Effect of Intravitreal Brolucizumab in the Treatment of Polypoidal Choroidal Vasculopathy With Foveal Lipid Exudation.

A 71-year-old woman with a history of blurred vision in her right eye for nearly two months came to our attention. A complete ophthalmological evaluation, including best-corrected visual acuity measurement, fundus examination, spectral-domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography, was performed. Multimodal imaging showed the presence of a polypoidal choroidal vasculopathy (PCV) lesion surrounded by diffuse hard exudates in the macular area. Our patient received three monthly intravitreal injections of brolucizumab during the loading phase, followed by an intravitreal injection every eight weeks for a total of 48 weeks of follow-up. The therapy appeared to be effective for improving both visual and anatomical outcomes revealing an important regression of the PCV and an almost complete reabsorption of lipid exudates. Intravitreal brolucizumab could be considered an effective treatment in the management of lipid exudation in PCV patients

nZVI mobility and transport: laboratory test and numerical model

Zerovalent iron nanoparticles (nZVI) are becoming one of the most widely recommended nanomaterials for soil and groundwater remediation. However, when nZVI are injected in the groundwater flow, the behavior (mobility, dispersion, distribution) is practically unknown. This fact generally results in the use of enormous quantities of them at the field scale. The uncertainties are on the effective volumes reached from the plume of nZVI because their tendency to aggregate and their weight can cause their settling and deposition. So, the mobility of nanoparticles is a real issue, which can often lead to inefficient or expensive soil remediation. Furthermore, there is another aspect that must be considered: the fate of these nZVI in the groundwater and their possible impact on the subsoil environment. All these considerations have led us to propose an application of nZVI simulating the permeation technique through a laboratory experience, finalized to have a better, or even simpler description of their real behavior when injected in a flow in the subsoil. A two-dimensional laboratory-scale tank was used to study the dispersion and transport of nZVI. A nZVI solution, with a concentration equal to 4.54 g/L, was injected into glass beads, utilized as porous medium. The laboratory experiment included a digital camera to acquire the images. The images were then used for calibrating a numerical model. The results of the mass balance confirm the validity of the proposed numerical model, obtaining values of velocity (5.41 x 10(-3) m/s) and mass (1.9 g) of the nZVI of the same order of those from the experimental tests. Several information were inferred from both experimental and numerical tests. Both demonstrate that nZVI plume does not behave as a solute dissolved in water, but as a mass showing its own mobility ruled mainly from the buoyancy force. A simple simulation of a tracer input and a nZVI plume are compared to evidence the large differences between their evolution in time and space. This means that commercial numerical models, if not corrected, cannot furnish a real forecast of the volume of influence of the injected nZVI. Further deductions can be found from the images and confirmed by means the numerical model where the detachment effect is much smaller than the attachment one (ratio k(d)/k(a) = 0.001). From what is reported, it is worthwhile to pay attention on the localization of the contaminants source/plume to reach an effective treatment and it is important to go further in the improvement of solution for the limiting the nanoparticles aggregation phenomenon

Augmented-reality within computer assisted orthopaedic surgery workflows: a proof of concept study

The integration of augmented-reality (AR) in medical robotics has been shown to reduce cognitive burden and improve information management in the typically cluttered environment of computer-assisted surgery. A key benefit of such systems is the ability to generate a composite view of medical-informatics and the real environment, streamlining the pathway for delivering patient-specific data. Consequently, AR was integrated within an orthopaedic setting by designing a system that captured and replicated the user- interface of a commercially available surgical robot onto a commercial head mounted see through display. Thus, a clinician could simultaneously view the operating-site and real- time informatics when carrying out an assisted patellofemoral-arthroplasty (PFA). The system was tested with 10 surgeons to examine its usability and impact on procedure- completion times when conducting simulated PFA on sawbone models. A statistically insignificant mean increase in procedure completion-time (+23.7s, p=0.240) was found, and the results of a post-operative qualitative-evaluation indicated a strongly positive consensus on the system, with a large majority of subjects agreeing the system provided value to the procedure without incurring noticeable physical discomfort. Overall, this study provides an encouraging insight into the high levels of engagement AR has with a clinical audience as well as its ability to enhance future generations of medical robotics

Surface doping in T6/ PDI-8CN2 Heterostructures investigated by transport and photoemission measurements

In this paper, we discuss the surface doping in sexithiophene (T6) organic field-effect transistors by PDI-8CN2. We show that an accumulation heterojunction is formed at the interface between the organic semiconductors and that the consequent band bending in T6 caused by PDI-8CN2 deposition can be addressed as the cause of the surface doping in T6 transistors. Several evidences of this phenomenon have been furnished both by electrical transport and photoemission measurements, namely the increase in the conductivity, the shift of the threshold voltage and the shift of the T6 HOMO peak towards higher binding energies.Comment: 5 pages, 5 figure

Management of Accidental Intravitreal Dexamethasone Injection Into the Lens: A Case Report.

An accidental injection of a dexamethasone implant inside the crystalline lens was observed in the right eye of a 63-year-old woman suffering from a macular edema secondary to a central retinal vein occlusion. A 23-gauge pars plana vitrectomy and lensectomy followed by an intraocular lens implantation were performed to carefully remove the lens and save the whole implant in order to preserve its therapeutics effects. A strict follow-up over the following 3 months revealed an improving of macular edema and no postoperative complications. The injection of a dexamethasone implant into the lens could be effectively and successfully managed with a pars plana vitrectomy and lensectomy

The Emerging Trends of Renewable Energy Communities’ Development in Italy

Increasing concerns over climate change and energy poverty have triggered the transition toward a decentralized energy system through the widespread adoption of renewable energy technologies. Although this transition was led, over past decades, mainly by major investors and large industrial players, citizens and local authorities are increasingly playing an active role in delivering clean energy investments. In particular, the current European Renewable Energy Directive introduced Renewable Energy Communities (RECs), which allow citizens to collectively organize their participation in the energy market, leading to a more distributed renewable energy system and new forms of sustainable, collaborative, and democratic economies. RECs currently under implementation show differences among European countries due to the different national contexts. A literature review exploring the peculiar Italian regulatory framework on RECs and its recent evolution has been carried out to identify available national and regional financial support mechanisms, barriers, and emerging trends in the diffusion of RECs across the country. The paper reviews and describes three main approaches that emerged in the development of RECs in Italy, discussing their strengths, and limitations. In addition, it provides a brief comparison of the regulatory framework in different European countries, highlighting the distinctive features of the Italian experience. Although the development of RECs in Italy involved a combination of both public and private initiatives, the leading role of local authorities as promoters and aggregators of RECs is evident. This role helps preserve the social impact of RECs but might slow down their implementation due to bureaucratic issues often linked to public procedures and procurement processes, as well as the lack of sufficient expertise within local authorities

Interobserver Agreement of Novel Classification of Central Serous Chorioretinopathy

Objective To validate the newly proposed multimodal-imaging-based classification for central serous chorioretinopathy (CSCR). Methods This was a retrospective study performed in a total of 87 eyes of 44 patients with a diagnosis of CSCR. Multimodal images in the form of auto-fluorescence, fundus fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT) images, of all the patients, were presented to two masked retina specialists. The masked observers graded each eye into simple or complex; primary, recurrent, resolved; and specific features such as foveal involvement, outer retinal atrophy, and choroidal neovascularization (CNV). Interobserver agreement was assessed using Cohen's kappa. In areas of non-consensus, a detailed discussion was carried out with a third independent grader. Results The mean age of the 44 patients (32 males and 12 females) was 49.2±9.3 years. We found a moderate-strong agreement between the two observers in all subclassifications, that included "simple or complex" (kappa value=0.91, 95% CI 0.82-0.99, p<0.001); "primary/recurrent/resolved" (kappa value=0.88, 95% CI 0.80-0.96, p<0.001) and "foveal involvement" (kappa value=0.89,95%CI 0.8-0.98, p<0.001). However, there was less agreement between the two graders with respect to classification of "outer retinal atrophy" (kappa value=0.72, 95%CI 0.57-0.87, p<0.001) and "presence/absence of CNV" (kappa value=0.75, 95% CI 0.58-0.92, p<0.001). Non-consensus in categorizing "outer retinal atrophy" was seen in eyes with sub-retinal hyper-reflective material (SHRM) and outer nuclear layer (ONL) thinning overlying subretinal fluid, and non-consensus in categorizing "CNV" was seen in eyes with inner choroidal atrophy. Conclusion Our study reports the validity and strong interobserver agreement in several aspects of the multimodal-imaging-based classification. This could support its implementation in clinical practice and pave way for appropriate treatment guidelines

Surgical management of gynecomastia: Experience of a general surgery center

Aim. Gynecomastia is a common finding in male population of all ages. The aim of our study was to present our experience and goals in surgical treatment of gynecomastia. Patients and Methods. Clinical records of patients affected by gynecomastia referred to our Department of Surgery between September 2008 and January 2015 were analyzed. 50 patients were included in this study. Results. Gynecomastia was monolateral in 12 patients (24%) and bilateral in 38 (76%); idiopathic in 41 patients (82%) and secondary in 9 (18%). 39 patients (78%) underwent surgical operation under general anaesthesia, 11 (22%) under local anaesthesia. 3 patients (6%) presented recurrent disease. Webster technique was performed in 28 patients (56%), Davidson technique in 16 patients (32%); in 2 patients (4%) Pitanguy technique was performed and in 4 patients (8%) a mixed surgical technique was performed. Mean surgical time was 80.72±35.14 minutes, median postoperative stay was 1.46±0.88 days. 2 patients (4%) operated using Davidson technique developed a hematoma, 1 patient (2%) operated with the same technique developed hypertrophic scar. Conclusions. Several surgical techniques are described for surgical correction of gynecomastia. If performed by skilled general surgeons surgical treatment of gynecomastia is safe and permits to reach satisfactory aesthetic results

No Changes in Keratometry Readings and Anterior Chamber Depth after XEN Gel Implantation in Patients with Glaucoma.

Background: This study aimed to compare keratometry and anterior chamber depth (ACD) changes after XEN implantation in primary open-angle glaucoma (POAG) cases over a 3-month follow-up period. Methods: Twenty patients with POAG who underwent XEN63 implantation, either standalone or combined with cataract surgery, were included. Preoperative data, including best-corrected visual acuity (BCVA), refraction, gonioscopy, ophthalmoscopy, intraocular pressure (IOP) evaluation, and axial length, were collected. Corneal topography and ACD measurements were assessed preoperatively and at postoperative days 1, 7, 15, 30, 60, and 90. Each patient’s eye that underwent XEN surgery was included in the study group, with the fellow eye serving as a control. Results: In the study group, there was a significant decrease in IOP after XEN stent implantation at all investigated time intervals (p < 0.05). However, changes in mean ACD did not show statistically significant differences at any follow-up examination in both the study and control groups. Additionally, keratometry readings revealed no significant changes in total astigmatism or steep keratometry values in either group. Conclusions: XEN implantation in POAG cases resulted in a significant decrease in IOP over the 3-month follow-up period. However, there were no significant changes observed in mean ACD or keratometry readings, indicating stability in these parameters post-XEN implantation. These findings suggest that XEN implantation may be an effective option for IOP reduction without affecting corneal curvature or ACD in POAG patients

UBEM's archetypes improvement via data-driven occupant-related schedules randomly distributed and their impact assessment

In Urban Building Energy Models (UBEMs), buildings are usually modelled via archetypes describing occupants’ behaviour via fixed schedules. This research (i) creates data-driven schedules for electric use and occupancy from smart meter readings randomly distributed in the model to improve residential archetypes, (ii) assesses the impact of these schedules on UBEMs’ energy results at different temporal resolutions and spatial scales. The novel assessment procedure exploits integrated heat maps based on coefficients of variation of the root means square error (CVRMSE). The outcomes show that differences in energy needs, with randomized schedules, range based on temporal and spatial aggregation. Yearly, for the entire neighbourhood, heating and cooling energy needs, and electric uses are estimated -2%, +1%, and +18% compared to the base case. The outputs show that, when simulations are focused on the entire district, fixed schedules can be enough to describe energy patterns. However, if the simulation is focused on small groups of buildings (e.g., 5 or fewer), randomising the schedules can create variability in the model in terms of electric use and occupancy among buildings characterized by the same archetype. The followed methodology can be exploited also with larger databases and eventually verified with also other types of data