Correction: Aflibercept for treatment-naïve diabetic macula oedema in a multi-ethnic population: Real-world outcomes from North West London.

[This corrects the article DOI: 10.1371/journal.pone.0246626.].

Aflibercept for treatment-naïve diabetic macula oedema in a multi-ethnic population: Real-world outcomes from North West London.

PURPOSE: To evaluate the clinical outcomes of patients with treatment-naïve diabetic macula oedema (DMO) treated with Aflibercept in routine clinic settings in ethnically diverse North West London (NWL) and compare to outcomes reported in the VIVID and VISTA clinical trials. METHODS: This was a retrospective multicentre interventional case series. Two hundred and seventy eyes of 221 treatment-naïve patients at three NWL hospitals initiated on Aflibercept and who had at least 12 months follow-up were included in the study. Visual acuity, central subfield thickness and macula volume were recorded at baseline, month 3, 6 and 12. RESULTS: There were significant differences between the NWL cohort and participants in the VIVID and VISTA trials at baseline including higher HbA1c and a higher proportion of eyes with proliferative diabetic retinopathy in the NWL cohort. The mean VA, mean CSFT and mean MV at baseline was 66.4 (± 14.6) letters, 417 (± 94) µm and 10.3 (± 1.9) mm3. The mean VA gain at 12 months was 4.0 (± 11.8) letters (p < 0.001); a total of 26% of eyes gained ≥ 10 letters, 15% of eyes gained ≥ 15 letters and 6% lost ≥15 letters. At 12-months, the mean reduction in CSFT was 108 (± 96) µm (p<0.001) and the mean reduction in MV was 1.05 (± 1.21) mm3 (p<0.001). An average of 6.2 (± 2.3) injections was given over 12 months. There was a significant association between functional and anatomical response category at 3 months and response category at 12 months (p<0.001). CONCLUSION: The effectiveness of treatment with Aflibercept for patients in NWL was meaningfully lower than was reported in the VIVID and VISTA clinical trials. A high proportion of patients with good visual acuity at baseline, poorer glycaemic control, worse diabetic retinopathy and under-treatment likely contributed to lower functional and anatomical outcomes.

The effects of epidural versus intravenous patient-controlled analgesia on postoperative outcomes in elderly patients who have undergone gastrectomy: a retrospective trial

BACKGROUND: Efforts for improving surgical outcomes in elderly patients should include the prevention of perioperative complications and proper postoperative pain management. Epidural analgesia is effective in decreasing perioperative stress and postoperative complications, and in improving recovery. Recently, it has been suggested that epidural analgesia may attenuate immune suppression during the perioperative period and lead to reductions in cancer recurrence and improvements in overall survival. Assuming that these effects of epidural analgesia are present in vulnerable elderly patients, we compared the efficacy of epidural patient-controlled analgesia and intravenous patientcontrolled analgesia on postoperative outcomes in elderly patients who had undergone gastrectomy. METHODS: We evaluated 214 elderly patients who had undergone elective open gastrectomy for gastric cancer from 2011 to 2014. The demographic characteristics, analgesic efficacy, complications within the first 30 postoperative days, hospital stay, 24-month postoperative morbidity, cancer recurrence, and mortality were studied retrospectively. RESULTS: Two-hundred and five patients were analyzed. Eighty-five patients received epidural patient-controlled analgesia (EPCA group) and 120 patients received intravenous patient- controlled analgesia (IVPCA group). The maximum pain scores were decreased to a greater extent in the EPCA group on the day of the operation (P < 0.001) and on the first postoperative day (P = 0.001) when compared to the IVPCA group. The patients in the EPCA group also required less analgesics on the day of the operation (P = 0.033) than those in the IVPCA group. The effect of EPCA on complications within the first 30 postoperative days, 24-month postoperative morbidity, cancer recurrence, and mortality were negligible in our study. CONCLUSIONS: EPCA provided more effective pain control than IVPCA in elderly patients who had undergone elective gastric cancer surgery, but did not affect postoperative outcomes.

The effects of epidural versus intravenous patient-controlled analgesia on postoperative outcomes in elderly patients who have undergone gastrectomy: a retrospective trial

BACKGROUND: Efforts for improving surgical outcomes in elderly patients should include the prevention of perioperative complications and proper postoperative pain management. Epidural analgesia is effective in decreasing perioperative stress and postoperative complications, and in improving recovery. Recently, it has been suggested that epidural analgesia may attenuate immune suppression during the perioperative period and lead to reductions in cancer recurrence and improvements in overall survival. Assuming that these effects of epidural analgesia are present in vulnerable elderly patients, we compared the efficacy of epidural patient-controlled analgesia and intravenous patientcontrolled analgesia on postoperative outcomes in elderly patients who had undergone gastrectomy. METHODS: We evaluated 214 elderly patients who had undergone elective open gastrectomy for gastric cancer from 2011 to 2014. The demographic characteristics, analgesic efficacy, complications within the first 30 postoperative days, hospital stay, 24-month postoperative morbidity, cancer recurrence, and mortality were studied retrospectively. RESULTS: Two-hundred and five patients were analyzed. Eighty-five patients received epidural patient-controlled analgesia (EPCA group) and 120 patients received intravenous patient- controlled analgesia (IVPCA group). The maximum pain scores were decreased to a greater extent in the EPCA group on the day of the operation (P < 0.001) and on the first postoperative day (P = 0.001) when compared to the IVPCA group. The patients in the EPCA group also required less analgesics on the day of the operation (P = 0.033) than those in the IVPCA group. The effect of EPCA on complications within the first 30 postoperative days, 24-month postoperative morbidity, cancer recurrence, and mortality were negligible in our study. CONCLUSIONS: EPCA provided more effective pain control than IVPCA in elderly patients who had undergone elective gastric cancer surgery, but did not affect postoperative outcomes.

A Microwave Ring-Resonator Sensor for Non-Invasive Assessment of Meat Aging.

The assessment of moisture loss from meat during the aging period is a critical issue for the meat industry. In this article, a non-invasive microwave ring-resonator sensor is presented to evaluate the moisture content, or more precisely water holding capacity (WHC) of broiler meat over a four-week period. The developed sensor has shown significant changes in its resonance frequency and return loss due to reduction in WHC in the studied duration. The obtained results are also confirmed by physical measurements. Further, these results are evaluated using the Fricke model, which provides a good fit for electric circuit components in biological tissue. Significant changes were observed in membrane integrity, where the corresponding capacitance decreases 30% in the early aging (0D-7D) period. Similarly, the losses associated with intracellular and extracellular fluids exhibit changed up to 42% and 53%, respectively. Ultimately, empirical polynomial models are developed to predict the electrical component values for a better understanding of aging effects. The measured and calculated values are found to be in good agreement.

Congenital Heart Disease: a Pictorial Illustration of Putting Segmental Approach into Practice

The human heart is a complex organ in which many complicated congenital defects may happen and some of them require surgical intervention. Due to the vast complexity of varied anatomical presentations, establishing an accurate and consistent nomenclature system is utmost important to facilitate effective communication among pediatric cardiologists, cardiothoracic surgeons and radiologists. The Van Praagh segmental approach to the complex congenital heart disease (CHD) was developed in the 1960s and has been used widely as the language for describing complex anatomy of CHD over the decades. It utilizes a systematic and sequential method to describe the cardiac segments and connections which in turn allows accurate, comprehensive and unambiguous description of CHD. It can also be applied to multiple imaging modalities such as echocardiogram, cardiac CT and MRI. The Van Praagh notation demonstrates a group of three letters, with each letter representative for a key embryologic region of cardiac anatomy: the atria, ventricles and great vessels. By using a 3-steps approach, we can evaluate complex CHD precisely and have no difficulties in communicating with other medial colleague. This pictorial essay revisits the logical steps of segmental approach, followed by a pictorial illustration of its application.

Human Tra2 proteins jointly control a CHEK1 splicing switch among alternative and constitutive target exons.

Alternative splicing--the production of multiple messenger RNA isoforms from a single gene--is regulated in part by RNA binding proteins. While the RBPs transformer2 alpha (Tra2α) and Tra2ß have both been implicated in the regulation of alternative splicing, their relative contributions to this process are not well understood. Here we find simultaneous--but not individual--depletion of Tra2α and Tra2ß induces substantial shifts in splicing of endogenous Tra2ß target exons, and that both constitutive and alternative target exons are under dual Tra2α-Tra2ß control. Target exons are enriched in genes associated with chromosome biology including CHEK1, which encodes a key DNA damage response protein. Dual Tra2 protein depletion reduces expression of full-length CHK1 protein, results in the accumulation of the DNA damage marker γH2AX and decreased cell viability. We conclude Tra2 proteins jointly control constitutive and alternative splicing patterns via paralog compensation to control pathways essential to the maintenance of cell viability.

Hypovitaminosis D in adults with inflammatory bowel disease: potential role of ethnicity.

BACKGROUND: Although vitamin D deficiency occurs in inflammatory bowel disease (IBD), it is currently unclear to what extent ethnicity affects vitamin D levels. Our aim was therefore to determine the ethnic variation in serum 25-hydroxyvitamin D status and its association with disease severity in adults with IBD. METHODS: We conducted a prospective cohort study in ambulatory care IBD patients. Clinical disease severity was assessed through validated questionnaires. Serum 25-hydroxyvitamin D levels were used for vitamin D status. C-reactive protein (CRP), ferritin and hemoglobin (Hgb) levels were correlated with serum 25-hydroxyvitamin D levels. RESULTS: Sixty ulcerative colitis (UC) and forty Crohn's disease (CD) patients were enrolled comprising 65 % Caucasians and 29 % South Asians. However, South Asians had consistently lower average serum 25-hydroxyvitamin D levels (All 44.8 ± 18.1 nmol/L, UC 48.2 ± 18.3 nmol/L, CD 24.3 ± 13.3 nmol/L). Hypovitaminosis D was found in 39 % of All, 36.7 % of UC and 42.5 % of CD patients. A significantly higher proportion of South Asians were vitamin D deficient when compared to Caucasians in All and CD groups (58.6 % vs. 30.8 %, p = 0.01 and 85.7 % vs. 32.3 %, p < 0.01, respectively). CONCLUSIONS: A significantly higher percentage of South Asians had hypovitaminosis D when compared to Caucasians. Disease severity trended towards an inverse relationship with vitamin D status in all South Asian and Caucasian CD patients, although most patients in this study had only mild to moderate disease. We suggest that vitamin D supplementation should be considered in all adult IBD patients.

Anesthetic management of a parturient for combined cesarean section and surgical removal of pituitary tumor: A case report / 대한마취과학회지

A 40-year-old woman was referred to our hospital because of bitemporal hemianopsia at 23 weeks of gestation. A brain magnetic resonance imaging showed a pituitary tumor having suprasellar extension. At 30 weeks of gestation, she complained of rapidly deteriorating vision and bitemporal hemianopsia in both eyes and the ensuing radiological examination revealed increased tumor size, displaced tumor location and compressed optic chiasm. The cesarean section was performed at 31 weeks and 3 days of gestation and simultaneous surgical removal of pituitary tumor was carried out due to the risk of irreversible blindness. Anesthetic management for combined cesarean section and brain surgery can be more complex and challenging for anesthesiologists, and the aim was to achieve both the control of intracranial pressure and fetal well being at the same time. In this case, maternal outcome was somewhat improved after the procedure, and neonatal complications were not detected.

Highly increased blood pressure following stellate ganglion block: A case report

Stellate ganglion block (SGB) is a procedure that is widely used for many diseases associated with sympathetically-maintained pain in the head, neck, and upper extremities. Various hemodynamic changes may occur after SGB. Among them, we experienced two patients who developed highly increased blood pressure after SGB. We suspect that the spread of local anesthetics produced parasympathetic blockade of the vagus nerve, an imbalance between the sympathetic and parasympathetic activities and deafferentiation of the glossopharyngeal and vagus nerve, which both innervated the carotid sinus, as the mechanism of this increased blood pressure.

Registration of in vivo fluorescence endomicroscopy images based on feature detection.

The confocal fluorescence endomicroscopy is an emerging technology for imaging the living subjects inside the animals and human bodies. However, the acquired images vary, due to two degrees of freedom-tissue movement and tissue expansion/contraction. This makes the 3D reconstruction of them difficult and thus limits the clinic applications. In this chapter, we propose a feature-based registration algorithm to correct the distortions between these fluorescence images. The good alignment enables us to reconstruct and visualize the 3D structure of the living cells and tissues in real time, which provides the opportunity for the clinicians to diagnose various diseases, including the early-stage cancers. Experimental results on a collection of more than 300 confocal fluorescence images of the gerbil brain microvasculature clearly demonstrate the effectiveness and accuracy of our method.

Maintenance of nitric oxide inhalation to a patient with hemoperitonium and acute respiratory distress syndrome during anesthesia: A case report / 대한마취과학회지

Inhaled nitric oxide (NO) is occasionally used to treat hypoxemia for patients with acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU). However, it is controversial whether or not to maintain inhalation of NO during general anesthesia because of complications, such as nitrogen dioxide (NO2) production, methemoglobinemia, and inhibition of platelet aggregation. In this case, a 67-year-old male fell from a roof and was brought to an emergency care center. During management, he vomited gastric contents and aspirated. In spite of tracheal intubation and mechanical ventilation with high oxygen therapy, the hypoxia did not improve. NO inhalation with mechanical ventilation was performed to treat hypoxemia due to ARDS in the ICU. We maintained the NO inhalation during the surgery for a hemoperitonium. The surgery was completed without intra-operative hemodynamic instability or any complications.

Left Adrenal Sarcoidosis

We present a 50-year-old woman with left adrenal sarcoidosis. She visited our hospital for right upper quadrant discomfort; she was then evaluated for right upper quadrant discomfort. She had no abnormal findings in the laboratory examination, including hormone study, but a mass was detected at left adrenal gland, incidentally. Initially, we thought the mass as nonfunction adrenal adenoma. After she had undergone laparoscopic left adrenalectomy, she was diagnosed with left adrenal sarcoidosis from her histological findings. Adrenal sarcoidosis is a very rare disease. This case provides insight to the experience of left adrenal sarcoidosis.

Cement leakage into subcutaneous tissue after kyphoplasty: A case report

We describe a case of cement leakage from the pedicle of vertebrae to the subcutaneous tissue after kyphoplasty.We attempted to remove all cement leakage, but residual cement remained in the paraspinal tissue without any neurological complications.This case illustrates the importance of the right timing of cement injection and when to detach the bone-filler device from the cement.

Spinal cord stimulation for neuropathic pain following idiopathic transverse myelitis: A case report / 대한마취과학회지

We present a patient with intractable neuropathic pain because of idiopathic transverse myelitis unresponsive to medical treatment. After a successful trial of spinal cord stimulation, a permanent stimulator was implanted. Improvement was noted in visual analogue scale, medication usage and daily function. Spinal cord stimulation may offer a therapeutic option for patients with neuropathic pain resulting from transverse myelitis and should be considered when other treatments are failed.

Ketamine Infusion Therapy in a Patient of Posttraumatic Syringomyelia / 대한통증학회지

The clinical syndrome of posttraumatic syringomyelia can complicate major spinal trauma and develops many months after spinal injury. The 50-90% of patients experienced the pain and especially the component of central pain. In patients with central pain following spinal cord injury, ketamine has been shown to be an effective analgesic. We report a case of posttraumatic syringomyelia in a 30-year-old woman who complained of central pain, weakness of both legs and dysesthesia. She had not responded to pulsed radiofrequency, or lidocaine infusion therapy, but a continuous intravenous infusion of ketamine, an N-methyl-D-asparate receptor antagonist, reduced her severe central pain. In conclusion, a ketamine infusion therapy resulted in a significant reduction of central pain without decreasing of motor power and function.

Effect of the Preoperative Intercostal Nerve Block in a Rat Model of Postthoracotomy Pain / 대한통증학회지

BACKGROUND: Chronic pain after thoracotomy has been recently reproduced in a rat model that allows investigating the effect of potentially beneficial drugs that might reduce the incidence of allodynia or alleviate pain. Local anesthetics produce antinociception in normal animals and alleviate mechanical allodynia in animals with nerve injury although their mechanisms of action may differ in these situations. Our purpose of this study was to test whether the preoperative intercostal nerve block of bupivacaine could prevent the development of allodynia in a rat model of chronic postthoracotomy pain. METHODS: All male Sprague-Dawley rats were anesthetized and the right 4th and 5th ribs were exposed surgically. The pleura were opened between the ribs to which a retractor was placed and was opened 10 mm in width. Retraction was maintained for one hour. Total 1 mg of 0.5% bupivacaine was injected at the intercostal nerves before (n = 17) or after (n = 16) surgery. A control group (n = 25) that underwent rib retraction did not receive any drug. Rats were tested for mechanical allodynia using calibrated von Frey filaments applied around the incision site during the three weeks following surgery. RESULTS: The incidence of development of mechanical allodynia in the group that received intercostal injection with bupivacaine before surgery was significantly lower than that in the control group (P < 0.05). CONCLUSIONS: Preoperative intercostal nerves block around the surgical incision before thoracotomy may decrease the incidence of postthoracotomy pain syndrome.

A Case of Paraplegia Associated with Epidural Anesthesia: A case report / 대한통증학회지

Paraplegia is a relatively rare complication of epidural anesthesia. Several possible factors may contribute to the development of paraplegia including arachnoiditis, trauma and ischemia. We experienced a case where paraplegia had developed after epidural anesthesia for cesarean section. So we present the case and consider the possible etiologies. A 30-year-old previously healthy woman was referred to our hospital for postpartum motor weakness of the lower limbs. Six days prior, the patient was admitted at a local obstetric clinic for delivery at 39 weeks gestation. The patient underwent a Cesarean section under epidural anesthesia induced with 20 ml 2% lidocaine and 5 ml 0.5% bupivacaine. In the early morning of the day following the Cesarean section, a motor and sensory deficit in both lower extremities was noted. A lumbar MRI showed diffuse enhancement along the cauda equina and spinal cord surface in the lower lumbar spine, suggesting diffuse arachnoiditis.

RECIST Criteria for Tumor Response in the Patients with Breast Cancer Who Had Neoadjuvant Chemotherapy

PURPOSE: This study compared the response evaluation using the WHO (World Health Organization) criteria for patients with breast cancer with that of the RECIST (Response Evaluation Criteria In Solid Tumor) criteria in order to determine the significance of the RECIST criteria in breast cancer. METHODS: Between 2001 and 2005, 42 patients with measurable lesions radiologically receiving neoadjuvant chemotherapy for a breast carcinoma were enrolled in this study. The results were compared using a kappa test as a concordance measure between the two response criteria. RESULTS: With the WHO criteria, the overall response and progression rate were 35.7% (CR 0, PR 15) and 16.6% (PD 7) respectively. On the other hand, the overall response and progression rate using the RECIST criteria were 38.0% (CR 0, PR 16) and 7% (PD 3) respectively. The kappa value as a concordance measure between two response criteria was 0.718. CONCLUSION: The RECIST criteria are comparable to the WHO criteria in evaluating the response of breast cancer patients who have undergone neoadjuvant chemotherapy. A comparison of these results with other studies of more common tumor types supports the implementation of RECIST as the standard criteria for evaluating the treatment response but also for monitoring progression.