An international collaborative evaluation of central serous chorioretinopathy: different therapeutic approaches and review of literature. The European Vitreoretinal Society central serous chorioretinopathy study

Purpose: To study and compare the efficacy of different therapeutic options for the treatment of central serous chorioretinopathy (CSCR). Methods: This is a nonrandomized, international multicentre study on 1719 patients (1861 eyes) diagnosed with CSCR, from 63 centres (24 countries). Reported data included different methods of treatment and both results of diagnostic examinations [fluorescein angiography and/or optical coherent tomography (OCT)] and best-corrected visual acuity (BCVA) before and after therapy. The duration of observation had a mean of 11 months but was extended in a minority of cases up to 7 years. The aim of this study is to evaluate the efficacy of the different therapeutic options of CSCR in terms of both visual (BCVA) and anatomic (OCT) improvement. Results: One thousand seven hundred nineteen patients (1861 eyes) diagnosed with CSCR were included. Treatments performed were nonsteroidal anti-inflammatory eye drops, laser photocoagulation, micropulse diode laser photocoagulation, photodynamic therapy (PDT; Standard PDT, Reduced-dose PDT, Reduced-fluence PDT), intravitreal (IVT) antivascular endothelial growth factor injection (VEGF), observation and other treatments. The list of the OTHERS included both combinations of the main proposed treatments or a variety of other treatments such as eplerenone, spironolactone, acetazolamide, beta-blockers, anti-anxiety drugs, aspirin, folic acid, methotrexate, statins, vitis vinifera extract medication and pars plana vitrectomy. The majority of the patients were men with a prevalence of 77%. The odds ratio (OR) showed a partial or complete resolution of fluid on OCT with any treatment as compared with observation. In univariate analysis, the anatomical result (improvement in subretinal fluid using OCT at 1 month) was favoured by age <60 years (p < 0.005), no previous observation (p < 0.0002), duration less than 3 months (p < 0.0001), absence of CSCR in the fellow eye (p = 0.04), leakage outside of the arcade (p = 0.05) and fluid height >500 \u3bcm (p = 0.03). The OR for obtaining partial or complete resolution showed that anti-VEGF and eyedrops were not statistically significant; whereas PDT (8.5), thermal laser (11.3) and micropulse laser (8.9) lead to better anatomical results with less variability. In univariate analysis, the functional result at 1 month was favoured by first episode (p = 0.04), height of subretinal fluid >500 \u3bcm (p < 0.0001) and short duration of observation (p = 0.02). Finally, there was no statistically significant difference among the treatments at 12 months. Conclusion: Spontaneous resolution has been described in a high percentage of patients. Laser (micropulse and thermal) and PDT seem to lead to significant early anatomical improvement; however, there is little change beyond the first month of treatment. The real visual benefit needs further clarification

EXTRUSION OF MOLECULAR CLUSTERS FROM SOLID-STATE MATERIALS - SYNTHESIS BY APPLICATION OF GAMMA-IRRADIATION - MOLECULAR AND CRYSTAL-STRUCTURE OF (H9O4)(ET4N)[MO3S7BR6]

Fedin VP, Müller A, FILIPEK K, et al. EXTRUSION OF MOLECULAR CLUSTERS FROM SOLID-STATE MATERIALS - SYNTHESIS BY APPLICATION OF GAMMA-IRRADIATION - MOLECULAR AND CRYSTAL-STRUCTURE OF (H9O4)(ET4N)[MO3S7BR6]. INORGANICA CHIMICA ACTA. 1994;223(1-2):5-7.The cluster [Mo3S7Br6]2- has been obtained by a lambda-irradiation of the polymeric compound Mo3S7Br4 in concentrated hydrobromic acid. The X-ray structure of (H9O4)(Et4N)[Mo3S7Br6] (1) was determined, whereby an unexpected aggregation of the [Mo3S7Br6]2- anions with short S...Br contacts was observed. Crystal data for 1: orthorhombic space group Pbca with a = 15.192(2), b = 13.771(2), c = 29.525(6) angstrom, Z = 8, D(calc) = 2.570 g/cm3, R = 0.063, R(w) = 0.056

Water management and development: the limits of coordination

International audienceActors involved in water resource management and development policies from the large water cycle (at the river basin level) to the small water cycle (drinking water, sanitation and distribution) are numerous and diversified, in their institutional and economic positioning, as well as in the logic of the approaches they develop. In view of the expectations of a comprehensive policy in this field and of the obviously limited results obtained so far, the phasing of these approaches and the coordination of these actors is a major axis of the actions to be carried out in order to better manage the water resources. We argue the need for an explicit and assumed strengthening of the coordination of water stakeholders at all levels of governance. We question the reasons for these partial successes and failures and the way to overcome these difficulties, questions renewed on the basis of recent experiences. In particular, interdisciplinary and intersectoral collaboration using new hybrid modeling approaches (coupling multi-agent system, geographic information system, equation models, cellular automata, etc.), allows to precisely simulate the scenarios of evolution of water resource management and development, to assess ex ante their social, economic and environmental impacts and to anticipate the contribution of an increased coordination of water stakeholders in a logic of development-friendly actions

Domestic Violence

As our communities and families are faced with the growing problem of violence, more information is needed as to what women in abusive relationships see as challenges that prevent or delay leaving. To address the issue in the brief therapeutic environment, 14 women in counseling for abuse agreed to participate in three task groups and were asked to identify and rank-order the challenges they faced that could prevent them from leaving. Group one included women who had a desire to leave but were not sure they could. Group two consisted of women working on a case plan but who still had concerns; and, the third group contained women who had left the relationship and were expecting not to return. Overall, when analyzing and comparing these groups, all women (regardless of the stage of leaving) expressed similar challenges and concerns. Major themes presented in all groups included: limited resources (e.g., money, shelter, day-care and medical expenses), fears (e.g., fear of being killed, retaliation, being alone, making the wrong choices, the unknown), commitment to the relationship, concern for children, love for the abuser and other emotional issues. These challenges are discussed and specific applications to facilitate practice are made. © 2005 by The Haworth Press, Inc. All rights reserved