Initial medication adherence in newly diagnosed glaucoma patients:three adherence measures

AIM:To determine initial medication adherence in newly diagnosed glaucoma patients treated with anti-glaucoma drugs.METHODS:This retrospective and observational study included all patients diagnosed with glaucoma in the Primary Health Care units in Portugal during the years 2012 and 2013,which in consequence received a first prescription for anti-glaucoma drugs.Data was collected from electronic prescribing records of the primary care units and from pharmacy claims records.Initiation of glaucoma treatment and early discontinuation were measured,and the combination of(non)-initiation and early discontinuation accounted for initial medication(non)-adherence.RESULTS:A total of 3548 new glaucoma patients(40.1%male;59.9%female)were included.The 1133(31.9%)patients were initially classified as non-users,since there was no pharmacy claim found for their first prescription for glaucoma treatment.Additionally,277(11.5%)patients early discontinued their treatment,acquiring only their first prescription.Overall,the initial medication non-adherence rate was 39.7%since 1410 patients either didn’t initiate treatment or discontinued it early.CONCLUSION:This study,reveals a major opportunity to improve glaucoma treatment and its control,since a large proportion of patients fail to engage with their prescribed therapy,which implies that implementation of individual or group strategies that enable patients with glaucoma to correctly perform their treatment is still needed.

From post-COVID-19-associated myocarditis to hemopericardium: a dangerous domino effect

The majority of patients infected with Severe Acute Respiratory Syndrome-COrona-Virus-2(SARS-CoV-2)either completely recover from symptoms in a few days or stay asymptomatic.[1−3]Nevertheless,a consistent proportion of subjects with a history of probable or confirmed SARS-CoV-2 infection refers persistency,new occurrence,relapse,or fluctuation of symptoms,and these manifestations are defined as post-COVID-19 condition.[4]Of note,the post-acute sequelae of COVID-19 include several cardiac manifestations,including direct myocardial and pericardial injury/inflammation,as well as cardiomyopathies and arrythmias,sustained by viral infiltration and/or dysregulation of adaptive immune response.[5]Even though rare,acute myocarditis may be an important post-COVID-19 condition and may be associated with the occurrence of new-onset atrial fibrillation.

Serum uric acid as a prognostic marker in the setting of advanced vascular disease： a prospective study in the elderly

BackgroundMany 流行病学的研究分析在 hyperuricemia 和心血管的结果之间的关系。这观察未来的研究调查有在一张老人口的不利心血管的事件和死亡的尿酸(SUA ) 层次由百和 76 个老病人由先进动脉粥样硬化影响了的先进 atherosclerosis.MethodsTwo 影响了的浆液的协会(217 男性和 59 女性；71.2 &#x000b1；7.8 年) 被包括。所有病人为心血管的疾病，癌症，肥胖和传统的风险因素的历史被估计。病人们为约 31 &#x000b1 被跟随；11 个月。主要事件在后续，定义同样心肌的梗塞，服的局部缺血，心肌或外部的 revascularization 和 death.ResultsMean SUA 期间被记录水平是 5.47 &#x000b1；1.43 mg/dL；然后，我们进一步在二个组划分了人口，根据中部的价值(5.36 mg/dL ) 。在期间一中部列在后面在上面 31，月(5 ～ 49 个月) ， 66 个心血管的事件， 9 个致命的心血管的事件和 14 癌症相关的死亡发生了。有增加的 SUA 水平的病人介绍了全部的心血管的事件的更高重要的发生(HR：1.867， P = 0.014， 95% CI：1.134-3.074 ) 。一样的病人显示出癌症相关的死亡的重要增加的风险(HR：4.335， P = 0.025， 95% CI：1.204-15.606 ).ConclusionsIncreased SUA 层次独立地并且显著地与心血管的事件的风险被联系，癌症在外部 vasculopathy 影响的主要老的病人的一张人口联系了死亡。

Pulmonary or otolaryngologic extraesophageal manifestations in patients with gastroesophageal reflux disease

The extraesophageal manifestations of gastroesophageal reflux disease that are similar to a heart attack or gastric diseases are well known, while those categorized as pulmonary or otolaryngological are less known and less studied. In this article, we introduce this less known aspect of gastroesophageal reflux.

Quantification of theophylline or paracetamol in milk matrices by high-performance liquid chromatography

A simple, accurate and sensitive high-performance liquid chromatography （HPLC） method was developed, validated and applied to the determination of either theophylline or paracetamol in milk-based samples. The method allowed drug quantification in fresh and powdered milk with a relatively short run time of analysis and it was also successfully applied to the quantification of the drugs in solid dosage forms intended for pediatric use. Moreover, the main significant advantages over other published works are the simplicity of the sample preparation, reduced assay time and sample loss. The method meets the International Conference on Harmonization guideline for analytical methods validation regarding specificity, linearity, accuracy, precision, specificity and robustness as required by health authorities and applied by industry while designing and marketing new drug products. The technique encompasses the separation of the analytes with a reverse phase C18 column under isocrafic conditions and UV detection at 272 nm and 243 nm, respectively, for theophylline and paraeetamol. The lower limit of quantification for both drugs was determined as 0.2 μg/mL and the between-batch accuracy was 99.7%. This HPLC method allows quantification of theophylline and paracetamol in milk matrices and it can be applied in the design, development and production of milk-based pediatric dosage forms.

凸起对纳米压痕测量含析出相的Cu-2wt.%Be的影响（英文）

研究凸起对具有纳米析出相的Cu 2wt.%Be纳米压痕测量分析的影响。将样品在540~680 K之间的不同温度下时效1 h,析出相形成。用经典的Oliver和Pharr法对载荷深度曲线进行分析,并将得到的弹性模量和硬度值与其他技术估算的值进行比较。在具有析出相的样品中发现了重要的凸起水平,且观察到时效和未时效处理样品的载荷深度曲线也不同。用Loubet模型估算硬度值,该模型在考虑有凸起的情况下,对接触深度进行修正。利用卸载功与压痕总功之比与H/Er(H为硬度,E为折合模量)比之间的关系确定弹性模量,并建立这两个参数间的特殊关系。

Statins decrease the risk of acute pancreatitis after endoscopic ultrasound fine-needle aspiration of pancreatic cysts

Background: Basic and clinical studies suggest that statins may prevent and even ameliorate acute pan- creatitis. The present study was to evaluate whether statin decreases the risk of acute pancreatitis in patients undergoing endoscopic ultrasound-guided ne-needle aspiration of pancreatic cysts. Methods: Out of 456 patients with pancreatic cysts referred to our center between 2006 and 2018, 365 were nally included in analyses: 86 were treated with statins and 279 were not at the time of endo- scopic ultrasound ne-needle aspiration. We compared the acute pancreatitis incidence between the two groups, and we also compared other complications such as bleeding and infections. Results: Median age was 64 years [interquartile range (IQR) 62 69] and median cyst size was 24mm (IQR, 21 29). The most frequent histology was intraductal papillary mucinous neoplasm (45.3% and 42.3% in the two groups, respectively;P =0.98). All 13 patients experiencing post-endoscopic ultrasound acute pancreatitis were from the control group (4.7%), of which 3 were classi ed as severe pancreatitis. None of statin users developed post-procedural acute pancreatitis (odds ratio: 0.15;95% con dence interval: 0.03 0.98;P=0.03). No difference was registered with regard to severe pancreatitis and other complications. Conclusions: Statins exert a bene cial role in preventing acute pancreatitis in patients with pancreatic cysts undergoing endoscopic ultrasound-guided ne-needle aspiration. If con rmed in prospective trials, our ndings may pave the way to an extensive use of statins as prophylactic agents in pancreatic inter- ventional endoscopy.

Transarterial chemoembolization as adjuvant treatment after surgery: The cure of huge hepatocellular carcinoma?

Hepatocellular carcinoma(HCC) represents the sixth common cancer and the second leading cause of cancer-related death. Its incidence is higher in Eastern countries. HCC is frequently detected at advanced stage of disease, and therefore, the mortality is high [1].

The Influence of Keratometry on Visual and Refractive Outcomes after Myopic LASER <i>in Situ</i>Keratomileusis

To evaluate the effect of preoperative keratometry on visual and refractive outcomes after Myopic LASER in Situ Keratomileusis (LASIK) in eyes with preoperative spherical equivalent (SE) of -6.00D or less. Material and Methods: A retrospective study enrolling clinical records of 482 eyes of 275 patients with myopia who underwent LASIK between 2009 and 2016. Subjects were grouped according to the degree of preoperative mean keratometry (Km), into three groups: Group 1 (Flat Cornea): Km ≤ 42.00 diopters (D);Group 2: 42.00 46.00D;Group 3 (Steep Cornea): Km ≥ 46.00D. To evaluate the prognostic impact of keratometry in Myopic LASIK, we considered the results measured at 6 months postoperatively, including uncorrected distance visual acuity (UDVA), postoperative sphere, cylinder, SE and its variation. Results: The mean preoperative SE was -3.91 ± 1.54D, ranging between -0.88 and -6.00D. The percentage of eyes achieving a postoperative SE of ±0.50D was 39.5%, 31.8% and 26% in groups 1, 2 and 3 respectively. Moreover, in group 3, 14.3% of the eyes had a residual SE of -2.00D or greater, contrasting with the groups 1 and 2 with only 6% - 7%. These results were found to be statistically significant. Concerning UDVA, eyes achieving 20/25 or more were 81.5%, 81.8% and 71.5%, and 20/50 or less were 6.7%, 6.2% and 11.7% in groups 1, 2 and 3 respectively. Conclusions: Myopic eyes with steeper corneas seem to have greater tendency to undercorrection, also presenting worse visual outcomes.

Natural History and Treatment of Brown’s Syndrome: Long-Term Experience

Purpose: Brown’s Syndrome (BS) is a restrictive strabismus characterized by a limitation of elevation in adduction. Several etiologies have been described, usually involving the superior oblique muscle. Spontaneous improvement has been reported in several studies, so surgery is reserved for a minority of cases. Our purpose is to review the characteristics, natural history and treatment of this pathology and present the experience of the Instituto de Oftalmologia Dr. Gama Pinto (IOGP). Methods: A consecutive retrospective series of BS patients seen at the Strabismus Department of IOGP between 1983 and 2014 was reviewed. All patients with complete clinical data were included in this study. The epidemiologic characteristics, clinical features, treatment, and clinical progression were reviewed. Results: Thirty-nine cases were selected, with a mean age at first diagnosis of 6.5 years. Of the thirty-nine cases, 6 were iatrogenic and the remainder idiopathic. Thirty-six cases were followed for a mean period of 6.1 years. Surgical intervention for BS was performed in 11 patients, using different approaches. Of these, 9 cases were considered successful. The remaining 25 cases were kept under observation without surgery, of which 17 showed spontaneous improvement and the other 7 remained unchanged. Conclusions: The surgical success rate was 82%, which demonstrates the good efficacy of the surgery despite the complexity and variety of pathophysiological mechanisms of the syndrome. In the patients kept under observation there was spontaneous improvement in 68%, confirming that a conservative approach seems to be adequate in most cases.

能量桩温度及变形特性现场实测研究

能量桩技术作为一种利用浅层地热能的新技术,可以有效降低建筑物能源消耗,减少二氧化碳排放。为研究能量桩系统在运行前后的较长时期内的进/出口换热液体温度、桩身温度以及轴向变形等特征,对位于法国塞纳-马恩省的Sept Sorts镇某新建污水预处理厂房的能量桩系统开展了现场全尺监测试验。监测结果显示,换热管网进口(T_(inlet))和出口(T_(outlet))液体之间的平均温度差约为5℃,表明该能量桩系统具有良好的换热能力。在能量桩运行前,随深度增加,桩身温度先减小然后趋于稳定,最终保持在13℃左右(桩体深度>5m)。在能量桩运行后,在装有换热管的7m深度范围内桩身温度基本保持恒定。此外,能量桩运行前后的桩身温度变化幅度相差不大,均小于10℃。由能量桩运行引起的桩身轴向变形与由季节性土体温度变化引起的轴向变形具有相同的数量级,但前者沿桩体上的区域分布更加均匀。在监测期间,桩身轴向应变变化范围为-50μm/m~+30μm/m,数值虽小但在设计中不应忽略。

放大生活细节

从日常生活的角度出发,把握产品的每一个细节,这就是PINTO设计最重要的特质。

脊椎形态计量学研究方法与进展

脊椎骨折是骨质疏松的标志，具有较高的发病率和死亡率。因大多数脊椎骨折没有特殊的外伤史，也无临床症状，故其诊断主要靠X线摄影。确定脊椎骨折严重程度的2种最为广泛应用的方法是测量椎体高度的视觉半定量（SQ）评估法与形态测定定量法。这两种测量方法可在常规脊柱X线摄影片（MRX：形态测定X线摄影）或双能X线吸收测定（DXA）扫描（MXA：形态测定X线吸收测定）上进行。利用先进的扇束DXA设备可评价脊椎骨折，

γ-谷氨酰胺转移酶可作为α-干扰素和利巴韦林治疗持续性病毒应答的丙肝患者的独立预测因子

Background: Recently, gamma-glutamyl transferase (GGT) has been investigated as a predictive factor for therapy response in hepatitis C patients, but so far its value in pretreatment screening has not been established. Therefore, this study aimed at evaluating GGT as an independent predictive factor for the response to treatment with interferon-α and ribavirin in hepatitis C virus (HCV)infected patients. Methods: Naive chronic hepatitis C patients undergoing a 6-month follow-up after interferon-alpha and ribavirin therapy had their sustained virologic response (SVR) analyzed according to age, sex, body mass index, GGT levels, genotype, and liver histology by use of a multivariate logistic regression model. Results: Of the 211 patients studied with amean age of 48 ± 10 years, 125 (59% )were males. Overweight was detected in 47% of patients. Genotype 1 was detected in 141 (75% ) of the 187 patients tested. Cirrhosis was present in 67 (32% ). A high pretreatment GGT level was observed in 134 (63% ). SVR was obtained in 84 (40% ) patients. In the final logistic regression model, the variables independently associated with SVR were GGT (P < 0.001), genotype (P < 0.001), and liver histology (P < 0.001). Conclusion: A normal GGT level is an independent predictive factor for SVR in HCV-infected patients and should be considered for pretreatment screening.

小肠肠系膜超声造影成像评分系统:一项很有前景的乳糜泻诊断与随访方法

Background: Small intestinal ultrasonography with anechoic contrast agents (SICUS) has been shown to have a diagnostic accuracy on small bowel morphology similar to X-ray barium follow-through. Although extremely investigated by transabdominal ultrasonography, celiac disease, a common disorder of the small bowel, has been never studied by SICUS. Aim: To asses SICUS characteristics of celiac disease patients. Patients and Methods: SICUS was performed using PEG 4000 as contrast agent. Twenty-three patients with celiac disease at the first diagnosis were enrolled and 30 healthy volunteers, matched for sex and age, were selected as control group. Celiac disease diagnosis was based on anti-gluten, anti-endomysium, and anti-transglutaminase positivity as well as jejunal histology. The following seven echographic parameters were considered: liquid endoluminal content before contrast, loop diameter, Kerckring’ s folds, peristaltic waves, ileal jejunalization, mesenteric lymphoadenomegaly,and Doppler resistance index (RI) of mesenteric superior artery. Statistical analysis was performed by Student’ s t test for unpaired data; one-way analysis of variance was used to correlate echographic and histologic pictures. Results: Loop diameter, Kerckring’ s fold number, peristaltic waves, and Doppler RI appeared to be significantly different between celiac disease patients and controls. Additionally, liquid content, ileal jejunalization, and mesenteric lymphoadenomegaly were present only in the celiacs (52.1% ,47.7% , and 95.6% , respectively), but not in controls. Only Doppler RI values significantly correlated with the histologic degree of damage. Conclusions: SICUS could be a reliable and noninvasive technique to confirm a diagnosis of celiac disease performed using conventional investigations. The possibility of investigating the whole small bowel and the safety of repeating examinations could be useful in the follow-up of celiac patients.

Diode Laser Cyclophotocoagulation in the Management of Pain and Intraocular Pressure Control in Patients with Terminal Glaucoma--Six Years’Experience

Objective: This study aims to describe the experience with diode laser cyclophotocoagulation in the control of intraocular pressure and resolution of pain in patients with refractory glaucoma. Methods: Retrospective study. 64 eyes of 60 patients who underwent cyclophotocoagulation between January 2008 and March 2014. Evaluation of the pre- and post-operative intraocular pressure, the control of ocular pain, the number of anti-glaucoma drugs used in pre- and post-intervention, the rate of complications and the success rate. Results: There was an overall success rate of 81.3%, with 9 eyes needing a second intervention. There was a mean reduction of 52.6% of the preoperative mean intraocular pressure of 41.25 to 19.56 mmHg at 12 months observation (p < 0.001). There was also a statistically significant reduction in the number of anti-glaucoma drugs used from 3.19 to 2.01 per eye and the resolution of pain in 75% of patients. Conclusions: cyclophotocoagulation is an effective procedure, with an expected positive impact on quality of life of patients as a result from the decreased number of anti-glaucoma drugs, sustained intraocular pressure reduction and resolution of pain.

AIDS患者肛周似瘤样肥大性单纯疱疹:5例病例报道

Five patients (4 males; mean age, 46.4 years) with pain-ful verrucous perianal lesions caused by herpes simplex virus are described. All patients had had AIDS for a long time and were using highly active antiretroviral therapy. CD4+ counts ranged from 73 to 370/mm3. All lesions were submitted to resection under subdural anesthesia. Histologic examinations revealed epithelial hyperplasia and dense inflammatory process, composed mainly of lymphocytes and plasma cells, extended just to the hypodermis. Immunohistochemistry was positive for herpes simplex virus Type 2 in four patients and for herpes simplex virus Type 1 in one patient, and did not detect human papillomavirus antigens. Three patients had recurrences after 3, 10, and 12 months. Resection was performed on two patients; one had a new recurrence after three months. Oral acyclovir eliminated the lesion in the third patient. The analysis of our patients suggests that herpes simplex virus, Types 1 and 2, may cause verrucous lesions simulating neoplasia in patients with AIDS using antiretroviral therapy.

The Graft Thickness in Descemet Stripping Automated Endothelial Keratoplasty:What Is the Importance to the Final Visual Outcome?

Introduction: Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) is currently considered the procedure of choice for the treatment of endothelial dysfunctions. Despite DSAEK being a promising procedure to improve visual acuity (VA), the ideal graft thickness donor still remains under discussion. Purpose: To analyze the influence of graft thickness on postoperative VA and complications in DSAEK surgery. Methods: Retrospective study of 112 eyes that underwent DSAEK surgery. Donor grafts were obtained by dissection with automatic microkeratome, using different head sizes. Central corneal thickness (CCT) of donor corneas before dissection was measured by ultrasound pachymetry. The choice of the cutting depth was based on CCT measurements and the final desired residual corneal thickness, corresponding to the estimated donor graft thickness (EDGT). The eyes were divided into 3 groups, depending on the EDGT: 200 μm (Group 3). Intraoperative, postoperative complications and the best corrected visual acuity (BCVA) at 6 months postoperatively were evaluated, comparing these 3 groups. Results: The average EDGT was 164 ± 10 μm in Group 1188 ± 7 μm in Group 2 and 234 ± 30 μm in Group 3. At 6 months postoperative the average BCVA was significantly better in Group 1 (BCVA: 0.74 ± 0.20), compared to Group 2 (BCVA: 0.54 ± 0.20) and Group 3 (BCVA: 0.39 ± 0.18). Intraoperative and postoperative complications included: graft perforation during cutting (0.9% of cases), graft rejection (3.6%), primary graft failure (4.5%), and graft detachment (3.6%). Its distribution was uniform between the 3 groups. Conclusion: The study proves that DSAEK is an effective surgical technique for the treatment of endothelial dysfunction, demonstrating that the use of thinner grafts (EDGT < 180 μm) can improve the final visual outcome, with a significant improvement on BCVA, without increasing the risk of complications.

维生素D缺乏:全球气候变化与环境污染

维生素D对于动物和人类的骨骼矿质供给是极其重要的。它对骨骼、肠和肾起着促进其钙稳衡作用。维生素D是皮肤暴露于太阳辐射下形成的,但也可通过食物获得。皮肤和食物母体通过肝和肾的特殊代谢反应而被激活。维生素D在皮肤中合成的效率取决于太阳辐射中紫外光的强度,并受到若干因素的影响,其中纬度和季节性因素是最重要的。这种合成效率随着与赤道距离缩短而增加。当阳光入射角在高纬度或在冬季较小时,合成的效率迅速减弱。

Exosomal glypican-1 is elevated in pancreatic cancer precursors and can signal genetic predisposition in the absence of endoscopic ultrasound abnormalities

BACKGROUND Individuals within specific risk groups for pancreatic ductal adenocarcinoma(PDAC)[mucinous cystic lesions(MCLs),hereditary risk(HR),and new-late onset diabetes mellitus(NLOD)]represent an opportunity for early cancer detection.Endoscopic ultrasound(EUS)is a premium image modality for PDAC screening and precursor lesion characterization.While no specific biomarker is currently clinically available for this purpose,glypican-1(GPC1)is overexpressed in the circulating exosomes(crExos)of patients with PDAC compared with healthy subjects or those harboring benign pancreatic diseases.AIM To evaluate the capacity of GPC1+crExos to identify individuals at higher risk within these specific groups,all characterized by EUS.METHODS This cross-sectional study with a prospective unicentric cohort included 88 subjects:40 patients with MCL,20 individuals with HR,and 20 patients with NLOD.A control group(CG)was submitted to EUS for other reasons than pancreatic pathology,with normal pancreas and absence of hereditary risk factors(n=8).The inclusion period was between October 2016 and January 2019,and the study was approved by the Ethics Committee of Centro Hospitalar Universitário de São João,Porto,Portugal.All patients provided written informed consent.EUS and blood tests for quantification of GPC1+crExos by flow cytometry and carbohydrate antigen 19-9(CA 19-9)levels by ELISA were performed in all subjects.EUS-guided tissue acquisition was done whenever necessary.For statistical analysis,SPSS®27.0(IBM Corp.,Armonk,NY,United States)version was used.All graphs were created using GraphPad Prism 7.00(GraphPad Software,San Diego,CA,United States).RESULTS Half of MCLs harbored worrisome features(WF)or high-risk stigmata(HRS).Pancreatic abnormalities were detected by EUS in 10.0%and 35.0%in HR and NLOD individuals,respectively,all considered non-malignant and“harmless.”Median levels of GPC1+crExos were statistically different:MCL[99.4%,interquartile range(IQR):94.9%-99.8%],HR(82.0%,IQR:28.9%-98.2%),NLOD(12.6%,IQR:5.2%-63.4%),and CG(16.2%,IQR:6.6%-20.1%)(P<0.0001).Median levels of CA 19-9 were within the normal range in all groups(standard clinical cut-off of 37 U/mL).Within HR,individuals with a positive history of cancer had higher median levels of GPC1+crExos(97.9%;IQR:61.7%-99.5%),compared to those without(59.7%;IQR:26.3%-96.4%),despite no statistical significance(P=0.21).Pancreatic cysts with WF/HRS were statistically associated with higher median levels of GPC1+crExos(99.6%;IQR:97.6%-99.8%)compared to those without(96.5%;IQR:81.3%-99.5%)(P=0.011),presenting an area under the receiver operating characteristic curve value of 0.723(sensitivity 75.0%and specificity 67.7%,using a cutoff of 98.5%;P=0.012).CONCLUSION GPC1+crExos may act as biomarker to support the diagnosis and stratification of PDAC precursor lesions,and in signaling individuals with genetic predisposition in the absence of EUS abnormalities.