Challenges in Diabetic Macular Edema Management: An Expert Consensus Report

Purpose: This paper aimed to present daily-practice recommendations for the management of diabetic macular edema (DME) patients based on available scientific evidence and the clinical experience of the consensus panel. Methods: A group of Spanish retina experts agreed to discuss different aspects related with the clinical management of DME patients. Results: Panel was mainly focused on therapeutic objectives in DME management; defini-tion terms; and role of biomarkers as prognostic and predictive factors to intravitreal treatment response. The panel recommends to start DME treatment as soon as possible in those eyes with a visual acuity less than 20/25 (always according to the retina unit capacity). Naive patient was defined, in a strict manner, as a patient who, up to that moment, had never received any treatment. A refractory DME patient may be defined as the one who did not achieve a complete resolution of the disease, regardless of the treatment administered. Different optical coherence tomography biomarkers, such as disorganization of the retinal inner layers, hyperreflective dots, and cysts, have been identified as prognostic factors. Conclusion: This document has sought to lay down a set of recommendations and to identify key issues that may be useful for the daily management of DME patients

A Multiple Stakeholder Multicriteria Decision Analysis in Diabetic Macular Edema Management: The MULTIDEX‑EMD Study

Background The clinical and economic management of retinal diseases has become more complex following the introduction of new intravitreal treatments. Multicriteria decision analysis (MCDA) offers the potential to overcome the challenges associated with traditional decision-making tools. Objectives A MCDA to determine the most relevant criteria to decision-making in the management of diabetic macular edema (DME) based on the perspectives of multiple stakeholders in Spain was developed. This MCDA was termed the MULTIDEX-EMD study. Methods Nineteen stakeholders (7 physicians, 4 pharmacists, 5 health authorities and health management experts, 1 psychologist, and 2 patient representatives) participated in this three-phase project. In phase A, an advisory board defined all of the criteria that could influence DME treatment decision-making. These criteria were then screened using a discrete choice experiment (DCE) (phase B). Next, a multinomial logit model was fitted by applying the backward elimination algorithm (relevant criteria: p value = 15 letters (p value < 0.001), effect duration per administration (p value = 0.008), retinal detachment (p value < 0.001), endophthalmitis (p value = 0.012), myocardial infarction (p value < 0.001), intravitreal hemorrhage (p value = 0.021), annual treatment cost per patient (p value = 0.001), health-related quality of life (HRQoL) (p value = 0.004), and disability level (p value = 0.021). Conclusions From a multi-stakeholder perspective, the selection of an appropriate treatment for DME patients should guarantee patient safety and maximize the visual acuity improvement and treatment effect duration. It should also contribute to system sustainability by being affordable, it should have a positive impact on HRQoL, and it should prevent disability

Renewable Energy Production

Coordinator: Hernán Míguez.Peer reviewe

A multiple stakeholder multicriteria decision analysis in diabetic macular edema management: the MULTIDEX‑EMD study

Background The clinical and economic management of retinal diseases has become more complex following the introduction of new intravitreal treatments. Multicriteria decision analysis (MCDA) ofers the potential to overcome the challenges associated with traditional decision-making tools. Objectives A MCDA to determine the most relevant criteria to decision-making in the management of diabetic macular edema (DME) based on the perspectives of multiple stakeholders in Spain was developed. This MCDA was termed the MULTIDEX-EMD study. Methods Nineteen stakeholders (7 physicians, 4 pharmacists, 5 health authorities and health management experts, 1 psychologist, and 2 patient representatives) participated in this three-phase project. In phase A, an advisory board defned all of the criteria that could infuence DME treatment decision-making. These criteria were then screened using a discrete choice experiment (DCE) (phase B). Next, a multinomial logit model was ftted by applying the backward elimination algorithm (relevant criteria: p value<0.05). Finally, the results were discussed in a deliberative process (phase C). Results Thirty-one criteria were initially defned (phase A) and grouped into 5 categories: efcacy/efectiveness, safety, organizational and economic impact, patient-reported outcomes, and other therapeutic features. The DCE results (phase B) showed that 10 criteria were relevant to the decision-making process for a 50- to 65-year-old DME patient: mean change in best corrected visual acuity (p value<0.001), percentage of patients with an improvement of ≥15 letters (p value<0.001), efect duration per administration (p value=0.008), retinal detachment (p value<0.001), endophthalmitis (p value=0.012), myocardial infarction (p value<0.001), intravitreal hemorrhage (p value=0.021), annual treatment cost per patient (p value=0.001), health-related quality of life (HRQoL) (p value=0.004), and disability level (p value=0.021). Conclusions From a multi-stakeholder perspective, the selection of an appropriate treatment for DME patients should guarantee patient safety and maximize the visual acuity improvement and treatment efect duration. It should also contribute to system sustainability by being afordable, it should have a positive impact on HRQoL, and it should prevent disability

Investigating mountain breezes characteristics and their effects on CO2 concentration at three different sites

International audienceThe characteristics of daytime and nighttime mountain breezes have been analysed and compared at three different sites: a) in the foothills of the Guadarrama Mountain range (El Escorial, Spain); b) on a plateau close to The Pyrenees (Lannemezan, France); and c) in the Salt Lake Valley (SLV, Utah, US). A systematic algorithm, based on synoptic and local meteorological conditions, has been used to detect automatically numerous events at each site. On the one hand, the wind characteristics of these mountain breezes depend on the scale of the breeze detected at each site. Their arrivals are observed approximately when the sensible heat flux changes sign, but they are delayed in the sites that are farther away from the mountains. On the other hand, the effects of these breezes on CO2 mixing ratios have been investigated. The typical increases and decreases of CO2 mixing ratios observed around the afternoon and morning transition do not always occur at the same time of the breeze arrival to the tower site, which unlinks these drastic changes in CO2 from the direct horizontal advection produced by the breezes. However, the CO2 mixing ratio is sensitive to changes in wind direction in highly heterogeneous sites, like the SLV site. Besides, the changes in surface turbulence produced by the breezes have an important effect on CO2. Indeed, a clear relationship is found for CO2 mixing ratio and the turbulent kinetic energy in the lowest atmospheric layers during the nighttime events

Investigating mountain breezes characteristics and their effects on CO2 concentration at three different sites

International audienceThe characteristics of daytime and nighttime mountain breezes have been analysed and compared at three different sites: a) in the foothills of the Guadarrama Mountain range (El Escorial, Spain); b) on a plateau close to The Pyrenees (Lannemezan, France); and c) in the Salt Lake Valley (SLV, Utah, US). A systematic algorithm, based on synoptic and local meteorological conditions, has been used to detect automatically numerous events at each site. On the one hand, the wind characteristics of these mountain breezes depend on the scale of the breeze detected at each site. Their arrivals are observed approximately when the sensible heat flux changes sign, but they are delayed in the sites that are farther away from the mountains. On the other hand, the effects of these breezes on CO2 mixing ratios have been investigated. The typical increases and decreases of CO2 mixing ratios observed around the afternoon and morning transition do not always occur at the same time of the breeze arrival to the tower site, which unlinks these drastic changes in CO2 from the direct horizontal advection produced by the breezes. However, the CO2 mixing ratio is sensitive to changes in wind direction in highly heterogeneous sites, like the SLV site. Besides, the changes in surface turbulence produced by the breezes have an important effect on CO2. Indeed, a clear relationship is found for CO2 mixing ratio and the turbulent kinetic energy in the lowest atmospheric layers during the nighttime events

Stem Cell Therapy for Erectile Dysfunction: A Step towards a Future Treatment

Background: The improvement of absent or partial response in the medical treatment of erectile dysfunction (ED) has led to the development of minimally invasive new treatment modalities in the field of regenerative medicine. Methods: A literature review on stem cell therapy for the treatment of ED was performed. We searched for the terms “erectile dysfunction” and “stem cell therapy” in PubMed and Clinicaltrials.gov. Literature searching was conducted in English and included articles from 2010 to 2022. Results: New treatment modalities for ED involving stem cell therapy are not only conceived with a curative intent but also aim to avoid unnecessary adverse effects. Several sources of stem cells have been described, each with unique characteristics and potential applications, and different delivery methods have been explored. A limited number of interventional studies over the past recent years have provided evidence of a safety profile in their use and promising results for the treatment of ED, although there are not enough studies to generate an appropriate protocol, dose or cell lineage, or to determine a mechanism of action. Conclusions: Stem cell therapy is a novel treatment for ED with potential future applications. However, most urological societies agree that further research is required to conclusively prove its potential benefit