Managing diabetic macular edema in clinical practice: systematic review and meta-analysis of current strategies and treatment options

Purpose: This meta-analysis aims to summarize 12-month best-corrected visual acuity (BCVA) outcomes in response to anti-vascular endothelial growth factor (VEGF) therapy and dexamethasone implant for the treatment of diabetic macular edema (DME) and to identify factors affecting treatment response using evidence generated from metaregression. Methods: A systematic review of electronic databases was conducted to identify randomized controlled trials (RCTs) and real-life/observational studies that reported 12-month changes in BCVA in patients with DME on anti-VEGF or dexamethasone implant treatment in monotherapy. Study factors that were analyzed are baseline patient characteristics, study type, drug employed, number of injections and 12-month change in BCVA. Data were pooled in a random-effects meta-analysis with BCVA change as the main outcome. Meta-regression was conducted to assess the impact of multiple covariates. Results: One-hundred-five heterogeneous study populations (45,032 eyes) were identified and included in the analysis. The use of anti-VEGFs and dexamethasone implant induced an overall increase of +8.13 ETDRS letters in BCVA at 12 months of follow-up. Metaregression provided evidence that mean BCVA change using anti-VEGFs was not statistically higher for RCTs (p=0.35) compared to observational studies. Dexamethasone implant showed a trend for better results in observational studies over RCTs. Populations following a fixed aflibercept regimen performed better than those following a reactive treatment regimen. Mean BCVA gain was higher in younger populations (p<0.001), with lower baseline BCVA (p<0.0001) and longer diabetes duration (p<0.0001), receiving a higher number of injections (p<0.0001). Conclusion: Intravitreal therapy with anti-VEGFs or dexamethasone implant produces a significant improvement in BCVA at 12 months in patients with DME. Meta-regression identified the modifiable covariates that can be targeted in order to maximize functional results

Diamond wire cutting of cast iron

Diamond wire has been the standard industrial practice in stone excavation for over three decades now. Today new applications in the construction and controlled demolition industry are emerging, which involve the cutting of metals and sometimes diamond wire seems the only viable solution. Diamond tool life cutting metals is about one order of magnitude lower than stone, so a better knowledge of this process is of direct industrial interest. In this paper we report the main results of experimental tests for a cylindrical and a tapered electroplated diamond bead cutting cast iron UNI G250. Experimental data to estimate the optimal process parameters and predict tool life are reported and an experimental model is presented. In addition a new tool wear criterion and a new standardized testing method for diamond bead cutting of cast iron and to compare the performance of different diamond bead ..

Infection control measures in ophthalmology during the COVID-19 outbreak: A narrative review from an early experience in Italy

Introduction: The novel coronavirus (SARS-CoV-2) is infecting people and spreading easily from person-to-person. Cases have been detected in most countries worldwide. Italy is one of the most affected countries as of 30 March 2020. Public health response includes a rapid reorganization of the Italian National Healthcare System in order to reduce transmission of COVID-19 within hospitals and healthcare facilities, while optimizing the assistance to patients with severe COVID-19 complications. Methods: We analysed the actions that were taken in three ophthalmology centres in northern Italy during the SARS-CoV-2 outbreak and how these measures affected patient\u2019s attendance. In addition, due to the rapidly evolving scenario, we reviewed the evidence available during the course of this pandemic. Results: A full reorganization of ophthalmology services is mandatory according to current existing infection containment measures in order to continue dispensing urgent procedures without endangering the community with amplification of the diffusion chain. Ophthalmologists are considered at elevated risk of exposure when caring patients and vice versa, due to their close proximity during eye examination. High volumes of procedures typically generated by ophthalmologists with concurrent implications on the risk of infection are considered when re-assessing healthcare facilities reorganization. Conclusion: Containment measures in the event of pandemic due to infective agents should be well known by healthcare professionals and promptly applied in order to mitigate the risk of nosocomial transmission and outbreak

Scleral fixation of a single-piece foldable acrylic IOL through a 1.80 mm corneal incision

A new scleral fixation technique of a single-piece acrylic foldable intraocular lens (IOL) (enVista MX60, Bausch & Lomb, Inc.) through a 1.80 mm corneal incision, using the IOL eyelets as anchoring point, is described. It was a retrospective review of 26 cases. The preoperative mean corrected distance visual acuity was 0.51 \ub1 0.21 logarithm of the minimum angle of resolution (logMAR). It improved significantly to 0.25 \ub1 0.27 logMAR (P < .01), 0.18 \ub1 0.16 logMAR (P < .01), and 0.17 \ub1 0.16 logMAR (P < .01) (at 1 month, 3 months, and 6 months postoperatively, respectively, repeated measures analysis of variance, P < .0001). No astigmatism increase of more than 0.75 diopters was recorded at any time point. In all 26 patients, the IOL was well centered and stable for the entire monitoring period. No complications were observed during follow-up. Scleral fixation of the foldable IOL through a 1.80 mm corneal incision provided excellent IOL stability during the 6-month follow-up of this study and might be an effective and safe surgical technique

The Gaseous Extent of Galaxies and the Origin of \lya Absorption Systems. III. Hubble Space Telescope Imaging of \lya-Absorbing Galaxies at z < 1

We present initial results of a program to obtain and analyze HST WFPC2 images of galaxies identified in an imaging and spectroscopic survey of faint galaxies in fields of HST spectroscopic target QSOs. We measure properties of 87 galaxies, of which 33 are associated with corresponding \lya absorption systems and 24 do not produce corresponding \lya absorption lines to within sensitive upper limits. Considering only galaxy and absorber pairs that are likely to be physically associated and excluding galaxy and absorber pairs within 3000 \kms of the background QSOs leaves 26 galaxy and absorber pairs and seven galaxies that do not produce corresponding \lya absorption lines to within sensitive upper limits. Redshifts of the galaxy and absorber pairs range from 0.0750 to 0.8912 with a median of 0.3718, and impact parameter separations of the galaxy and absorber pairs range from 12.4 to $157.4 h^{-1}$ kpc with a median of $62.4 h^{-1}$ kpc. The primary result of the analysis is that the amount of gas encountered along the line of sight depends on the galaxy impact parameter and B-band luminosity but does not depend strongly on the galaxy average surface brightness, disk-to-bulge ratio, or redshift. This result confirms and improves upon the anti-correlation between \lya absorption equivalent width and galaxy impact parameter found previously by Lanzetta et al. (1995). There is no evidence that galaxy interactions play an important role in distributing tenuous gas around galaxies in most cases. Galaxies might account for all \lya absorption systems with $W > 0.3$ \AA, but this depends on the unknown luminosity function and gaseous cross sections of low-luminosity galaxies as well as on the uncertainties of the observed number density of \lya absorption systems.Comment: Minor changes. Figure 1 stays intact and is available at ftp://ftp.ess.sunysb.edu/pub/lanzetta/wfpc

Breakthrough pain in oncology: a longitudinal study.

Abstract CONTEXT: Existing studies on breakthrough pain (BP) have reported different prevalence rates because of different settings, populations, and assessment methods. These studies have used cross-sectional designs, and the relationship of BP with analgesic treatment has not been evaluated. OBJECTIVES: The aim of this study was to longitudinally assess BP in cancer patients admitted to oncology units. METHODS: A consecutive sample of patients admitted to oncology centers was selected. At admission (T0), three months after admission (T3), and six months after admission (T6), data on background pain and BP were recorded. BP was assessed in terms of its intensity, duration, number of episodes, onset with movement, spontaneous relief after stopping activity, limitation of physical activity, and effectiveness of analgesics. RESULTS: Three hundred two patients completed the study. At T0, T3, and T6, 39%, 38%, and 33% patients, respectively, had continuous pain (P=0.294). Pain intensity significantly decreased (P=0.004 and 0.027 at T3 and T6, respectively). Most patients had BP at T0 (87.1%), T3 (80.9%), and T6 (73.2%), and there was a significant decrease in the prevalence of BP over time (P=0.016). Of 149 patients with BP, pain on movement was recorded in 43.6%, 43.4%, and 32.4% at T0, T3, and T6, respectively (P=0.228). Pain spontaneously decreased or ceased when stopping physical activity in 66%, 56%, and 62% at T0, T3, and T6, respectively (P=0.537). Pain on movement strongly limited physical activity in most patients. CONCLUSION: These data expand current information about BP and underline the need for a longitudinal assessment of a phenomenon that is invariably dependent on stage of disease, patient, and therapeutic factors

On ionisation effects and abundance ratios in damped Lyman-alpha systems

The similarity between observed velocity structures of Al III and singly ionised species in damped Lyman-alpha systems (DLAs) suggests the presence of ionised gas in the regions where most metal absorption lines are formed. To explore the possible implications of ionisation effects we construct a simplified two-region model for DLAs consisting of an ionisation bounded region with an internal radiation field and a neutral region with a lower metal content. Within this framework we find that ionisation effects are important. If taken into account, the element abundance ratios in DLAs are quite consistent with those observed in Milky Way stars and in metal-poor H II regions in blue compact dwarf galaxies. In particular we cannot exclude the same primary N origin in both DLAs and metal-poor galaxies. From our models no dust depletion of heavy elements needs to be invoked; little depletion is however not excluded.Comment: to appear in "Evolution of Galaxies. I. Observational clues", Eds. J.M. Vilchez, G. Stasinska, Astrophysics and Space Science, in press. 5 pages, including 3 figure