A history of the renewal of the corneal epithelium : a 3D animation

Background: To compare the different schemes that have been proposed during the last thirteen years to explain the renewal of the corneal epithelium. Material and Methods:We analyzed all the data present in the literature to explain the renewal of the corneal epithelium in mammals. According to the schemes proposed in the literature we developed a 3D animation to facilitate the understanding of the different concepts. Results:Three different schemes have been proposed to explain the renewal of the corneal epithelium in mammals during the last thirteen years. 1950-1981: the corneal epithelium was thought being renewed by mitosis of cells located in the basal layer. At this time scientist were not talking about stem cells. 1981-1986 was the period of the "XYZ hypothesis" or the transdifferentiation paradigm. At this time the conjunctival epithelium renewed the corneal epithelium in a centripetal migration. 1986-2008: the limbal stem cell paradigm, there were no stem cells in the corneal epithelium, all the corneal stem cells were located in the limbus and renewed the central cornea after a migration of 6 to 7 mm of transient amplifying cells toward the centre of the cornea. 2008, epithelial stem cells were found in the central cornea in mammals (Nature, Majo et al. November 2008). Discussion:We thought that the renewal of the corneal epithelium was completely defined. According to the last results we published in Nature, the current paradigm will be revisited. The experiments we made were on animals and the final demonstration on human has still to be done. If we find the same results in human, a new paradigm will be define and will change the way we consider ocular surface therapy and reconstruction

Comparazione dell’efficacia di differenti antibiotici sistemici nel trattamento dell’acne intermedia

Obiettivo del nostro lavoro è stato quello di valutare le modificazioni del quadro clinico e della qualità di vita, prima e dopo terapia sistemica antibiotica, in 115 pazienti (64 maschi, 51 femmine, età media 19 anni) affetti da acne di grado intermedio trattati con quattro distinti antibiotici (12 con limeciclina, 11 con doxiciclina, 47 con metaciclina, 45 con azitromicina). L’aspetto clinico dei pazienti e ogni miglioramento durante la terapia sono stati valutati con il Global Acne Grading System (GAGS). Il nostro studio dimostra chiaramente che azitromicina, doxiciclina, limeciclina e metaciclina sono efficaci nel trattamento dell’acne, migliorando notevolmente l’aspetto clinico dei pazienti. Dai nostri dati risulta che, seppure in modo lieve e statisticamente non significativo, la metaciclina è più efficace degli altri antibiotici testati. Ad un miglioramento clinico dei nostri pazienti corrisponde sempre un miglioramento della qualità della vita. Non sono state riscontrate differenze significative tra i due sessi per quanto riguarda il miglioramento del quadro clinico (GAGS), mentre per quanto riguarda la qualità di vita il sesso femminile, pur partendo da una condizione peggiore, mostra un miglioramento superiore a quello del sesso maschile al termine della terapia. Inoltre, i soggetti tra i 25 e i 39 anni presentano, a fine trattamento, un più marcato miglioramento del quadro clinico rispetto ai soggetti di altre classi di età. In conclusione qualsiasi terapia antibiotica sistemica determina un miglioramento clinico e della qualità di vita dei pazienti con acne intermedia. Tale miglioramento non è influenzato dal sesso ed i soggetti di età compresa tra i 25 e i 39 anni rispondono meglio rispetto alle altre fasce di età

Factors affecting signal quality in implantable cardiac monitors with long sensing vector

Purpose: Electrical artefacts are frequent in implantable cardiac monitors (ICMs). We analyzed the subcutaneous electrogram (sECG) provided by an ICM with a long sensing vector and factors potentially affecting its quality. Methods: Consecutive ICM recipients underwent a follow-up where demographics, body mass index (BMI), implant location, and surface ECG were collected. The sECG was then analyzed in terms of R-wave amplitude and P-wave visibility. Results: A total of 84 patients (43% female, median age 68 [58-76] years) were enrolled at 3 sites. ICMs were positioned with intermediate inclination (n\ua0=\ua044, 52%), parallel (n\ua0=\ua035, 43%), or perpendicular (n\ua0=\ua05, 6%) to the sternum. The median R-wave amplitude was 1.10 (0.72-1.48) mV with P waves readily visible in 69.2% (95% confidence interval, CI: 57.8%-79.2%), partially visible in 23.1% [95% CI: 14.3%-34.0%], and never visible in 7.7% [95% CI: 2.9%-16.0%] of patients. Men had higher R-wave amplitudes compared to women (1.40 [0.96-1.80] mV vs 1.00 [0.60-1.20] mV, P\ua0=.001), while obese people tended to have lower values (0.80 [0.62-1.28] mV vs 1.10 [0.90-1.50] mV, P\ua0=.074). The P-wave visibility reached 86.2% [95% CI: 68.3%-96.1%] in patients with high-voltage P waves ( 650.2\ua0mV) at surface ECG. The sECG quality was not affected by implant site. Conclusion: In ordinary clinical practice, ICMs with long sensing vector provided median R-wave amplitude above 1\ua0mV and reliable P-wave visibility of nearly 70%, regardless of the position of the device. Women and obese patients showed lower but still very good signal quality

Multiparametric Implantable Cardioverter-Defibrillator Algorithm for Heart Failure Risk Stratification and Management: An Analysis in Clinical Practice

BACKGROUND: The HeartLogic algorithm combines multiple implantable cardioverter-defibrillator sensors to identify patients at risk of heart failure (HF) events. We sought to evaluate the risk stratification ability of this algorithm in clinical practice. We also analyzed the alert management strategies adopted in the study group and their association with the occurrence of HF events.METHODS: The HeartLogic feature was activated in 366 implantable cardioverter-defibrillator and cardiac resynchronization therapy implantable cardioverter-defibrillator patients at 22 centers. The median follow-up was 11 months [25th-75th percentile: 6-16]. The HeartLogic algorithm calculates a daily HF index and identifies periods IN alert state on the basis of a configurable threshold.RESULTS: The HeartLogic index crossed the threshold value 273 times (0.76 alerts/patient-year) in 150 patients. The time IN alert state was 11% of the total observation period. Patients experienced 36 HF hospitalizations, and 8 patients died of HF during the observation period. Thirty-five events were associated with the IN alert state (0.92 events/patient-year versus 0.03 events/patient-year in the OUT of alert state). The hazard ratio in the IN/OUT of alert state comparison was (hazard ratio, 24.53 [95% CI, 8.55-70.38], P<0.001), after adjustment for baseline clinical confounders. Alerts followed by clinical actions were associated with less HF events (hazard ratio, 0.37 [95% CI, 0.14-0.99], P=0.047). No differences in event rates were observed between in-office and remote alert management.CONCLUSIONS: This multiparametric algorithm identifies patients during periods of significantly increased risk of HF events. The rate of HF events seemed lower when clinical actions were undertaken in response to alerts. Extra in-office visits did not seem to be required to effectively manage HeartLogic alerts. Registration: URL: ; Unique identifier: NCT02275637