3,473 research outputs found
DepĂłsitos marinos del Cuaternario antiguo (?) sobre la cuarzita armoricana del Cabo Torres (GijĂłn).
Depto. de GeodinĂĄmica, EstratigrafĂa y PaleontologĂaFac. de Ciencias GeolĂłgicasFALSEpu
Ab interno trabecular bypass surgery with Schlemm´s canal microstent (Hydrus) for open angle glaucoma
Background:
Glaucoma is a leading cause of irreversible blindness. A number of minimallyâinvasive surgical techniques have been introduced as a treatment to prevent glaucoma from progressing; ab interno trabecular bypass surgery with the Schlemm's canal Hydrus microstent is one of them.
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Objectives:
To evaluate the efficacy and safety of ab interno trabecular bypass surgery with the Hydrus microstent in treating people with open angle glaucoma (OAG).
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Search methods:
On 7 May 2019, we searched CENTRAL (2019, Issue 5), which contains the Cochrane Eyes and Vision Trials Register; Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov; and the WHO ICTRP.
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Selection criteria:
We searched for randomised controlled trials (RCTs) of the Hydrus microstent, alone or with cataract surgery, compared to other surgical treatments (cataract surgery alone, other minimallyâinvasive glaucoma device techniques, trabeculectomy), laser treatment, or medical treatment.
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Data collection and analysis:
A minimum of three authors independently extracted data from reports of included studies, using a data collection form and analysed data, based on standard Cochrane methods.
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Main results:
We included three published studies, with 808 people randomised. Two studies had multiple international recruitment centres in the USA and other countries. The third study had several sites based in Europe. All three studies were sponsored by the Hydrus manufacturer Ivantis Inc. All studies included participants with mainly mild or moderate OAG (mean deviation between â3.6 dB (decibel) and â8.4 dB in all study arms), which was controlled with medication in many participants (mean medicated intraocular pressure (IOP) 17.9 mmHg to 19.1 mmHg). There were no concerns regarding allocation concealment bias, but masking of outcome assessors was high or unclear risk in all studies; masking of participants was achieved, and losses to followâup were not a concern.
Two studies compared the Hydrus microstent combined with cataract surgery to cataract surgery alone, in participants with visually significant cataracts and OAG.
We found moderateâcertainty evidence that adding the Hydrus microstent to cataract surgery increased the proportion of participants who were medicationâfree from about half to more than three quarters at 12âmonth, shortâterm followâup (risk ratio (RR) 1.59, 95% confidence interval (CI) 1.39 to 1.83; 2 studies, 639 participants; I² = 0%; and 24âmonth, mediumâterm followâup (RR 1.63, 95% CI 1.40 to 1.88; 2 studies, 619 participants; I² = 0%).
The Hydrus microstent combined with cataract surgery reduced the mediumâterm mean change in unmedicated IOP (after washout) by 2 mmHg more compared to cataract surgery alone (mean difference (MD) â2.00, 95% CI â2.69 to â1.31; 2 studies, 619 participants; I² = 0%; moderateâcertainty evidence), and the mean change in IOPâlowering drops (MD â0.41, 95% CI â0.56 to â0.27; 2 studies, 619 participants; I² = 0%; lowâcertainty evidence). We also found lowâcertainty evidence that adding a Hydrus microstent to cataract surgery reduced the need for secondary glaucoma surgery from about 2.5% to less than 1% (RR 0.17, 95% CI 0.03 to 0.86; 2 studies, 653 participants; I² = 27%; lowâcertainty evidence).
Intraocular bleeding, loss of 2 or more visual acuity (VA) lines, and IOP spikes of 10 mmHg or more were rare in both groups; estimates were imprecise, and included both beneficial and harmful effects. There were no cases of endophthalmitis in either group.
No data were available on the proportion of participants achieving IOP less than 21 mmHg, 17 mmHg, or 14 mmHg; healthârelated quality of life (HRQOL), or visual field progression.
One study provided shortâterm data for the Hydrus microstent compared with the iStent trabecular microâbypass stent (iStent: implantation of two devices in a single procedure) in 152 participants with OAG (148 in analyses). Use of the Hydrus increased the proportion of medicationâfree participants from about a quarter to about half compared to those who received iStent, but this estimate was imprecise (RR 1.94, 95% CI 1.21 to 3.11; lowâcertainty evidence). Use of the Hydrus microstent reduced unmedicated IOP (after washout) by about 3 mmHg more than the iStent (MD â3.10, 95% CI â4.17 to â2.03; moderateâcertainty evidence), and the use of IOPâlowering medication (MD â0.60, 95% CI â0.99 to â0.21; lowâcertainty evidence). Both devices achieved a final IOP < 21 mmHg in most participants (Hydrus microstent: 91.8%; iStent: 84%; RR 1.09, 95% CI 0.97 to 1.23; lowâcertainty evidence).
None of the participants who received the Hydrus microstent (N = 74) required additional glaucoma surgery; two participants who received the iStent (N = 76) did.
Few adverse events were found in either group.
No data were available on the proportion of participants achieving IOP less than 17 mmHg or 14 mmHg, or on HRQOL.
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Authors' conclusions:
In people with cataracts and generally mild to moderate OAG, there is moderateâcertainty evidence that the Hydrus microstent with cataract surgery compared to cataract surgery alone, likely increases the proportion of participants who do not require IOP lowering medication, and may further reduce IOP at shortâ and mediumâterm followâup.
There is moderateâcertainty evidence that the Hydrus microstent is probably more effective than the iStent in lowering IOP of people with OAG in the shortâterm.
Few studies were available on the effects of the Hydrus microstent, therefore the results of this review may not be applicable to all people with OAG, particularly in selected people with medically uncontrolled glaucoma, since IOP was controlled with medication in many participants in the included studies. Complications may be rare using the Hydrus microstent, as well as the comparator iStent, but larger studies are needed to investigate its safety
Lengthâweight relationships of bivalve species in Italian razor clam Ensis minor (Chenu, 1843) (Mollusca: Bivalvia) fishery
Lengthâweight relationships of bivalve species collected during razor clam (Ensis minor) surveys along Italian coastal waters (Northern Adriatic and Tyrrhenian Sea) in the 3-year period 2016â2018 are reported. A total of 13,588 individuals, belonging to 12 bivalve species and 20 populations between the Adriatic and Tyrrhenian Seas, were sampled for this study. Analyzing growth parameters for each population, we found 11 allometries and nine isometries. About half of the species investigated showed different growth characteristics between the two areas
Pots vs trammel nets: A catch comparison study in a Mediterranean small-scale fishery
Passive bottom-set nets are the most widely used fishing gears in Mediterranean small-scale fisheries (SSFs). Trammel nets, in particular, have key advantages such as their ease of use and handling and high capture efficiency for numerous commercial species. However, they entail high discard rates (5\u201344% of the total catch) connected to high mortality, thus exerting an adverse impact on benthic communities, besides catching individuals of commercial species under the minimum conservation reference size (MCRS) and specimens of protected species. Fish pots are seen as alternative and a more sustainable gear type that allow reducing discards in SSFs. In this study, a collapsible pot was tested at three coastal sites in the north-western Adriatic Sea (GFCM GSA 17) to compare its catch efficiency with that of the local traditional trammel nets. Data analysis demonstrated a similar catch efficiency for the commercial species, both among sites and as a whole. Moreover, the trammel net caught a larger amount of discards, both in terms of species number and of CPUEW. The catch comparison study involved the two most abundant landed species, common cuttlefish Sepia officinalis and annular sea bream Diplodus annularis. The pots were more effective for S. officinalis, whereas the trammel net was more effective for the shorter length classes for D. annularis, which were mostly under the MCRS (12 cm). The innovative pots could provide a valuable alternative to the trammel nets traditionally used in the Adriatic Sea, at least in certain areas and periods. Their main advantages include that they do not require a different rigging and they can be used without bait, while their foldable design allows large numbers to be easily loaded on board SSF vessels. The results of this pilot study indicate that pots can achieve the objectives of reducing discards and bycatch in SSFs without penalizing the catch of commercial species
Subpicosecond photoinduced Stark spectroscopy in fullerene-based devices
Published versio
Ascorbic acid (RedoxonÂŽ) supplementation modulates gene expression in peripheral blood mononuclear cells specifically upon an inflammatory stimulus. A pilot study
Hidradenitis suppurativa: guidelines of the Italian Society of Dermatology and Venereology (SIDeMaST) for the use of anti-TNF-Îą agents.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by nodules, abscesses and sinus tracts, primarily affecting the intertriginous areas. The occlusion of the upper part of the folliculopilosebaceous unit, leading to rupture of the sebofollicular canal with the consequent development of perifollicular lympho-histiocytic inflammation, is believed to be the initial pathogenic event in HS. Giving the chronic nature of HS, its destructive impact on social, working and daily life of patients, its management is often frustrating both for patients and physicians. The HS treatment choices are influenced by disease severity and its individual subjective impact. In this article, the Board of the Italian Society of Dermatology and Venereology (SIDeMaST) on HS has prepared a document focusing on the role of biologic drugs (anti-TNF-Îą) in HS management, providing also a flow-chart for HS handling and the inclusion and exclusion criteria for HS treatment with anti-TNF-Îą
Gravitational radiation from precessing accretion disks in gamma-ray bursts
We study the precession of accretion disks in the context of gamma-ray burst
inner engines. Our aim is to quantitatively estimate the characteristics of
gravitational waves produced by the precession of the transient accretion disk
in gamma-ray bursts. We evaluate the possible periods of disk precession caused
by the Lense-Thirring effect using an accretion disk model that allows for
neutrino cooling. Assuming jet ejection perpendicular to the disk plane and a
typical intrinsic time-dependence for the burst, we find gamma-ray light curves
that have a temporal microstructure similar to that observed in some reported
events. The parameters obtained for the precession are then used to evaluate
the production of gravitational waves. We find that the precession of accretion
disks of outer radius smaller than cm and accretion rates above 1 solar
mass per second could be detected by Advanced LIGO if they occur at distances
of less than 100 Mpc. We conclude that the precession of a neutrino-cooled
accretion disk in long gamma-ray bursts can be probed by gravitational wave
astronomy. Precession of the disks in short gamma-ray events is undetectable
with the current technology.Comment: 5 pages, 5 figures, accepted for publication in A&
Optic nerve head and fibre layer imaging for diagnosing glaucoma
Background
The diagnosis of glaucoma is traditionally based on the finding of optic nerve head (ONH) damage assessed subjectively by ophthalmoscopy or photography or by corresponding damage to the visual field assessed by automated perimetry, or both. Diagnostic assessments are usually required when ophthalmologists or primary eye care professionals find elevated intraocular pressure (IOP) or a suspect appearance of the ONH. Imaging tests such as confocal scanning laser ophthalmoscopy (HRT), optical coherence tomography (OCT) and scanning laser polarimetry (SLP, as used by the GDx instrument), provide an objective measure of the structural changes of retinal nerve fibre layer (RNFL) thickness and ONH parameters occurring in glaucoma.
Objectives
To determine the diagnostic accuracy of HRT, OCT and GDx for diagnosing manifest glaucoma by detecting ONH and RNFL damage.
Search methods
We searched several databases for this review. The most recent searches were on 19 February 2015.
Selection criteria
We included prospective and retrospective cohort studies and case-control studies that evaluated the accuracy of OCT, HRT or the GDx for diagnosing glaucoma. We excluded population-based screening studies, since we planned to consider studies on self-referred people or participants in whom a risk factor for glaucoma had already been identified in primary care, such as elevated IOP or a family history of glaucoma. We only considered recent commercial versions of the tests: spectral domain OCT, HRT III and GDx VCC or
Data collection and analysis
We adopted standard Cochrane methods. We fitted a hierarchical summary ROC (HSROC) model using the METADAS macro in SAS software. After studies were selected, we decided to use 2 x 2 data at 0.95 specificity or closer in meta-analyses, since this was the most commonly-reported level.
Main results
We included 106 studies in this review, which analysed 16,260 eyes (8353 cases, 7907 controls) in total. Forty studies (5574 participants) assessed GDx, 18 studies (3550 participants) HRT, and 63 (9390 participants) OCT, with 12 of these studies comparing two or three tests. Regarding study quality, a case-control design in 103 studies raised concerns as it can overestimate accuracy and reduce the applicability of the results to daily practice. Twenty-four studies were sponsored by the manufacturer, and in 15 the potential conflict of interest was unclear.
Comparisons made within each test were more reliable than those between tests, as they were mostly based on direct comparisons within each study. The Nerve Fibre Indicator yielded the highest accuracy (estimate, 95% confidence interval (CI)) among GDx parameters (sensitivity: 0.67, 0.55 to 0.77; specificity: 0.94, 0.92 to 0.95). For HRT measures, the Vertical Cup/Disc (C/D) ratio (sensitivity: 0.72, 0.60 to 0.68; specificity: 0.94, 0.92 to 0.95) was no different from other parameters. With OCT, the accuracy of average RNFL retinal thickness was similar to the inferior sector (0.72, 0.65 to 0.77; specificity: 0.93, 0.92 to 0.95) and, in different studies, to the vertical C/D ratio.
Comparing the parameters with the highest diagnostic odds ratio (DOR) for each device in a single HSROC model, the performance of GDx, HRT and OCT was remarkably similar. At a sensitivity of 0.70 and a high specificity close to 0.95 as in most of these studies, in 1000 people referred by primary eye care, of whom 200 have manifest glaucoma, such as in those who have already undergone some functional or anatomic testing by optometrists, the best measures of GDx, HRT and OCT would miss about 60 cases out of the 200 patients with glaucoma, and would incorrectly refer 50 out of 800 patients without glaucoma. If prevalence were 5%, e.g. such as in people referred only because of family history of glaucoma, the corresponding figures would be 15 patients missed out of 50 with manifest glaucoma, avoiding referral of about 890 out of 950 non-glaucomatous people.
Heterogeneity investigations found that sensitivity estimate was higher for studies with more severe glaucoma, expressed as worse average mean deviation (MD): 0.79 (0.74 to 0.83) for MD < -6 db versus 0.64 (0.60 to 0.69) for MD >=-6 db, at a similar summary specificity (0.93, 95% CI 0.92 to 0.94 and, respectively, 0.94; 95% CI 0.93 to 0.95; P < 0.0001 for the difference in relative DOR).
Authors' conclusions
The accuracy of imaging tests for detecting manifest glaucoma was variable across studies, but overall similar for different devices. Accuracy may have been overestimated due to the case-control design, which is a serious limitation of the current evidence base.
We recommend that further diagnostic accuracy studies are carried out on patients selected consecutively at a defined step of the clinical pathway, providing a description of risk factors leading to referral and bearing in mind the consequences of false positives and false negatives in the setting in which the diagnostic question is made. Future research should report accuracy for each threshold of these continuous measures, or publish raw data
An overview of bottom trawl selectivity in the Mediterranean Sea
In the Mediterranean Sea, where bottom trawling for demersal species is the most important fishery in terms of landings, around 75% of the assessed fish stocks are overfished. Its status as one of the worldâs most heavily exploited seas and the one subject to the highest trawling pressure has become a global concern. An extensive overview of bottom trawl selectivity studies was performed to assess the sustainability of this fishery in the Mediterranean. The selectivity parameters were collected from 93 peer-reviewed publications from 10 countries, totalling 742 records and 65 species. Our review highlighted that i) the catch of the bottom trawls commonly employed in the Mediterranean, although they comply with current codend mesh regulations, still includes immature individuals of 64-68% of the species investigated, and individuals under the minimum conservation reference size (MCRS) of 78% of the species investigated, and that ii) the MCRS set for 59% of the species analysed is well below their length at first maturity and is therefore ecologically inadequate. Although square-mesh codends are slightly more selective, the models developed herein demonstrate that improving size and species selectivity would require considerably larger meshes, which may significantly reduce profitability. The urgent need to mitigate the biological impacts of bottom trawling in the Mediterranean should be addressed by promoting the adoption of more ecologically sustainable fishing gears through the introduction of more selective meshes or of gear modifications
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