Comparative Study of the Effects of 2% Ibopamine, 10% Phenylephrine, and 1% Tropicamide on the Anterior Segment

PURPOSE To assess in normal and glaucomatous eyes the effect of the dopaminergic drug 2% ibopamine on visual acuity, IOP, pupil size and anterior segment geometry, compared with 10% phenylephrine and 1% tropicamide. METHODS Fifteen healthy subjects and 15 patients with primary open-angle glaucoma, aged from 40 to 70 years (mean age: 54.8 +/- 9.6), were recruited into this open prospective study. After instillation of 2% ibopamine, refraction, visual acuity, pupil diameter, IOP, five A-scan ultrasonographic parameters, and 15 ultrasound biomicroscopy parameters were evaluated. The study was repeated with assessment of the same parameters 20 to 30 days later in 10 subjects (5 normal and 5 with glaucoma), using first 10% phenylephrine and then 1% tropicamide. A second group of 15 healthy subjects, aged from 45 to 70 years (mean age: 53.5 +/- 8.6) was examined to evaluate the dose-response effect and time course on pupil diameter, of ibopamine, phenylephrine, and tropicamide. RESULTS After 40 minutes 2% ibopamine induced a marked mydriatic effect (from 5 to 9.1 mm; P < 0.0001) greater than that produced by 10% phenylephrine (from 4.7 to 7.9 mm; P < 0.0001) or 1% tropicamide (from 4.6 to 6.9 mm; P < 0.0001), with no changes in refraction or visual acuity. IOP was significantly increased only in patients with glaucoma after instillation of either 2% ibopamine (from 22.2 to 24.8 mm Hg; P < 0.0001) or 1% tropicamide (from 21.2 to 23.6 mm Hg; P = 0.004), whereas 10% phenylephrine induced no statistically significant changes. Ibopamine (2%) caused a significant increase in iris thickness with a reduction of the sulcus ciliaris and posterior chamber depth. The anterior chamber angle (ACA) showed a mean 5 degrees widening with an increase in scleral-iris angle (SIA) and sclera-ciliary process angle. In 11 (37%) of 30 cases, separation of the pupil border and lens surface occurred, whereas contact was maintained only with the zonule in the other 19 (63%) of 30. The changes after 10% phenylephrine instillation were similar, although only the increase in iris thickness and SIA was statistically significant. Tropicamide (1%) induced a slight but significant increase in SIA. CONCLUSIONS The results confirm the potent mydriatic effect of 2% ibopamine, which is greater than that of either 10% phenylephrine or 1% tropicamide, as well as its ability to induce an increase in intraocular pressure when used in patients with glaucoma alone. These data support the hypothesis that the widening of the ACA induced by 2% ibopamine is due to posterior rotation of the iris plane and ciliary processes. These changes are quantitatively greater than those induced by 10% phenylephrine and 1% tropicamide and are related to the greater mydriatic effect of the drug

Association of Upfront Peptide Receptor Radionuclide Therapy With Progression-Free Survival Among Patients With Enteropancreatic Neuroendocrine Tumors

open57noIMPORTANCE Data about the optimal timing for the initiation of peptide receptor radionuclide therapy (PRRT) for advanced, well-differentiated enteropancreatic neuroendocrine tumors are lacking. OBJECTIVE To evaluate the association of upfront PRRT vs upfront chemotherapy or targeted therapy with progression-free survival (PFS) among patients with advanced enteropancreatic neuroendocrine tumors who experienced disease progression after treatment with somatostatin analogues (SSAs). DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study analyzed the clinical records from 25 Italian oncology centers for patients aged 18 years or older who had unresectable, locally advanced or metastatic, well-differentiated, grades 1 to 3 enteropancreatic neuroendocrine tumors and received either PRRT or chemotherapy or targeted therapy after experiencing disease progression after treatment with SSAs between January 24, 2000, and July 1, 2020. Propensity score matching was done to minimize the selection bias. EXPOSURES Upfront PRRT or upfront chemotherapy or targeted therapy. MAIN OUTCOMES AND MEASURES The main outcome was the difference in PFS among patients who received upfront PRRT vs among those who received upfront chemotherapy or targeted therapy. A secondary outcome was the difference in overall survival between these groups. Hazard ratios (HRs) were fitted in a multivariable Cox proportional hazards regression model to adjust for relevant factors associated with PFS and were corrected for interaction with these factors. RESULTS Of 508 evaluated patients (mean ([SD] age, 55.7 [0.5] years; 278 [54.7%] were male), 329 (64.8%) received upfront PRRT and 179 (35.2%) received upfront chemotherapy or targeted therapy. The matched group included 222 patients (124 [55.9%] male; mean [SD] age, 56.1 [0.8] years), with 111 in each treatment group. Median PFS was longer in the PRRT group than in the chemotherapy or targeted therapy group in the unmatched (2.5 years [95%CI, 2.3-3.0 years] vs 0.7 years [95%CI, 0.5-1.0 years]; HR, 0.35 [95%CI, 0.28-0.44; P &lt; .001]) and matched (2.2 years [95% CI, 1.8-2.8 years] vs 0.6 years [95%CI, 0.4-1.0 years]; HR, 0.37 [95%CI, 0.27-0.51; P &lt; .001]) populations. No significant differences were shown in median overall survival between the PRRT and chemotherapy or targeted therapy groups in the unmatched (12.0 years [95%CI, 10.7-14.1 years] vs 11.6 years [95%CI, 9.1-13.4 years]; HR, 0.81 [95%CI, 0.62-1.06; P = .11]) and matched (12.2 years [95% CI, 9.1-14.2 years] vs 11.5 years [95%CI, 9.2-17.9 years]; HR, 0.83 [95%CI, 0.56-1.24; P = .36]) populations. The use of upfront PRRT was independently associated with improved PFS (HR, 0.37; 95%CI, 0.26-0.51; P &lt; .001) in multivariable analysis. After adjustment of values for interaction, upfront PRRT was associated with longer PFS regardless of tumor functional status (functioning: adjusted HR [aHR], 0.39 [95%CI, 0.27-0.57]; nonfunctioning: aHR, 0.29 [95%CI, 0.16-0.56]), grade of 1 to 2 (grade 1: aHR, 0.21 [95%CI, 0.12-0.34]; grade 2: aHR, 0.52 [95%CI, 0.29-0.73]), and site of tumor origin (pancreatic: aHR, 0.41 [95%CI, 0.24-0.61]; intestinal: aHR, 0.19 [95%CI, 0.11-0.43]) (P &lt; .001 for all). Conversely, the advantage was not retained in grade 3 tumors (aHR, 0.31; 95%CI, 0.12-1.37; P = .13) or in tumors with a Ki-67 proliferation index greater than 10% (aHR, 0.73; 95%CI, 0.29-1.43; P = .31). CONCLUSIONS AND RELEVANCE In this cohort study, treatment with upfront PRRT in patients with enteropancreatic neuroendocrine tumors who had experienced disease progression with SSA treatment was associated with significantly improved survival outcomes compared with upfront chemotherapy or targeted therapy. Further research is needed to investigate the correct strategy, timing, and optimal specific sequence of these therapeutic options.openPusceddu, Sara; Prinzi, Natalie; Tafuto, Salvatore; Ibrahim, Toni; Filice, Angelina; Brizzi, Maria Pia; Panzuto, Francesco; Baldari, Sergio; Grana, Chiara M.; Campana, Davide; Davì, Maria Vittoria; Giuffrida, Dario; Zatelli, Maria Chiara; Partelli, Stefano; Razzore, Paola; Marconcini, Riccardo; Massironi, Sara; Gelsomino, Fabio; Faggiano, Antongiulio; Giannetta, Elisa; Bajetta, Emilio; Grimaldi, Franco; Cives, Mauro; Cirillo, Fernando; Perfetti, Vittorio; Corti, Francesca; Ricci, Claudio; Giacomelli, Luca; Porcu, Luca; Di Maio, Massimo; Seregni, Ettore; Maccauro, Marco; Lastoria, Secondo; Bongiovanni, Alberto; Versari, Annibale; Persano, Irene; Rinzivillo, Maria; Pignata, Salvatore Antonio; Rocca, Paola Anna; Lamberti, Giuseppe; Cingarlini, Sara; Puliafito, Ivana; Ambrosio, Maria Rosaria; Zanata, Isabella; Bracigliano, Alessandra; Severi, Stefano; Spada, Francesca; Andreasi, Valentina; Modica, Roberta; Scalorbi, Federica; Milione, Massimo; Sabella, Giovanna; Coppa, Jorgelina; Casadei, Riccardo; Di Bartolomeo, Maria; Falconi, Massimo; de Braud, FilippoPusceddu, Sara; Prinzi, Natalie; Tafuto, Salvatore; Ibrahim, Toni; Filice, Angelina; Brizzi, Maria Pia; Panzuto, Francesco; Baldari, Sergio; Grana, Chiara M.; Campana, Davide; Davì, Maria Vittoria; Giuffrida, Dario; Zatelli, Maria Chiara; Partelli, Stefano; Razzore, Paola; Marconcini, Riccardo; Massironi, Sara; Gelsomino, Fabio; Faggiano, Antongiulio; Giannetta, Elisa; Bajetta, Emilio; Grimaldi, Franco; Cives, Mauro; Cirillo, Fernando; Perfetti, Vittorio; Corti, Francesca; Ricci, Claudio; Giacomelli, Luca; Porcu, Luca; Di Maio, Massimo; Seregni, Ettore; Maccauro, Marco; Lastoria, Secondo; Bongiovanni, Alberto; Versari, Annibale; Persano, Irene; Rinzivillo, Maria; Pignata, Salvatore Antonio; Rocca, Paola Anna; Lamberti, Giuseppe; Cingarlini, Sara; Puliafito, Ivana; Ambrosio, Maria Rosaria; Zanata, Isabella; Bracigliano, Alessandra; Severi, Stefano; Spada, Francesca; Andreasi, Valentina; Modica, Roberta; Scalorbi, Federica; Milione, Massimo; Sabella, Giovanna; Coppa, Jorgelina; Casadei, Riccardo; Di Bartolomeo, Maria; Falconi, Massimo; de Braud, Filipp

The Surface Anodization of Titanium Dental Implants Improves Blood Clot Formation Followed by Osseointegration

The anodization of titanium dental implant influences the biologic processes of osseointegration. 34 grit-blasted and acid-etched titanium specimens were used to evaluate micro- and nano-roughness (Ra), contact angle (&theta;) and blood clot extension (bce). 17 samples were anodized (test) while the remaining were used as control. The bce, was measured using 10 &micro;L of human blood left in contact with titanium for 5 min at room temperature. The micro- and nano-scale Ra were measured under CLSM and AFM, respectively, while the &theta; was analyzed using the sessile drop technique. The bone-implant contact (BIC) rate was measured on two narrow implants retrieved for fracture. bce was 42.5 (&plusmn;22) for test and 26.6% (&plusmn;13)% for control group (p = 0.049). The micro-Ra was 6.0 (&plusmn;1.5) for the test and 5.8 (&plusmn;1.8) &micro;m for control group (p &gt; 0.05). The &theta; was 98.5&deg; (&plusmn;18.7&deg;) for test and 103&deg; (&plusmn;15.2&deg;) for control group (p &gt; 0.05). The nano-Ra was 286 (&plusmn;40) for the test and 226 (&plusmn;40) nm for control group (p &lt; 0.05). The BIC rate was 52.5 (&plusmn;2.1) for test and 34.5% (&plusmn;2.1%) for control implant (p = 0.014). (Conclusions) The titanium anodized surface significantly increases blood clot retention, significantly increases nano-roughness, and favors osseointegration. When placing dental implants in poor bone quality sites or with immediate loading protocol anodized Ti6Al4V dental implants should be preferred

Evaluation of the new Ocuton S tonometer

Purpose: To evaluate the intra- and interobserver variability of the Ocuton S tonometer, its correlation with Goldmann tonometry, the reliability of self-tonometry and the safety of the instrument. Methods: Thirty-five healthy subjects and 45 patients with primary open-angle glaucoma (POAG), aged from 38 to 80 years (mean age: 64.6 +/- 12.2 years), underwent tonometry with the Ocuton S tonometer in one eye chosen at random. The intra- and interobserver variability between two operators (kappa coefficient), the Ocuton S/Goldmann correlation and the reliability of self-tonometry were evaluated by performing two tonometries on each patient in subgroups. Each tonometry was considered as the mean of three consecutive measurements. Central ultrasonic pachymetry, keratometry and corneal biomicroscopy were also evaluated. Results: The intra- and interobserver variability ranged from 0.38 to 0.66. The difference between the means of intraocular pressure (IOP) with the Ocuton S (24.4 +/- 4.7 mmHg) and the Goldmann tonometer (18.1 +/- 4.7 mmHg) was statistically significant (p < 0.0001). Linear regression analysis revealed a good Ocuton S/Goldmann correspondence (r = 0.88, p = 0.0001). However, IOP values detected with the Ocuton were consistently overestimated, compared to those detected with the Goldmann tonometer. The correlation between corneal thickness and IOP was statistically significant both for the Goldmann (r = 0.510, p = 0.021) and for the Ocuton S tonometer (r = 0.520, p = 0.019). No correlation was found between keratometry and IOP. The mean measurement obtained by self-tonometry (21.9 +/- 3.6 mmHg) showed no statistically significant difference when compared to the mean measurement obtained by an expert operator (21.3 +/- 3.4 mmHg). Conclusion: The Ocuton S tonometer is a safe instrument that can be used easily by the patient. However, in comparison to the Goldmann tonometer, it overestimates IOP and requires further technical and methodological refinements in order to ensure greater reliability