Efficacy and timing of adjunctive therapy in the anti-VEGF treatment regimen for macular oedema in retinal vein occlusion:12-month real-world result

PurposeVarious combination treatment regimens have been tried to improve the short-term efficacy of intravitreal monotherapy for the treatment of macular oedema (MO) secondary to retinal vein occlusion (RVO). Our study introduces the RandOL protocol (Ranibizumab and Ozurdex with Laser photocoagulation) of initial anti-VEGF therapy, controlling recurrent non-ischaemic MO with an intravitreal steroid and applying laser therapy to non-perfused retina. We describe our 12-month follow-up experience on timing for adjunctive therapy and real-world effectiveness and safety data.MethodsA retrospective analysis was carried out on 66 consecutive treatment-naive RVO patients with MO who received our RandOL treatment regimen. Baseline visual acuity (VA) and central retinal thickness (CRT) were compared with 12-month result.ResultsAt 12 months, 77% had significant VA improvement, 52% had ≥3-line improvement, and 15% were worse. Significant improvements in CRT were observed in 97% (baseline median CRT=531 μm (IQR 435-622) reduced to 245 μm (IQR 221-351, P<0.001) at 12 months); 76% achieved a dry fovea at 1 year. Mean number of total injections required was 5.5 (range 2-11) and 6% required ≥9 injections in 1 year. Although 70% received additional Ozurdex, 82% received ≥1 sessions of laser therapy. The BRVO subgroup achieved better VA and CRT improvement at 1 year, but small numbers limit definitive statistical conclusions.ConclusionsOur real-world results using a combination treatment protocol for RVO-related MO achieved similar desirable anatomical and visual outcomes as with a single-agent therapy with less intravitreal re-treatment rates at first year. Randomised controlled studies are needed to evaluate the role of laser and the ideal timing of combination therapy

Obstetric opinions regarding the method of delivery in women that have had surgery for retinal detachment

OBJECTIVES: We sought to determine international obstetric opinions regarding the influence of a history of rhegmatogenous retinal detachment on the management of labour and to review the evidence base. DESIGN: A questionnaire containing closed questions, with pre-coded response opinions, was designed to obtain a cross-section of the obstetric opinions. SETTING: Questionnaires were distributed at the 20th European Congress of Obstetrics and Gynaecology in Lisbon, Portugal. PARTICIPANTS: One hundred questionnaires were distributed among obstetricians attending the congress and 74 agreed to participate. MAIN OUTCOME MEASURES: Participants were asked to state their preferred method of delivery in such patients and the reasons for their recommendation. Furthermore, we questioned whether there was any difference in opinions depending on generation. RESULTS: The majority of respondents (76%) would recommend assisted delivery (either Caesarean section or instrumental delivery), whereas the remaining 24% would advise normal delivery. Generation is not a factor influencing this decision. The majority (58%) based their decision to alter the management of labour on their personal opinion of standard of care. CONCLUSION: The literature shows that there is little evidence to support the belief that previous retinal surgery increases the risk of re-detachment of the retina during spontaneous vaginal delivery. This short survey shows that the majority of an international sample of obstetricians questioned does not share this viewpoint. Therefore, unnecessary interventions may be occurring in otherwise fit women with a history of retinal detachment

The Children and Young People's Health Partnership Evelina London Model of Care: process evaluation protocol

Introduction Children and young people (CYP) in the UK have poor health outcomes, and there is increasing emergency department and hospital outpatient use. To address these problems in Lambeth and Southwark (two boroughs of London, UK), the local Clinical Commissioning Groups, Local Authorities and Healthcare Providers formed The Children and Young People’s Health Partnership (CYPHP), a clinical-academic programme for improving child health. The Partnership has developed the CYPHP Evelina London model, an integrated healthcare model that aims to deliver effective, coordinated care in primary and community settings and promote better self-management to over approximately 90 000 CYP in Lambeth and Southwark. This protocol is for the process evaluation of this model of care. Methods and analysis Alongside an impact evaluation, an in-depth, mixed-methods process evaluation will be used to understand the barriers and facilitators to implementing the model of care. The data collected mapped onto a logic model of how CYPHP is expected to improve child health outcomes. Data collection and analysis include qualitative interviews and focus groups with stakeholders, a policy review and a quantitative analysis of routine clinical and administrative data and questionnaire data. Information relating to the context of the trial that may affect implementation and/or outcomes of the CYPHP model of care will be documented. Ethics and dissemination The study has been reviewed by NHS REC Cornwall & Plymouth (17/SW/0275). The findings of this process evaluation will guide the scaling up and implementation of the CYPHP Evelina London Model of Care across the UK. Findings will be disseminated through publications and conferences, and implementation manuals and guidance for others working to improve child health through strengthening health systems. Trial registration number NCT03461848

Productivity and Thermal Performance Enhancements of Hollow Fiber Water Gap Membrane Distillation Modules Using Helical Fiber Configuration: 3D Computational Fluid Dynamics Modeling

Although hollow fiber water gap membrane distillation (HF-WGMD) units offer certain advantages over other MD desalination systems, they still require enhancements in terms of distillate flux and productivity. Therefore, this work proposes a novel configuration by incorporating the helical turns of HF membranes within the water gap channel of the HF-WGMD modules. A fully coupled 3D CFD model is developed and validated to simulate the multifaceted energy conservations and diffusion mechanisms that are inherent to the transport phenomena in the proposed HF-WGMD module. Single and double helical HF membrane designs with different numbers of turns are compared to the reference modules of single and double straight HF membrane designs under various operational conditions. At a feed temperature of 70 °C, a noteworthy 11.4% enhancement in the distillate flux is observed when employing 20 helical turns, compared to the single straight HF membrane module. Furthermore, the specific productivity revealed a maximum enhancement of 46.2% when using 50 helical turns. The thermal performance of the proposed HF-WGMD module shows higher energy savings of up to 35% in specific thermal energy consumption for a one-stage module. Using three stages of single helical modules can increase the gain output ratio from 0.17 for the single stage to 0.37, which represents an increase of 117.6%. These findings indicate the high potential of the proposed approach in advancing the performance of HF-WGMD systems

Performance of Layer-by-Layer-Modified Multibore® Ultrafiltration Capillary Membranes for Salt Retention and Removal of Antibiotic Resistance Genes

Polyether sulfone Multibore® ultrafiltration membranes were modified using polyelectrolyte multilayers via the layer-by-layer (LbL) technique in order to increase their rejection capabilities towards salts and antibiotic resistance genes. The modified capillary membranes were characterized to exhibit a molecular weight cut-off (at 90% rejection) of 384 Da. The zeta-potential at pH 7 was −40 mV. Laboratory tests using single-fiber modified membrane modules were performed to evaluate the removal of antibiotic resistance genes; the LbL-coated membranes were able to completely retain DNA fragments from 90 to 1500 nt in length. Furthermore, the pure water permeability and the retention of single inorganic salts, MgSO$_{4}$, CaCl$_{2}$ and NaCl, were measured using a mini-plant testing unit. The modified membranes had a retention of 80% toward MgSO$_{4}$ and CaCl$_{2}$ salts, and 23% in case of NaCl. The modified membranes were also found to be stable against mechanical backwashing (up to 80 LMH) and chemical regeneration (in acidic conditions and basic/oxidizing conditions)

Assessing the Efficiency of Remote Sensing and Machine Learning Algorithms to Quantify Wheat Characteristics in the Nile Delta Region of Egypt

Monitoring strategic agricultural crops in terms of crop growth performance, by accurate cost-effective and quick tools is crucially important in site-specific management to avoid crop reductions. The availability of commercial high resolution satellite images with high resolution (spatial and spectral) as well as in situ spectra measurements can help decision takers to have deep insight on crop stress in a certain region. The research attempts to examine remote sensing dataset for forecasting wheat crop (Sakha 61) characteristics including the leaf area index (LAI), plant height (plant-h), above ground biomass (AGB) and Soil Plant Analysis Development (SPAD) value of wheat across non-stress, drought and salinity-induced stress in the Nile Delta region. In this context, the ability of in situ spectroradiometry measurements and QuickBird high resolution images was evaluated in our research. The efficiency of Random Forest (RF) and Artificial Neural Network (ANN), mathematical models was assessed to estimate the four measured wheat characteristics based on vegetation spectral reflectance indices (V-SRIs) extracted from both approaches and their interactions. Field surveys were carried out to collect in situ spectroradiometry measurements concomitant with the acquisition of QuickBird imagery. The results demonstrated that several V-SRIs extracted from in situ spectroradiometry data and the QuickBird image correlated with the LAI, plant-h, AGB, and SPAD value of wheat crop across the study site. The determination coefficient (R2) values of the association between V-SRIs of in situ spectroradiometry data and various determined wheat characteristics varied from 0.26 to 0.85. The ANN-GSIs-3 was found to be the optimum predictive model, demonstrating a greater relationship between the advanced features and LAI. The three features of V-SRIs comprised in this model were strongly significant for the prediction of LAI. The attained results indicated high R2 values of 0.94 and 0.86 for the training and validation phases. The ANN-GSIs-3 model constructed for the determination of chlorophyll in the plant which had higher performance expectations (R2 = 0.96 and 0.92 for training and validation datasets, respectively). In conclusion, the results of our study revealed that high resolution remote sensing images such as QuickBird or similar imagery, and in situ spectroradiometry measurements have the feasibility of providing necessary crop monitoring data across non-stressed and stressed (drought and salinity) conditions when integrating V-SRIs with ANN and RF algorithms

Antiretroviral Therapy Outcomes in HIV-Infected Children after Adjusting Protease Inhibitor Dosing during Tuberculosis Treatment

Modification of ritonavir-boosted lopinavir (LPV/r)-based antiretroviral therapy is required for HIV-infected children co-treated for tuberculosis (TB). We aimed to determine virologic and toxicity outcomes among TB/HIV co-treated children with the following modifications to their antiretroviral therapy (ART): (1) super-boosted LPV/r, (2) double-dose LPV/r or (3) ritonavir.A medical record review was conducted at two clinical sites in Johannesburg, South Africa. The records of children 6-24 months of age initiating LPV/r-based therapy were reviewed. Children co-treated for TB were categorized based on the modifications made to their ART regimen and were compared to children of the same age at each site not treated for TB. Included are 526 children, 294 (56%) co-treated for TB. All co-treated children had more severe HIV disease, including lower CD4 percents and worse growth indicators, than comparisons. Children in the super-boosted group (n = 156) were as likely to be virally suppressed (<400 copies/ml) at 6 months as comparisons (69.2% vs. 74.8%, p = 0.36). Children in the double-dose (n = 47) and ritonavir groups (n = 91) were significantly less likely to be virally suppressed at 6 months (53.1% and 49.3%) than comparisons (74.8% and 82.1%; p = 0.02 and p<0.0001, respectively). At 12 months only children in the ritonavir group still had lower rates of virological suppression relative to comparisons (63.9% vs 83.3% p<0.05). Grade 1 or greater ALT elevations were more common in the super-boosted (75%) than double-dose (54.6%) or ritonavir (33.9%) groups (p = 0.09 and p<0.0001) but grade 3/4 elevations were observed in 3 (13.6%) of the super-boosted, 7 (15.9%) of the double-dose and 5 (8.9%) of the ritonavir group (p = 0.81 and p = 0.29).Good short-term virologic outcomes were achieved in children co-treated for TB and HIV who received super-boosted LPV/r. Treatment limiting toxicity was rare. Strategies for increased dosing of LPV/r with TB treatment warrant further investigation

Functional Recellularization of Acellular Rat Liver Scaffold by Induced Pluripotent Stem Cells: Molecular Evidence for Wnt/B-Catenin Upregulation.

BACKGROUND: Liver transplantation remains the only viable therapy for liver failure but has a severely restricted utility. Here, we aimed to decellularize rat livers to form acellular 3D bio-scaffolds suitable for seeding with induced pluripotent cells (iPSCs) as a tool to investigate the role of Wnt/β-catenin signaling in liver development and generation. METHODS: Dissected rat livers were randomly divided into three groups: I (control); II (decellularized scaffolds) and III (recellularized scaffolds). Liver decellularization was established via an adapted perfusion procedure and assessed through the measurement of extracellular matrix (ECM) proteins and DNA content. Liver recellularization was assessed through histological examination and measurement of transcript levels of Wnt/β-catenin pathway, hepatogenesis, liver-specific microRNAs and growth factors essential for liver development. Adult rat liver decellularization was confirmed by the maintenance of ECM proteins and persistence of growth factors essential for liver regeneration. RESULTS: iPSCs seeded rat decellularized livers displayed upregulated transcript expression of Wnt/β-catenin pathway-related, growth factors, and liver specification genes. Further, recellularized livers displayed restored liver-specific functions including albumin secretion and urea synthesis. CONCLUSION: This establishes proof-of-principle for the generation of three-dimensional liver organ scaffolds as grafts and functional re-establishment