Chronic Central Serous Chorioretinopathy with Pigment Epithelium Detachment Treated with Sildenafil: A Case Report

Central serous chorioretinopathy (CSCR) is a retinal disease that may be complicated by the development of serous retinal pigment epithelial detachment (PED). The exact molecular mechanisms of CSCR have remained uncertain as well as there is no effective medical therapy. Herein, we describe a case of a 43-year-old male suffering from chronic CSCR with PED and visual acuity reduction (20/40) that showed improvement in visual acuity (20/25) and metamorphopsia 2 weeks after daily intake of 20 mg sildenafil tablets. Optical coherence tomography (OCT) scan showed resolution of PED with residual degeneration of the photoreceptor inner and outer segment layer and retinal pigmented epithelium. The patient continued treatment with sildenafil 20 mg for 2 months. Six months after the discontinuation of therapy, visual acuity was maintained, with absence of PED at OCT. Our case supports the hypothesis that phosphodiesterase type 5 (PDE-5) inhibitors may be an alternative in the treatment of patients with CSCR, alone or combined with other medications

Spinal cord atrophy in a primary progressive multiple sclerosis trial: Improved sample size using GBSI

Background: We aimed to evaluate the implications for clinical trial design of the generalised boundary-shift integral (GBSI) for spinal cord atrophy measurement. / Methods: We included 220 primary-progressive multiple sclerosis patients from a phase 2 clinical trial, with baseline and week-48 3DT1-weighted MRI of the brain and spinal cord (1 × 1 × 1 mm3), acquired separately. We obtained segmentation-based cross-sectional spinal cord area (CSA) at C1-2 (from both brain and spinal cord MRI) and C2-5 levels (from spinal cord MRI) using DeepSeg, and, then, we computed corresponding GBSI. / Results: Depending on the spinal cord segment, we included 67.4–98.1% patients for CSA measurements, and 66.9–84.2% for GBSI. Spinal cord atrophy measurements obtained with GBSI had lower measurement variability, than corresponding CSA. Looking at the image noise floor, the lowest median standard deviation of the MRI signal within the cerebrospinal fluid surrounding the spinal cord was found on brain MRI at the C1-2 level. Spinal cord atrophy derived from brain MRI was related to the corresponding measures from dedicated spinal cord MRI, more strongly for GBSI than CSA. Spinal cord atrophy measurements using GBSI, but not CSA, were associated with upper and lower limb motor progression. / Discussion: Notwithstanding the reduced measurement variability, the clinical correlates, and the possibility of using brain acquisitions, spinal cord atrophy using GBSI should remain a secondary outcome measure in MS studies, until further advancements increase the quality of acquisition and reliability of processing

Longitudinal tear protein changes correlate with ocular chronic gvhd development in allogeneic hematopoietic stem cell transplant patients

Ocular graft-versus-host disease (oGVHD) is a manifestation of chronic GVHD, frequently occurring in patients after allogeneic hematopoietic stem cell transplant (HSCT). We analyzed tear protein changes before and after allogeneic HSCT, and correlated their levels with the oGVHD development. This retrospective study included 102 patients, and data were recorded before the conditioning treatment, and after 3 to 6 months postoperatively. Tear protein analysis was performed with the Agilent-2100 Bioanalyzer on individual tears sampled by aspiration. Total protein (TP), Lysozyme-C (LYS-C), Lactoferrin (LACTO), Lipocalin-1 (LIPOC-1), Transferrin (TRANSF), Albumin (ALB), and Zinc-alpha-2-glycoprotein (ZAG-2) levels were retrieved and statistically analyzed. Following HSCT forty-three patients developed oGVHD. TP, LACTO, LYS-C, and ZAG-2 levels significantly decreased post-HSCT as compared to pre HSCT levels. In univariate analysis, TP, LACTO, and ZAG-2 decrease was associated with an increased development of oGVHD (OR = 4.49; 95% CI, 1.9 to 10.5; p < 0.001; OR = 3.08; 95% CI 1.3 to 7.6; p = 0.01; OR = 11.1; 95% CI 2.7 to 46.6; p < 0.001, respectively). TRANSF post-HSCT levels significantly increased (OR 15.7; 95% CI, 4.1 to 52.2; p = 0.0001). No pre-post-HSCT changes were shown in ALB and LIPOC-1 levels. Data suggest that TP content, LACTO, TRANSF, and ZAG-2 pre-post changes might be significant predictors of oGVHD development

Simulating Turing Machines with Polarizationless P Systems with Active Membranes

We prove that every single-tape deterministic Turing machine working in t(n) t(n) time, for some function t:N→N t:N→N , can be simulated by a uniform family of polarizationless P systems with active membranes. Moreover, this is done without significant slowdown in the working time. Furthermore, if logt(n) log⁡t(n) is space constructible, then the members of the uniform family can be constructed by a family machine that uses O(logt(n)) O(log⁡t(n)) space.Ministerio de Economía y Competitividad TIN2012-3743

Managing Health and Well-Being in SMEs through an Adviceline: A Typology of Managerial Behaviours

Despite evidence supporting the application of health and well-being policies and practices in the workplace, small and medium-sized enterprises (SMEs) still struggle to manage health at work. To address this gap, this research explores the role of a new occupational health (OH) adviceline assisting and managing health at work within SMEs. From our qualitative data we develop a typology of managerial response patterns, which can be summarised into four behavioural types: business case behaviour, social model behaviour, protective behaviour, and avoidant behaviour. The study posits that both the business case and the social justice arguments need to be acknowledged while implementing and managing health and well-being initiatives in SMEs. However, the combination of these two models is very difficult to achieve, and in addition to an OH adviceline, other interventions need to be implemented to support SMEs

Importance of tides for periastron precession in eccentric neutron star-white dwarf binaries

Although not nearly as numerous as binaries with two white dwarfs, eccentric neutron star-white dwarf (NS-WD) binaries are important gravitational-wave (GW) sources for the next generation of space-based detectors sensitive to low frequency waves. Here we investigate periastron precession in these sources as a result of general relativistic, tidal, and rotational effects; such precession is expected to be detectable for at least some of the detected binaries of this type. Currently, two eccentric NS-WD binaries are known in the galactic field, PSR J1141-6545 and PSR B2303+46, both of which have orbits too wide to be relevant in their current state to GW observations. However, population synthesis studies predict the existence of a significant Galactic population of such systems. Though small in most of these systems, we find that tidally induced periastron precession becomes important when tides contribute to more than 3% of the total precession rate. For these systems, accounting for tides when analyzing periastron precession rate measurements can improve estimates of the inferred WD component mass and, in some cases, will prevent us from misclassifying the object. However, such systems are rare, due to rapid orbital decay. To aid the inclusion of tidal effects when using periastron precession as a mass measurement tool, we derive a function that relates the WD radius and periastron precession constant to the WD mass.Facultad de Ciencias Astronómicas y Geofísica

Emerging properties of financial time series in the “Game of Life”

We explore the spatial complexity of Conway’s “Game of Life,” a prototypical cellular automaton by means of a geometrical procedure generating a two-dimensional random walk from a bidimensional lattice with periodical boundaries. The one-dimensional projection of this process is analyzed and it turns out that some of its statistical properties resemble the so-called stylized facts observed in financial time series. The scope and meaning of this result are discussed from the viewpoint of complex systems. In particular, we stress how the supposed peculiarities of financial time series are, often, overrated in their importance

Acute kidney injury and acute kidney disease in high-dose cisplatin-treated head and neck cancer

Background: In locally advanced head and neck squamous cell carcinoma (LA-SCCHN) at least 200mg/m2 (standard dose 300 mg/m2) of cisplatin concomitant with radiotherapy represents the standard of care, both in postoperative and conservative settings. Nevertheless, high dose administration every 3 weeks is often replaced with low dose weekly cisplatin to avoid toxicities like kidney injury, though often failing to reach the therapeutic dose. Our aim was to investigate the incidence of renal impairment in the real-life setting, integrating high dose cisplatin with adequate supportive therapy, and to explore both Acute Kidney Injury (AKI) and Acute Kidney Disease (AKD), a recently described clinical renal syndrome that encompasses functional alterations of the kidney lasting fewer than 3 months. Methods: One hundred and nine consecutive patients affected by LA-SCCHN and treated with at least a cumulative dosage of 200 mg/m2 of cisplatin concomitant with radiotherapy were enrolled in this prospective observational study. Results: AKI was reported in 12.8% of patients, 50% of whom were stage 1 (KDIGO criteria), while 25.7% of the cohort developed AKD. Patients with baseline estimated Glomerular Filtration Rate (eGFR) < 90 ml/min showed a higher incidence of AKD (36.2% vs 17.7%). Hypertension, baseline eGFR, and therapy with Renin-angiotensin-aldosterone system inhibitors proved to be significant factors associated with both AKI and AKD. Conclusion: AKI and AKD are not rare complications of high-dose cisplatin, but an appropriate prevention strategy and accurate monitoring of patients during treatment could lead to a reduction of the burden of these conditions