Luz pulsada intensa: resultados en ojo seco crónico tras LASIK / Intense pulsed light: results in chronic dry eye syndrome after LASIK

Se presentan los resultados clínicos y visuales obtenidos en un estudio retrospectivo de una serie de casos de pacientes con síndrome de ojo seco (SOS) evaporativo crónico, tras cirugía refractiva, manejados con luz pulsada intensa (LPI). Se realizaron 4 sesiones de LPI. Contestaron el cuestionario Ocular Surface Disease Index (OSDI) antes del inicio de LPI y después de la última sesión. Se registró AV, refracción, valoración clínica (grado de severidad DEWS y grado de tinción Oxford) y topografía Orbscan. Se trataron 20 ojos con los siguientes valores pre- y post-LPI: SchirmerI 14,7 ± 5,6; 15,6 ± 3,4 mm, BUT 3,4 ± 1,6; 5,1 ± 1,2 s (p < 0,003), DEWS 3,4 ± 0,5; 1,6 ± 0,7 (p < 0,003), grado Oxford 0,8 ± 0,77; 0,4 ± 0,75 (p > 0,003), AV 0,67±0,26; 0,90 ± 0,15 (p < 0,0001), AVcc 0,83 ± 0,18; 0,92 ± 0,14 (p > 0,003), EE -0,31 ± 0,6; -0,08 ± 0,38D (p > 0,003), OSDI 34 ± 16; 28 ± 11,0 puntos (p > 0,003), uso de lágrimas 3,4 ± 2,0; 2,5 ± 1,9 veces/día (p > 0,03). Se registró mejoría visual y clínica significativa, mejoría sintomática y disminución de uso de lágrimas artificiales, tras LPI, en pacientes operados de LASIK con SOS evaporativo crónico

A report is presented on the visual and clinical results from a retrospective case series of patients with chronic, evaporative, dry eye syndrome (DES), after refractive surgery, and treated with intense pulsed light treatment (IPL). Four sessions were performed, and the Ocular Surface Disease Index (OSDI) questionnaire was completed before initiating treatment and after the last session. Pre- and post-treatment data included: visual acuity (VA), refraction, clinical evaluation (DEWS severity grading, and Oxford corneal staining), and Orbscan topography. Twenty eyes were treated and the following data recorded: SchirmerI 14.7± 5.6; 15.6 ± 3.4 mm, tear breakup time (TBUT) 3.4 ± 1.6; 5.1 ± 1.2s (P > .003), DEWS 3.4 ± 0.5; 1.6 ± 0.7 (P<.003), Oxford grade 0.8 ± 0.77; 0.4 ± 0.75 (P > .003), VA 0.67 ± 0.26; 0.90 ± 0.15 (P < .0001), best corrected VA 0.83 ± 0.18; 0.92 ± 0.14 (P>.003), spherical equivalent -0.31 ± 0.6; -0.08 ± 0.38 D (P > .003), OSDI 34 ± 16; 28 ± 11.0 points (P > .003), frequency artificial tear use 3.4 ± 2.0; 2.5 ± 1.9 times/day (P > .03). A significant clinical and visual improvement was observed, together with a decreased frequency in artificial tear use, in LASIK patients with chronic DES after IPL treatment

Intense pulsed light: results in chronic dry eye syndrome after LASIK. / Luz pulsada intensa: resultados en ojo seco crónico tras LASIK.

A report is presented on the visual and clinical results from a retrospective case series of patients with chronic, evaporative, dry eye syndrome (DES), after refractive surgery, and treated with intense pulsed light treatment (IPL). Four sessions were performed, and the Ocular Surface Disease Index (OSDI) questionnaire was completed before initiating treatment and after the last session. Pre- and post-treatment data included: visual acuity (VA), refraction, clinical evaluation (DEWS severity grading, and Oxford corneal staining), and Orbscan topography. Twenty eyes were treated and the following data recorded: SchirmerI 14.7±5.6; 15.6±3.4mm, tear breakup time (TBUT) 3.4±1.6; 5.1±1.2s (P>.003), DEWS 3.4±0.5; 1.6±0.7 (P<.003), Oxford grade 0.8±0.77; 0.4±0.75 (P>.003), VA 0.67±0.26; 0.90±0.15 (P<.0001), best corrected VA 0.83±0.18; 0.92±0.14 (P>.003), spherical equivalent -0.31±0.6; -0.08±0.38D (P>.003), OSDI 34±16; 28±11.0 points (P>.003), frequency artificial tear use 3.4±2.0; 2.5±1.9 times/day (P>.03). A significant clinical and visual improvement was observed, together with a decreased frequency in artificial tear use, in LASIK patients with chronic DES after IPL treatment.

Organ Donation European Quality System: ODEQUS project methodology.

Differences in the number of organ donors among hospitals cannot be explained only by the number of intensive care unit beds used or neurologic patients treated. The figures obtained are influenced by the organizational structure of the donation process and how efficient it is. The Organ Donation European Quality System (ODEQUS) is a 3-year project (from October 2010 to September 2013) co-financed by the European Agency for Health and Consumers (EAHC20091108) which aims to define a methodology to evaluate organ procurement performance at the hospital level. ODEQUS's specific objectives are to identify quality criteria and to develop quality indicators in three types of organ donation (after brain death, after cardiac death, and living donation). Those tools will be useful for hospitals' self-assessment as well as for developing an international auditing model. A consortium has been established involving 14 associated partners from Austria, Croatia, France, Germany, Italy, Poland, Portugal, Romania, Spain, Sweden, and the United Kingdom, as well as five collaborating partners from Greece, Hungary, Malta, Slovenia, and Turkey. The project has been established in three steps: 1) Design of a survey about the use of quality tools in a wide sample of European hospitals; 2) Development of quality criteria and quality indicators by the project experts. The main fields considered have been organizational structures, clinical procedures, and outcomes; and 3) Elaboration of an evaluation system to test the quality indicators in 11 European hospitals. Two types of training have been designed and performed: one concerns the development of quality criteria and quality indicators, whereas another is focused on how to use evaluation tools. Following this methodology, the project has so far identified 131 quality criteria and developed 31 quality indicators. Currently, the quality indicators are being tested in 11 selected hospitals.

International Registry in Organ Donation and Transplantation 2010.

The International Registry in Organ Donation and Transplantation (IRODaT) seeks to support the transplant community by providing up-to-date data on organ donation and transplantation worldwide at three different levels: national, regional, and Hospital. The database provides up-to-date information provided by a network of professionals directly involved in the various stages of the donation and transplantation process. All collected data are made public online, so professionals can use them as descriptive and epidemiological references. The registry provides numbers on donors after brain death, donors after cardiac death, and living donors, as well as on specific organ transplantation activities related to the three types of organ donation. A subregistry on tissue and cell donation has been made available as well. All numbers are continuously checked, updated, and validated and, when needed, responsible representatives are contacted for the required statistics. Data on organ donation and transplantation from 2009 and 2010 have been collected from 63 countries. The information reveals a remarkable increase in the donation rate in some countries such as Croatia, Italy, Slovenia, Czech Republic, Germany, Hungary, Australia, Luxemburg, Poland, Brazil, Singapore, Iran, Saudi Arabia, Venezuela, Romania, Bulgaria, Mexico, Russia, and Argentina. IRODaT provides data concerning the organ donation and transplantation activities for the general public and professionals around the world. National and comparative statistics generated on an international basis can be provided that is of extreme value to scientific programs and social and governmental bodies because they can support different initiatives of current practices in organ and tissue donation in any country or region of the world.

Three-dimensional reconstruction of subsurface defects using finite-difference modeling on pulsed thermography.

We develop a technique to analyze pulsed thermography videos in order to detect and reconstruct subsurface defects in homogeneous and layered objects. The technique is based on the analysis of the thermal response of an object to a heat pulse. This thermal response is compared to the predictions of a finite-difference model that is systematically and progressively adjusted to minimize a cost function. With this minimization process, we obtain a depth and a thickness function that allow us to determine the three-dimensional shape, size, depth, thickness, and location of internal defects. The detected defects are reliably reconstructed with graphics of easy interpretation.

Bidimensional fluorescence analysis and thermal design of europium thenoyltrifluoroacetonate based thermal-to-visible converter.

We perform a bidimensional analysis to evaluate the variation of the fluorescence decay of europium thenoyltrifluoroacetonate (EuTTA) with temperature changes. We analyze how a specific thermal distribution modifies the spatial temperature of the sensing film and we study the corresponding fluorescence response using an integral functional of the emission decay. We present experimental results of a thermal distribution registered with the EuTTA-based thermal-to-visible conversion method. Furthermore, we analyze the spatial and temporal response of the proposed sensing element by using heat-transfer theory. Based on the presented analysis, we establish the optimal thermal and physical design for the sensing element of the proposed thermal-to-visible converter.

[Lack of concordance between dry eye syndrome questionnaires and diagnostic tests]. / Falta de concordancia entre los cuestionarios y las pruebas diagnósticas en el síndrome de ojo seco.

PURPOSE: To report the prevalence of dry eye syndrome (DES) in a subset of patients > 50 years old in Valladolid, Spain, calculate internal validity of two DES screening questionnaires, and correlate the results with DES diagnostic tests. METHODS: Patients > 50 years-old were randomly selected from the medical network census in Valladolid; they answered the modified McMonnies questionnaire (Q1) and the Ocular Surface Index questionnaire (Q2) and then underwent an ophthalmic evaluation which included: tear break-up time (TBUT), fluorescein and Rose Bengal staining, and Schirmer with anesthesia were performed. Descriptive analysis, test concordance analysis, and Q1 and Q2 reliability using ROC curves were performed. RESULTS: A total of 270 subjects (58.2% female; 41.8% male) with an average age of 64.5 years (95% CI: 63.3 - 65.7) were enrolled. The prevalence of DES based on the Schirmer-Tear break-up time tests combination was 24.2%. The mean Q1 score was 1.2, and 1.4 for Q2. Grittiness and discomfort in dry environments (28.9%) were the most common symptoms recorded for Q1. For Q2 "grittiness" (99.2%) and "burning sensation" (98.9%)were the most common symptoms. With the Schirmer-TBUT combination, DES prevalence in Valladolid was 24.2%, 45.8% with TBUT, and 45.6% with Schirmer test. Values for the areas under the ROC curve for Q1, Q2, and most objective tests were < 0.5, except for Q2 and TBUT (0.503). Cronbach alpha was > 0.7 for all Q1 and Q2 items. Statistically significant concordance was reported for Schirmer - TBUT (κ=0.14) and TBUT- fluorescein staining (κ=0.09); (P<0.05). CONCLUSIONS: Q1 and Q2 were unreliable for DES diagnosis and showed poor internal consistency. Fluorescein and Rose Bengal staining were the most concordant tests for DES diagnosis. Finally, there was no correlation between either screening questionnaire and objective DES diagnostic tests.

The Hsp90 inhibitor IPI-504 rapidly lowers EML4-ALK levels and induces tumor regression in ALK-driven NSCLC models.

Heat shock protein 90 (Hsp90) is an emerging target for cancer therapy due to its important role in maintaining the activity and stability of key oncogenic signaling proteins. We show here that the echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) fusion protein, presumed to be the oncogenic driver in about 5% of patients with non-small cell lung cancer (NSCLC), is associated with Hsp90 in cells and is rapidly degraded upon exposure of cells to IPI-504. We find EML4-ALK to be more sensitive to Hsp90 inhibition than either HER2 or mutant epidermal growth factor receptor (EGFR) with an inhibitory concentration (IC)(50) for protein degradation in the low nanomolar range. This degradation leads to a potent inhibition of downstream signaling pathways and to the induction of growth arrest and apoptosis in cells carrying the EML4-ALK fusion. To generate a causative link between the expression of EML4-ALK and sensitivity to IPI-504, we introduced an EML4-ALK cDNA into HEK293 cells and show that the expression of the fusion protein sensitizes cells to IPI-504 both in vitro and in vivo. In a xenograft model of a human NSCLC cell line containing the ALK rearrangement, we observe tumor regression at clinically relevant doses of IPI-504. Finally, cells that have been selected for resistance to ALK kinase inhibitors retain their sensitivity to IPI-504. We have recently observed partial responses to administration of IPI-504 as a single agent in a phase 2 clinical trial in patients with NSCLC, specifically in patients that carry an ALK rearrangement. This study provides a molecular explanation for these clinical observations.

Falta de concordancia entre los cuestionarios y las pruebas diagnósticas en el síndrome de ojo seco / Lack of concordance between dry eye syndrome questionnaires and diagnostic tests

PropósitoReportar la prevalencia del síndrome de ojo seco (SOS) y calcular la validez interna de dos cuestionarios para diagnosticar el síndrome de ojo seco y correlacionarlo con los resultados de varias pruebas diagnósticas.Material y métodoSe seleccionaron pacientes mayores de 50 años del sistema de salud de Castilla y León, en Valladolid. Contestaron los cuestionarios modificados de McMonnies (Q1) y Ocular Surface Index questionnaire (OSDI, Q2) y se les realizó: tiempo de ruptura lagrimal (TBUT), tinciones con fluoresceína y rosa de bengala y Schirmer con anestesia. Se registraron los resultados y se realizó análisis descriptivo, de concordancia y fiabilidad de Q1 y Q2 mediante áreas bajo la curva ROC.ResultadosUn total de 270 sujetos (58,2% mujeres; 41,8% hombres) con edad promedio de 64,5 años (IC 95%: 63,3 - 65,7) se enrolaron. El promedio de Q1 fue de 1,2 y la “sensación de arenillas” y las “molestias en ambientes secos” los síntomas más frecuentes. Para Q2 99,2% fueron “sensación de arenillas” y 98,9% “sensación de ardor”. Con la combinación Schirmer-TBUT, la prevalencia del SOS en Valladolid fue del 24,2%, 45,8% con TBUT y 45,6% con Schirmer. Utilizando Schirmer-TBUT, la prevalencia del SOS fue de 27,6% para mujeres (p<0,15) y 19,6% para hombres. Los valores del área bajo la curva ROC para Q1, Q2 y la mayoría de las pruebas diagnósticas fueron<0,5, excepto para Q2 y TBUT (0,503). Para Schirmer-TBUT, el valor de Q1 fue de 0,49 y 0,45 para Q2. Los valores de Cronbach alfa fue > 0,7 para todos los ítems de Q1 y Q2. Se obtuvieron concordancias estadísticamente significativas (p<0,05) con la combinación Schirmer – TBUT (κ=0,14) y TBUT- tinción fluoresceína (κ=0,09)(AU)

ConclusionesQ1 y Q2 no son fiables para el diagnóstico del SOS y tienen pobre consistencia interna. Las tinciones con fluoresceína y rosa de bengala resultaron ser las más concordantes para el diagnóstico del SOS. No hay correlación entre los cuestionarios y las pruebas diagnósticas objetivas del SOS(AU)

PurposeTo report the prevalence of dry eye syndrome (DES) in a subset of patients > 50 years old in Valladolid, Spain, calculate internal validity of two DES screening questionnaires, and correlate the results with DES diagnostic tests.MethodsPatients > 50 years-old were randomly selected from the medical network census in Valladolid; they answered the modified McMonnies questionnaire (Q1) and the Ocular Surface Index questionnaire (Q2) and then underwent an ophthalmic evaluation which included: tear break-up time (TBUT), fluorescein and Rose Bengal staining, and Schirmer with anesthesia were performed. Descriptive analysis, test concordance analysis, and Q1 and Q2 reliability using ROC curves were performed.ResultsA total of 270 subjects (58.2% female; 41.8% male) with an average age of 64.5 years (95% CI: 63.3 - 65.7) were enrolled. The prevalence of DES based on the Schirmer-Tear break-up time tests combination was 24.2%. The mean Q1 score was 1.2, and 1.4 for Q2. Grittiness and discomfort in dry environments (28.9%) were the most common symptoms recorded for Q1. For Q2 “grittiness” (99.2%) and “burning sensation” (98.9%)were the most common symptoms. With the Schirmer-TBUT combination, DES prevalence in Valladolid was 24.2%, 45.8% with TBUT, and 45.6% with Schirmer test. Values for the areas under the ROC curve for Q1, Q2, and most objective tests were < 0.5, except for Q2 and TBUT (0.503). Cronbach alpha was > 0.7 for all Q1 and Q2 items. Statistically significant concordance was reported for Schirmer – TBUT (κ=0.14) and TBUT- fluorescein staining (κ=0.09); (P<0.05).ConclusionsQ1 and Q2 were unreliable for DES diagnosis and showed poor internal consistency. Fluorescein and Rose Bengal staining were the most concordant tests for DES diagnosis. Finally, there was no correlation between either screening questionnaire and objective DES diagnostic tests(AU)

Reconstruction and analysis of pulsed thermographic sequences for nondestructive testing of layered materials.

We develop a heat transfer model to reconstruct pulsed thermographic data of layered objects. One of its salient features is its incorporation of normalized variables for a generalized approach to such problems. Additionally, we establish a methodology to determine the spatial and temporal limits of the data reconstruction process. Moreover, we describe an effective nondestructive technique for detecting and characterizing internal defects in multilayer objects. This inspection technique is verified on the construction of physical models and their examination. The depth, transverse dimensions, and front-surface shape of the detected defects are straightforwardly obtained from 3D depthgrams.

EULID project: European living donation and public health.

The choice of transplantation from a living donor offers advantages over a deceased donor. However, it also carries disadvantages related to donor risks in terms of health and safety. Furthermore, there are several controversial ethical aspects to be taken into account. Several national and international institutions and the scientific community have stated standards that have great influence on professional codes and legislations. Living organ donation and transplantation are to some extent regulated by parliamentary acts in most European countries. It is necessary to take a step forward to develop a legal framework to regulate all of these processes to guarantee the quality and to prevent illegal and nonethical practices. It is also necessary to develop and implement living donor protection practices not only in terms of physical health, but also to minimize potential impacts on the psychological, social, and economic spheres. Finally, an additional effort should be made to create a database model with recommendations for registration practices as part of the standardized follow-up care for the living donor. The European Living Donation (EULID) project's (http://www.eulivingdonor.eu/) main objective was to contribute to a European consensus to set standards and recommendations about legal, ethical, and living donor protection practices to guarantee the health and safety of living donors.

Training of health care students and professionals: a pivotal element in the process of optimal organ donation awareness and professionalization.

OBJECTIVE: Successes in organ donation and transplantation programs are directly evidence-based education. Transplant Procurement Management (TPM) is an international educational project on organ donation and transplantation. Our purpose was to evaluate the TPM educational project. We compared the data of 17 years of experience, strategies, and methods. MATERIALS AND METHODS: We retrospectively performed a descriptive analysis of all educational activities developed between 1991 and 2008. RESULTS: We identified 7 crucial points. (1) In 1991, TPM was started under the auspices of the University of Barcelona (UB) and the National Spanish Transplant Organization (ONT; national training, face-to-face). (2) In 1994, TPM became international (international advanced training and country-based). (3) Since 1997 in Italy and 2006 in France, national training courses were organized adapting the same methodologies as the advanced international TPM courses. TPM also implemented short (1-3 days) introductory courses worldwide. (4) In 2002, the e-learning platform program was launched to facilitate the education of professionals. (5) In 2005, an international master's degree was created at UB under the Life-Long Learning Institute (IL3). (6) In 2006, the courses were expanded to include pregraduate health science faculties with the International Project on Education and Research in Donation at University of Barcelona (PIERDUB). (7) In 2007, the European-funded European Training Program on Organ Donation (ETPOD) project was started. Currently, TPM offers face-to-face, e-learning, and blended international courses. As of 2008, TPM has trained 6498 professionals in 89 countries on 5 continents. CONCLUSIONS: TPM has impacted positively on the various essential levels in the process of organ donation and transplantation, with lifelong follow-up and an international network through the capacity to adapt to specific country needs as well as continuous quality improvement thanks to the collaboration of expert teachers and consultants.

IRODaT: the International Online Registry for Organ Donation and Transplantation 2007.

OBJECTIVE: IRODaT, an international registry for organ donation and transplantation, presents preliminary data reports on global trends on a regular basis and at various times of the year. The purpose of this report was not only to present statistics, but also to make organ donation effectiveness rates a useful tool to reveal similarities between various countries on an international level. MATERIALS AND METHODS: The IRODaT database produced this report for 2007 thanks to early reporting performed by professionals in coordination and transplant services from 49 countries. The countries were grouped as follows: countries with >200 total donors countries with 50 to 200 donors, and countries with <50 donors. RESULTS: The percentages of deceased and living donors according to the total number of donors from the 49 countries showed that countries performing >200 effective donation procedures yearly in 2007 showed a clear positive trend when compared for number of living donors, donors per million inhabitants, and number of transplantable organs per donor. CONCLUSIONS: The results obtained through this new presentation of the IRODaT provide a quick, clear, and illustrative view of organ donation activity in various countries.

Evaluation of transplant procurement management courses: an educational project as a tool for the optimization of transplant coordination.

The process of obtaining organs and tissues includes a series of procedures and skills that are fundamental to obtain a large number and high quality of transplants. Health professionals involved in transplant coordination require robest and comprehensive training to integrate the donation-transplantation process within the clinical health care field. Based on a learning-through-experience model, Transplant Procurement Management (TPM) designed various courses adapted to local educational need to train transplant coordinators, to increase active donor detection, and to promote a positive attitude towards donation; namely, Advanced, Introductory and New Life Cycle courses respectively. Moreover, TPM has coordinated international programs (INTERCATT and INTERITALY). Since 1991, the model has included 29 Advanced courses (1215 participants), 22 Introductory courses (575 pupils), and 7 New Life Cycle courses (more than 400 attendees). The Advanced courses were attended by medical (intensive care unit, nephrology, and others) and nursing professionals. Assessment of the educational program showed achievement of teaching objectives. The evaluation averages above 3.5 (scale, 1-5) for content, presentation, and ability to answer questions. Likewise, the program's organization showed an average score of 4.4. The acquired knowledge was assessed by means of a self-evaluation test (correct answers >69%). Practical skills assessed through direct observation showed an average of 7 (scale, 1-10). The TPM educational program offers a range of necessary knowledge and skills to increase organ donation. Health professionals concerned about the organ shortage may find TPM training useful to increase their knowledge.

Risley prisms to control wave-front tilt and displacement in a vectorial shearing interferometer.

A pair of thin prisms is used to deviate a light beam without changing the image orientation in a vectorial shearing interferometer. The relative angle between prisms determines the displacement of the wave front and its tilt. The direction of the beam displacement is controlled by means of changing the relative angle between prisms. This system is employed to control the displacement of a sheared wave front as a vector quantity and to introduce a controlled amount of tilt in what we believe is a novel interferometric shearing system. The predicted performance of this wave-front director is confirmed experimentally.