The effect of multiple vitrectomies and its indications on intraocular pressure

Background: To assess the relationship between different indications for trans pars plana vitrectomies (PPV's) and the intraocular pressure (IOP), and the effect of multiple PPV's on the IOP. We also examined whether there were differences in the number of IOP-lowering medications or surgeries before and after PPV. Methods: A retrospective study including all patients that underwent at least one PPV in the period from 2001 till 2014 at our clinic. Medical records of all patients were reviewed and clinically relevant data were entered in a database. Generalized estimating equations models for repeated measurements were used to examine the effect of the number of PPV's on the IOP and on the risk of undergoing glaucoma surgery, for each of the indications for PPV. Results: Of 1072 PPV's 447 eyes fulfilled the inclusion criteria. The IOP increased with 3.0 mmHg after a PPV with indication retinal detachment (p < 0.001), but remained stable after PPV for epiretinal membrane (p = 0.555), macular hole (p = 0.695), and vitreous hemorrhage (p = 0.787). At the end of the follow-up period the number of IOP-lowering medications was significantly higher compared to baseline, except in the macular hole group (p = 0.103). Also, the number of eyes that underwent glaucoma surgery was significantly higher compared to the fellow (not-operated) eyes (p < 0.001). There was a significant association between the number of PPV's and the final IOP for the indication retinal detachment (p = 0.009), and between the number of PPV's and glaucoma surgery (odds ratio [95% confidence interval]: 2.60 [1.62-4.15]). Conclusions: The IOP rises significantly after PPV with indication retinal detachment. This association was not found for other indications for PPV. Also, the risk of IOP-lowering surgeries was higher after PPV, but not different between the PPV indications. The IOP should be monitored carefully after PPV, since there may be a higher risk of secondary glaucoma

The Use of Molecular Analyses in Voided Urine for the Assessment of Patients with Hematuria

Introduction:Patients presenting with painless hematuria form a large part of the urological patient population. In many cases, especially in younger patients, the cause of hematuria is harmless. Nonetheless, hematuria could be a symptom of malignant disease and hence most patients will be subject to cystoscopy. In this study, we aimed to develop a prediction model based on methylation markers in combination with clinical variables, in order to stratify patients with high risk for bladder cancer.Material and Methods:Patients (n=169) presenting with painless hematuria were included. 54 patients were diagnosed with bladder cancer. In the remaining 115 patients, the cause of hematuria was non-malignant. Urine samples were collected prior to cystoscopy. Urine DNA was analyzed for methylation of OSR1, SIM2, OTX1, MEIS1 and ONECUT2. Methylation percentages were calculated and were combined with clinical variables into a logistic regression model.Results:Logistic regression analysis based on the five methylation markers, age, gender and type of hematuria resulted in an area under the curve (AUC) of 0.88 and an optimism corrected AUC of 0.84 after internal validation by bootstrapping. Using a cut-off value of 0.307 allowed stratification of patients in a low-risk and high-risk group, resulting in a sensitivity of 82% (44/54) and a specificity of 82% (94/115). Most aggressive tumors were found in patients in the high-risk group. The addition of cytology to the prediction model, improved the AUC from 0.88 to 0.89, with a sensitivity and specificity of 85% (39/46) and 87% (80/92), retrospectively.Conclusions:This newly developed prediction model could be a helpful tool in risk stratification of patients presenting with painless hematuria. Accurate risk prediction might result in less extensive examination of low risk patients and thereby, reducing patient burden and costs. Further validation in a large prospective patient cohort is necessary to prove the true clinical value of this model

Efficacy of tarsoconjunctivomullerectomy in adults with acquired aponeurogenic blepharoptosis: a large single-surgeon case-series

Purpose: To evaluate the reoperation rate and symmetry after uni- or bilateral tarsoconjunctivomullerectomy (TCM) in a large, consecutive series of adult patients suffering from mild to moderate acquired aponeurogenic blepharoptosis. Methods: Patients who underwent TCM because of mild to moderate acquired aponeurogenic blepharoptosis between January 2005 and September 2016 were analysed. Main outcome was reoperation rate. Secondary outcomes were eyelid symmetry and the effects of uni- or bilateral surgery, and in unilateral cases contralateral ptosis surgery. MRD-1 (Margin to Reflex Distance) similarity within 1 mm and contour of the eyelid were used for grading eyelid symmetry. Results: We analysed the data of 243 patients, of whom 178 underwent unilateral, and 65 bilateral TCM. Previous ptosis surgery of the same eyelid had been performed (by another surgeon) in 44 patients. Reoperation was performed in four patients after unilateral (2.2%) and in 1 patient after bilateral surgery (1.5%) (p = 1.00). After unilateral surgery, contralateral ptosis surgery due to increased contralateral ptosis was performed in 16 patients (9.0%). We found no difference in reoperation rate between patients in whom ptosis surgery had been performed previously versus primary surgery (p =.22). Symmetry was good in 44%, acceptable in 44% and poor in 12% of the patients. Conclusions: After TCM, the reoperation rate was about 2% with good or acceptable eyelid symmetry in most cases. There was no difference in reoperation results between uni- and bilateral cases. However, if we include secondary ptosis surgery of the contralateral eyelid in unilateral cases, results were better after bilateral surgery

Degradation of polar and non-polar pharmaceutical pollutants in water by solar assisted photocatalysis using hydrothermal TiO2-SnS2

International audiencePhotocatalytic performance of a hydrothermally obtained TiO2-SnS2-HT composite was evaluated for the degradation of polar and non-polar pharmaceuticals in water, diclofenac (DCF) and memantine (MEM) respectively, under simulated solar irradiation. Favourable action of SnS2 for band gap narrowing and consequent higher effectiveness of TiO2-SnS2-HT in comparison to TiO2-P25 benchmark, came forth in the case of DCF, which is prone to adsorption and subsequent h+ attack under illumination. Subpar degradation of MEM was attributed to its’ non-reactive structure and the lack of surface interactions in accordance with the density functional theory calculations, which indicated lower interaction energies for SnS2 and MEM than SnS2 and DCF. In comparison, the initial removal of DCF at pH 4 was 59.8% with 50% SnS2 wt.%, whereas the removal of MEM was <5.3%. After 60 min of treatment, TiO2-SnS2 with 50% SnS2 wt.% achieved DCF conversion of 76.21%, outperforming the benchmark TiO2-P25, however in the case of MEM the conversion was miniscule. Solar/TiO2-SnS2 treatment of DCF yielded a decrease of toxicity towards Vibrio fischeri whilst biodegradability remained low. The observed decrease in effectiveness of solar/TiO2-SnS2 treatment in the presence of water matrix constituents is mainly contributed to sulfates and phosphates, acting as h+ scavengers

Elucidating the Photocatalytic Behavior of TiO2-SnS2 Composites Based on Their Energy Band Structure

TiO2-SnS2 composite semiconducting photocatalysts with different building component ratios were prepared by hydrothermal synthesis (TiO2-SnS2-HT) and by immobilization of commercial TiO2 and SnS2 particles (TiO2-SnS2-COMM). The band gap values, which determine the catalysts&rsquo; photoactivity, were examined by diffuse reflectance spectroscopy and Kubelka&ndash;Munk transformations. The catalysts&rsquo; surface properties: specific surface area, charge and adsorption capacitance at the solid&ndash;solution interface were characterized using BET analysis, potentiometric titration and electrochemical impedance spectroscopy, respectively. The electronic band structure of TiO2-SnS2 photocatalyst, as the key property for the solar-driven photocatalysis, was deduced from the thermodynamic data and the semiconducting parameters (type of semiconductivity, concentration of the charge carriers, flat band potential) obtained by Mott&ndash;Schottky analysis. The photoactivity of both composites was studied in photocatalytic treatment of diclofenac (DCF) under simulated solar irradiation and was compared to the benchmark photocatalyst (TiO2 P25) activity. The influence of process parameters, such as pH, H2O2, and composite formulation on the effectiveness of DCF removal and conversion was investigated and discussed by employing response surface modeling (RSM) approach. The photocatalytic efficiency of both composite materials was discussed on the basis of the hetereojunction formation that facilitated the photoelectron transfer, promoting more efficient photocatalytic degradation of DCF

Comparative analysis of UV-C/H2O2 and UV-A/TiO2 processes for the degradation of diclofenac in water

The study investigates the treatment of diclofenac (DCF), a pharmaceutical included in the first watch list of the European Water Framework Directive as a new potential priority substance in water. Since the conventional wastewater treatment technologies do not efficiently remove DCF, advanced treatment technologies capable of its complete removal or destruction of its biological activity, need to be evaluated and eventually employed. For that purpose, typical representatives of photooxidative and photocatalytic advanced oxidation processes were applied. The effectiveness of UV-C/H2O2 and UV-A/TiO2 were compared regarding DCF conversion and mineralization kinetics, water quality parameters for assessing biodegradability and toxicity. In spite of similar biodegradability profiles, the obtained results indicate different DCF degradation pathways, which are reflected in different profiles of toxicity towards Vibrio fischeri. The observed DCF conversion and mineralization kinetics revealed the benefits of UV-C/H2O2 process. However, lower toxicity favored the application of photocatalytic over photooxidative treatment for DCF removal

The Use of Molecular Analyses in Voided Urine for the Assessment of Patients with Hematuria

Introduction:Patients presenting with painless hematuria form a large part of the urological patient population. In many cases, especially in younger patients, the cause of hematuria is harmless. Nonetheless, hematuria could be a symptom of malignant disease and hence most patients will be subject to cystoscopy. In this study, we aimed to develop a prediction model based on methylation markers in combination with clinical variables, in order to stratify patients with high risk for bladder cancer.Material and Methods:Patients (n=169) presenting with painless hematuria were included. 54 patients were diagnosed with bladder cancer. In the remaining 115 patients, the cause of hematuria was non-malignant. Urine samples were collected prior to cystoscopy. Urine DNA was analyzed for methylation of OSR1, SIM2, OTX1, MEIS1 and ONECUT2. Methylation percentages were calculated and were combined with clinical variables into a logistic regression model.Results:Logistic regression analysis based on the five methylation markers, age, gender and type of hematuria resulted in an area under the curve (AUC) of 0.88 and an optimism corrected AUC of 0.84 after internal validation by bootstrapping. Using a cut-off value of 0.307 allowed stratification of patients in a low-risk and high-risk group, resulting in a sensitivity of 82% (44/54) and a specificity of 82% (94/115). Most aggressive tumors were found in patients in the high-risk group. The addition of cytology to the prediction model, improved the AUC from 0.88 to 0.89, with a sensitivity and specificity of 85% (39/46) and 87% (80/92), retrospectively.Conclusions:This newly developed prediction model could be a helpful tool in risk stratification of patients presenting with painless hematuria. Accurate risk prediction might result in less extensive examination of low risk patients and thereby, reducing patient burden and costs. Further validation in a large prospective patient cohort is necessary to prove the true clinical value of this model