, the dog was free to explore the environment (while receiving treats) and play for five minutes before and after the visit 2) throughout the medical examination the veterinarians’ attitude and handling techniques were always aimed at preventing stress and guaranteeing the best physical support possible. The videos were then evaluated for the number of fear and stress signs the subjects showed. The examined physiological variables were respiration (breath/min), heart rate (HR) and rectal temperature (RT). Physiological variables were analysed by t-Test for paired data while frequency of behavioural fear indicators by Wilcoxon signed-rank test. Rectal temperature was within range in both groups but significantly higher (P<0.05) during LSH visit, while low head, lip licks and whale eye behaviours were significantly higher (P<0.05) during TT visit. These results suggest that low stress handling decreases frequency of some fear-related behaviours and could improve the quality of human-dog interactions. Future research that aims to replicate and further investigate these results in a large canine population is required

Solid lipid microparticles as an approach to drug delivery

Introduction : Solid lipid particles have been introduced since the early 1990s as an alternative drug carrier system to emulsions, liposomes and polymeric microparticles. While lipid nanoparticles have been examined/the object of a substantial number of reviews, fewer are available on lipid microparticles despite their distinct advantages, including biocompatibility, ease of production and characterization, extended release properties and high loading. Areas covered : This review presents an overview of the advantages and drawbacks of lipid microparticles (LMs), i.e. lipid-based particles with dimensions in the micrometer range. Specific focus is on the role of the main excipients used for LMs formulations, lipids and surfactants, and their effect on LM properties. Furthermore, an update on preparation techniques and characterization methods are also presented, with particular emphasis on more recent technologies. The interaction of LMs with biological systems, and in particular with cells will be also reviewed. Moreover, the various LM administration routes will be examined, with special attention to most recent applications (i.e., pulmonary and nasal delivery). Expert opinion: LMs represents an attractive and versatile carrier system, however their pharmaceutical applicability has been rather limited. Investigation on the use of LMs for less established administration routes, such as pulmonary delivery, may provide further interest on the development of LM-based systems both in the industry and in the clinics