Bilateral Ultrathin Descemet's Stripping Automated Endothelial Keratoplasty vs. Bilateral Penetrating Keratoplasty in Fuchs' Dystrophy: Corneal Higher-Order Aberrations, Contrast Sensitivity and Quality of Life

Background and Objectives: The objective of this paper is to compare the visual outcomes and quality of life (QoL) after bilateral ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK) with bilateral penetrating keratoplasty (PK) for Fuchs' endothelial dystrophy (FED). Materials and Methods: Retrospective comparative cohort study, including 11 patients with FED who underwent bilateral PK and 13 patients with FED who underwent bilateral UT-DSAEK. All patients were already pseudophakic or had undergone a combined cataract procedure. The main outcomes were corrected distance visual acuity (CDVA) corneal higher-order aberrations (HOAs), contrast sensitivity (CS) and quality of life (QoL). Results: The mean follow-up after the second eye surgery was 32.5 ± 10.2 months in PK and 19.6 ± 8.6 months in UT-DSAEK patients. The CDVA in the UT-DSAEK group was significantly better than in the PK one (0.18 ± 0.07 vs. 0.35 ± 0.16 logMAR, p < 0.0001). The mean anterior corneal total HOAs of the central 5 mm were significantly lower in UT-DSAEK eyes than in PK eyes (0.438 ± 0.078 and 1.282 ± 0.330 respectively, p < 0.0001), whilst the mean posterior total HOAs did not differ between groups (0.196 ± 0.056 and 0.231 ± 0.089 , respectively, p = 0.253). The CS was lower at 0.75 and 1.5 cycles/degree in P the K group when compared to the DSAEK one (p = 0.008 and 0.005, respectively). The QoL scores by the NEI RQL-42 test exhibited better values in DSAEK patients in 9 out of 13 scales. Conclusion: Our study confirms that UT-DSAEK provides a better visual function in terms of CDVA and CS, together with lower HOAs, when compared to PK. Hence, the vision-related QoL, binocularly evaluated by the NEI RQL-42 items, indicates a higher satisfaction in UT-DSAEK eyes

Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP)

Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of "indirect" and "direct" cardiac and pulmonary lung ultrasound signs

Does Workers’ Compensation Status Affect Outcomes after Lumbar Spine Surgery? : A Systematic Review and Meta-Analysis

Low back pain (LBP) is currently the leading cause of disability worldwide and the mostcommon reason for workers’ compensation (WC) claims. Studies have demonstrated that receivingWC is associated with a negative prognosis following treatment for a vast range of health conditions.However, the impact of WC on outcomes after spine surgery is still controversial. The aim of thismeta-analysis was to systematically review the literature and analyze the impact of compensationstatus on outcomes after lumbar spine surgery. A systematic search was performed on Medline,Scopus, CINAHL, EMBASE and CENTRAL databases. The review included studies of patientsundergoing lumbar spine surgery in which compensation status was reported. Methodologicalquality was assessed through ROBINS-I and quality of evidence was estimated using the GRADErating. A total of 26 studies with a total of 2668 patients were included in the analysis. WC patientshad higher post-operative pain and disability, as well as lower satisfaction after surgery whencompared to those without WC. Furthermore, WC patients demonstrated to have a delayed return towork. According to our results, compensation status is associated with poor outcomes after lumbarspine surgery. Contextualizing post-operative outcomes in clinical and work-related domains helpsunderstand the multifactorial nature of the phenomenon.Peer reviewe

Is Ranibizumab effective in stopping the loss of vision for Choroidal Neovascularization in Pathologic Myopia? A Long Term Follow-up Study

International audiencePurpose: To assess the efficacy and safety of Ranibizumab in the treatment of choroidal neovascularization (CNV) caused by pathologic myopia (PM). Design: Prospective, multicenter, interventional case series. Methods: 40 of 39 consecutive patients with PM and CNV were treated with "on-demand" intravitreal injection of ranibizumab 0.5 mg. Final best-corrected VA (BCVA) and its change from baseline were the main outcome measures. Changes in Optical Coherence Tomography (OCT) central retinal thickness (CRT) were a secondary outcome. Results: Mean age was 53 ± 13 years, mean refractive error -13.5 ± 6.5 diopters. Median follow-up was 13.3 ± 2 months (range 12 - 18). Fifteen eyes (37.5%) had previously been treated with photodynamic therapy (PDT). The mean baseline logMAR BCVA (ETDRS vision chart) was 0.68 ± 0.34 (Snellen equivalent 20/131) and 21 ± 16 letters. The final mean logMAR BCVA was 0.27 ± 0.2 (p 0.008) (20/42) and 40.5 ± 14 letters (p 0.01). Mean final VA improved in 82.5% of patients, in 60% by 3 or more lines,(median number of lines gained 2.9). Even six out of seven cases of low vision (≤ 1.1 LogMAR) at the final examination improved vision. Mean OCT CRT reduced from 218±70 μm to 175±46 μm (p 0.02). Age and previous PDT did not influence results (p›0,05). The mean number of injection was 2.8 ± 1.2 (range 1-6). No ocular or systemic side effects were observed. Conclusion: Ranibizumab was an effective treatment for stabilizing and improving vision in 92.5 % of myopic CNV in a long term follow-up with a low number of injections

Impact of Metabolic Syndrome on Coronary Microvascular Dysfunction: A Single Center Experience

Coronary microvascular dysfunction (CMD) represents a widespread condition and a prevalent cause of ischemic heart disease. Total TIMI frame count (TTFC) can be a good indicator of CMD in different populations. The aim of our study was to evaluate the incidence of CMD in different populations such as METS patients compared with diabetic and hypertensive patients. The study was carried out on patients with chest pain and/or positive stress test and angiographically undamaged coronary arteries. Our CMD population was divided into three subgroups; patients with arterial hypertension, patients with type II diabetes mellitus and patients with metabolic syndrome. TIMI Frame Count (TFC) and Myocardial Blush Grade (MBG) are indices used to evaluate the degree of microcirculatory dysfunction, in particular the TIMI frame count and the Myocardial Blush degree. Patients with Mets had worse coronary perfusion indices with a higher TFC than the hypertensive population (LAD TFC 33.1 ± 5.6 vs 28.4 ± 5.6 p = 0.018), (TFC RCA 27.2 ± 5.2 vs 23.1 ± 5.2 p = 0.014) (TFC CX 27.9 ± 5.4 vs 26.9 ± 5.4 p = 0.03). However, no differences were found in the three coronary vessels in terms of MBG which, however, was reduced in both groups (7.1 ± 0.49 versus 7.1 ± 0.6 p-value = 0.04). According to the TTFC patients with Mets had worse coronary perfusion than patients with type II diabetes (LAD TFC 33.1 ± 5.6 vs 30.6 ± 6.2 p = 0.04), (TFC RCA 27, 2 ± 5.2 vs 25 ± 5.3 p = 0.02), (TFC CX 27.9 ± 5.4 vs 27.2 ± 5.6 p = 0.05) while MBG was lower in patients with diabetes. In our study, we observed that patients with MetS had slower coronary blood flow using TFC imaging technique analysis than diabetic or hypertensive patients. These indices could help in the diagnosis and management of CMD

Genetic and environmental factors in human osteoporosis from Sub-Saharan to Mediterranean areas

The aim of this study was to determine the prevalence of known gene polymorphisms associated with osteoporosis in postmenopausal normal women from Burkina Faso and Sicily, compared to postmenopausal Sicilian women with osteoporosis, and to establish the weight of environmental factors in the mechanism of osteoporosis. Bone mass density (BMD) was measured by phalangeal quantitative ultrasound (QUS) in Burkinabe woman and by the dual X-ray absorptiometry at the femoral neck in Sicilian women. The polymorphisms of the vitamin D receptor (VDR) gene, estrogen receptor (ESR) gene, calcitonin receptor (CTR) gene and COL1A1 collagen gene were characterized by PCR. The social characteristics of studied women were evaluated by a specific questionnaire. The observed percentages of single specific polymorphisms did not differ from that expected with exception of VDR B allele and ESR X and P allele in Burkinabe and Sicilian women, respectively. Association analyses and multivariate two-step regression model of social and molecular parameters, demonstrated that in comparison to the VDR, ESR, CTR polymorphisms, physical activities and healthy diet, associated with outdoor work are the best favourable prognostic factors for osteoporosis. A diet rich in calcium, other minerals and vitamin D in association with physical activity represents the most effective way to maintain not only a healthy bone structure but also an acceptable BMD. This is particularly true for Sub-Saharan women

Infracyanine Green vs. Brilliant Blue G in Inverted Flap Surgery for Large Macular Holes: A Long-Term Swept-Source OCT Analysis

Background and Objectives: To compare the long-term toxicity of infracyanine green (IFCG) to brilliant blue G (BBG) in inverted internal limiting membrane flap surgery (I-ILMFS) for large, full-thickness macular holes (FTMHs). Materials and Methods: Prospective randomized study including 39 eyes with ≥ 400 µm idiopathic FTMH who underwent I-ILMFS with either IFCG or BBG. Postoperative 6- and 12-month corrected distance visual acuity (CDVA), closure rate, and swept-source optical coherence tomography parameters, including ellipsoid zone (EZ) and external limiting membrane (ELM) mean defect length, central foveal thicknesses (CFT), parafoveal macular thickness (MT), ganglion cells and inner plexiform layer (GCL++) thickness, and peripapillary nerve fiber layer (pRNFL) thickness, were compared. Results: Nineteen eyes were included in the IFCG group and 20 eyes in the BBG group. In all cases a FTMH closure was found. CDVA improved at 6 and 12 months in both groups (p < 0.0005); the increase at 12 months was greater in the BBG group (p = 0.036). EZ and ELM defects did not differ between groups at either follow-up time. CFT at 12 months was greater in the BBG group (p = 0.041). A 12-months compared to 6-months MT decrease was present in both groups (p < 0.01). The GCL++ superior inner sector was thicker in the BBG group at 12 months (p = 0.036), as were the superior outer sector (p = 0.039 and p = 0.027 at 6 and 12 months, respectively) and inferior outer sector (p = 0.011 and p = 0.009 at 6 and 12 months, respectively). Conclusion: In our study BBG in I-ILMFS exhibits better long-term CDVA and retinal thickness than does IFCG, suggesting a lesser toxicity from BBG. These findings support the use of BBG over IFCG in I-ILMFS

Statistical Analysis of Mineral Concentration for the Geographic Identification of Garlic Samples from Sicily (Italy), Tunisia and Spain

We performed a statistical analysis of the concentration of mineral elements, by means of inductively coupled plasma mass spectrometry (ICP-MS), in different varieties of garlic from Spain, Tunisia, and Italy. Nubia Red Garlic (Sicily) is one of the most known Italian varieties that belongs to traditional Italian food products (P.A.T.) of the Ministry of Agriculture, Food, and Forestry. The obtained results suggest that the concentrations of the considered elements may serve as geographical indicators for the discrimination of the origin of the different samples. In particular, we found a relatively high content of Selenium in the garlic variety known as Nubia red garlic, and, indeed, it could be used as an anticarcinogenic agent

Endoscopic therapy of weight regain after bariatric surgery

Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological, anatomical and metabolic factors. Surgical revision of these patients has significant risks and limited benefits. Endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective, safe, less invasive and even reproducible treatment. We herein discuss the indication, selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery. Future research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery