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

Ambient Intelligence and Pervasive Systems for the Monitoring of Citizens at Cardiac Risk: New Solutions from the EPI-MEDICS Project.

In western countries, heart disease is the main cause of premature death. Most of cardiac deaths occur out of hospital. Symptoms are often interpreted incorrectly. Victims do not survive long enough to benefit from in-hospital treatments. To reduce the time before treatment, the only useful diagnostic tool to assess the presence of a cardiac event is the electrocardiogram (ECG). Event and transtelephonic ECG recorders are used to improve decision-making but require setting up new infra-structures. The pervasive solution proposed by the European EPI-MEDICS project is an intelligent Personal ECG Monitor for the early detection of cardiac events. It includes decision-making techniques, generates different alarm levels and forwards alarm messages to the relevant care providers by means of new generation wireless communication. It is cost saving, involving care provider only if necessary without specific infrastructure. Healthcare becomes personalized, wearable, ubiquitous. 1

With cognitive enhancement comes great responsibility?

Although drugs that enhance the cognition of ‘healthy’ individuals (e.g. methylphenidate and modafinil) have received attention from ethicists and philosophers, little research has focused on the concrete opportunities they present for particular groups in society. Recent policy discussion has gone as far as suggesting there may be a moral obligation for individuals in high-risk professions (e.g. surgeons, pilots) to take enhancers. This chapter outlines a theoretical framework and methodology for investigating the claims that some professionals: (a) might have a responsibility to enhance and (b) might acquire more responsibilities once enhanced. Our methodology is interdisciplinary — as we examine normative hypotheses alongside psychological data and legal precedent — and practice-oriented—as we ultimately aim to make recommendations for policy and the professionals within its remit. Philosophical analysis exposes the conceptual and normative questions involved in a discussion of enhancement in professional contexts, offering and refining definitions of concepts (capacity, responsibility) and theory about their relationship. Psychological inquiry uses surveys and experimental methods to collect data from lay people and professionals on attitudes and responsibility attributions associated with enhancement. Legal analysis examines the conditions under which professional duties to enhance might emerge and how the law might impose or limit liability