Impact of Madden-Julian Oscillation (MJO) on global distribution of total water vapor and column ozone

The Madden-Julian Oscillation (MJO) is the leading mode of intra-seasonal variability in the tropical troposphere, characterized by an eastward moving 'pulse' of cloud and rainfall near the equator. In this study, total precipitable water (TPW) and total column ozone (TCO) datasets from ECMWF ERA-Interim reanalysis were used to analyse the impact of the MJO on the distribution of water vapor and column ozone in the tropics from 1979 to 2013. The results show that seasonal variations of TPW modulated by the MJO are maximized in the tropics of about 10°S-10°N during boreal winter, while the variation in TCO is maximized in the mid-latitudes of about 30°S - 40°N in the same season. The composite analysis shows that MJO modulates TPW and TCO anomalies eastward across the globe. The underlying mechanism of the MJO's impact on TPW is mainly associated with variation of tropical convection modulated by the MJO, while the underlying mechanism of the MJO's impact on TCO is mainly associated with an intra-seasonal variability of tropopause height modulated by the MJO activity. This knowledge helps to improve the prediction skill of the intra-seasonal variation of water vapor and column ozone in the tropics during boreal winter

Incidence of submacular haemorrhage (SMH) in Scotland : a Scottish Ophthalmic Surveillance Unit (SOSU) study

PURPOSE: Submacular haemorrhage (SMH) is a cause of severe visual loss in neovascular age-related macular degeneration (nAMD). The incidence is uncertain and furthermore there is no widely used classification system nor agreed best practice. The aim of this national surveillance study was to identify the incidence, presenting features and clinical course of new fovea-involving submacular haemorrhage associated with nAMD. METHODS: A questionnaire was sent monthly to every ophthalmic specialist in Scotland over a 12-month period asking them to report all newly presenting patients with acute SMH secondary to nAMD of at least two disc diameters (DDs) in greatest linear diameter. A follow-up questionnaire was sent 6 months after initial presentation. Cases related to other causes were excluded. RESULTS: Twenty-nine cases were reported giving an incidence of 5.4 per million per annum (range 2-15). The mean age was 83 years (range 66-96) and females accounted for 17/29 (59%). Fifteen of the 29 cases (52%) had a past history of AMD, of which 7 had nAMD. Nineteen of the 29 cases (66%) presented within 7 days of onset and the majority had SMH of < 11 DD (20/29, 69%). Treatment options comprised the following: observation (n = 6, 21%), anti-VEGF alone (n = 6, 21%) or vitrectomy with co-application of tissue plasminogen activator (TPA), anti-VEGF and gas (n = 17, 58%). The vitrectomy group experienced the greatest change in vision from logMAR 1.89-1.50 (p = 0.374). Four of 20 (20%) cases with 6 months follow-up suffered a re-bleed at a mean time of 96 days. CONCLUSIONS: The incidence, clinical features and course of a consecutive national cohort of patients with SMH secondary to nAMD are presented

Sarcoidosis presenting as an epididymal mass.

Sarcoidosis is a multisystem inflammatory disease that characteristically involves the lungs and lymph nodes. Involvement of the genitourinary system is rare. We report the case of a 39-year-old African American man who presented with an asymptomatic right-sided epididymal mass and underwent partial epididymectomy. Pathologic analysis revealed numerous noncaseating granulomas. Results from computed tomography imaging of the chest and lung biopsy were consistent with sarcoidosis

Evolving strategies in the management of diabetic macular edema: clinical trials and current management

Diabetic macular edema (DME) is the leading cause of vision loss in the working-age population in developed countries. Management has traditionally consisted of focal/grid macular laser, according to the guidelines established by the Early Treatment of Diabetic Retinopathy Study. More recent prospective clinical trials examining the effect of intravitreal ranibizumab in the treatment of DME—most notably, READ-2, RESOLVE, RESTORE, RISE/RIDE, and DRCR.net protocol I—have demonstrated improved visual outcomes with pharmacologic targeting of vascular endothelial growth factor. Similar treatment benefits have also been noted in clinical trials evaluating intravitreal bevacizumab and aflibercept (BOLT and DA VINCI, respectively). Intravitreal steroids, particularly in refractory cases, continue to have a limited role in the management of DME. In patients with symptomatic visual loss, the treatment paradigm for DME has shifted toward intravitreal pharmacotherapeutics, principally anti–vascular endothelial growth factor therapy, and this review examines the clinical trials leading to this change. L'oedème maculaire diabétique (ŒMD) est la principale cause de perte de vision chez les populations des pays développés en âge de travailler. La gestion reposait, traditionnellement, sur le laser focal ou en damier, selon les lignes directrices établies par l'Ètude sur le traitement précoce de la rétinopathie diabétique (ÈTPRD). Des essais cliniques plus récents examinant l'effet du ranibizumab intravitréen dans le traitement de l'ŒMD — notamment, READ-2, RESOLVE, RESTORE, RISE/RIDE, et DRCR.net Protocol I — ont démontré l'amélioration des résultats visuels obtenus avec le ciblage pharmacologique du facteur de croissance de l'endothélium vasculaire (FCEV). L'on a aussi noté un traitement semblable dans les essais cliniques d'évaluation du bévacizumab intravitréen et de l'aflibercept (BOLT et DA VINCI, respectivement). Les stéroïdes intravitréens, notamment dans les cas réfractaires, continuent d'avoir un rôle limité dans la gestion de l'ŒMD. Chez les patients ayant une perte visuelle symptomatique, le nouveau paradigme de traitement de l'ŒMD s'est orienté sur la pharmacothérapie intravitréenne, principalement la thérapie du FCEV, puis cette revue examine les essais cliniques qui ont mené à ce changement