Patterns and Predictors of Successful Treatment Discontinuation in Retinal Vein Occlusions With Macular Edema in the Real World.

BACKGROUND AND OBJECTIVE: To identify factors associated with successful treatment discontinuation in eyes with retinal vein occlusions (RVOs) and macular edema (ME) in real-world settings. PATIENTS AND METHODS: Retrospective study of 214 eyes with RVO and ME with 24-month follow-up at five academic centers. Regression analyses identified factors associated with (1) successful treatment discontinuation for at least 6 months without fluid recurrence and (2) best-corrected visual acuity (BCVA) at 24 months. RESULTS: Forty percent of eyes with branch RVO and 35% with central RVO (CRVO) / hemi-retinal RVO (HRVO) successfully discontinued therapy without fluid recurrence, with median time to discontinuation of 6 and 7 months, respectively. Lower 6-month central subfield thickness was associated with greater likelihood of treatment discontinuation within 24 months for eyes with CRVO/HRVO (P = .001), whereas better 6-month BCVA was associated with better 24-month BCVA for all RVO subtypes (P < .001). CONCLUSION: Early anatomic response at 6 months is associated with greater likelihood of stopping treatments. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:84-92.].

Two Homogametic Genotypes - One Crayfish: On the Consequences of Intersexuality.

In the Australian redclaw crayfish, Cherax quadricarinatus (WZ/ZZ system), intersexuals, although exhibiting both male and female gonopores, are functional males bearing a female genotype (WZ males). Therefore, the occurrence of the unusual homogametic WW females in nature is plausible. We developed W/Z genomic sex markers and used them to investigate the genotypic structure of experimental and native C. quadricarinatus populations in Australia. We discovered, for the first time, the natural occurrence of WW females in crustacean populations. By modeling population dynamics, we found that intersexuals contribute to the growth rate of crayfish populations in the short term. Given the vastly fragmented C. quadricarinatus habitat, which is characterized by drought-flood cycles, we speculate that intersexuals contribute to the fitness of this species since they lead to occasional increment in the population growth rate which potentially supports crayfish population restoration and establishment under extinction threats or colonization events.

Design and Validation of a Cervical Laminectomy Simulator using 3D Printing and Hydrogel Phantoms.

BACKGROUND: The development of technical skills for a cervical laminectomy are traditionally acquired through intraoperative learning and cadaveric courses. These methods provide little objective assessment, involve financial and biohazard considerations, and may not incorporate desired pathology. OBJECTIVE: To develop an inexpensive cervical spine laminectomy simulator capable of measuring operative performance and to assess its face, content, and construct validity. METHODS: A virtual model was generated and 3D printed into negative molds. A multilayered surgical phantom was fabricating by filling molds with hydrogels, plaster, and fiberglass. A pressure transducer measured simulated spinal cord manipulation. Participants completed full-procedural laminectomy simulations. Post-simulation surveys assessed face and content validity. Construct validity was assessed by comparing expert and novice procedural metrics. RESULTS: Twelve surgeons participated. The simulator received median face and content validity ratings of 4/5. Differences between experts and novices were found in mean intrathecal pressure wave count (84 vs 153, P = .023), amplitude (4 vs 12% > 2SD above expert mean, P < .001), area under curve (4 vs 12% > 2SD above expert mean, P < .001), procedure time (35 vs 69 min P = .003), and complication rates (none vs 3 incorrect levels decompressed and 1 dural tear, P = .06). Insignificant differences were found in mean pressure wave slope and blood loss. CONCLUSION: This inexpensive cervical laminectomy simulator received favorable face and content validity ratings, and distinguished novice from expert participants. Further studies are needed to determine this simulator's role in the training and assessment of novice surgeons.

Production of WW males lacking the masculine Z chromosome and mining the Macrobrachium rosenbergii genome for sex-chromosomes.

The cultivation of monosex populations is common in animal husbandry. However, preselecting the desired gender remains a major biotechnological and ethical challenge. To achieve an efficient biotechnology for all-female aquaculture in the economically important prawn (Macrobrachium rosenbergii), we achieved - for the first time - WW males using androgenic gland cells transplantation which caused full sex-reversal of WW females to functional males. Crossing the WW males with WW females yielded all-female progeny lacking the Z chromosome. We now have the ability to manipulate - by non-genomic means - all possible genotype combinations (ZZ, WZ and WW) to retain either male or female phenotypes and hence to produce monosex populations of either gender. This calls for a study of the genomic basis underlying this striking sexual plasticity, questioning the content of the W and Z chromosomes. Here, we report on the sequencing of a high-quality genome exhibiting distinguishable paternal and maternal sequences. This assembly covers ~ 87.5% of the genome and yielded a remarkable N50 value of ~ 20 × 106 bp. Genomic sex markers were used to initiate the identification and validation of parts of the W and Z chromosomes for the first time in arthropods.

Effect of treated domestic wastewater on soil physicochemical and microbiological properties.

A main concern with reuse of treated domestic wastewater (DWW) in irrigation is its possible effect on the soil. Few studies have focused on DWW treated in on-site settings, which generally use low-tech systems that can be constructed and serviced locally. One such system is the recirculating vertical flow constructed wetland (RVFCW). The aim of this study was to assess short- to midterm effects of irrigation with DWW treated in the RVFCW. Four groups of plastic barrels, filled with a sandy loam soil, were irrigated for 36 mo with fresh water (FW), FW with added fertilizer, raw DWW, or DWW treated in the RVFCW followed by ultraviolet disinfection. Principal component analysis revealed that the soil irrigated with treated DWW had physicochemical properties similar to those irrigated with FW amended with fertilizer. Levels of surfactants in soil irrigated with treated DWW were identical to those expected from standard irrigation practices, abating concerns for possible changes in soil hydraulic properties. was not detected in the soil irrigated with treated DWW, demonstrating the importance of disinfection of treated effluents before reuse in irrigation. Furthermore, irrigation with treated DWW did not alter the bacterial community structure according to terminal restriction fragment analysis. This 3-yr study suggests that the practice of irrigation with RVFCW effluents is safe. Continuation of the experiment is required to determine whether longer-term irrigation might show a different pattern.

Soil microbial abundance and diversity along a low precipitation gradient.

The exploration of spatial patterns of abundance and diversity patterns along precipitation gradients has focused for centuries on plants and animals; microbial profiles along such gradients are largely unknown. We studied the effects of soil pH, nutrient concentration, salinity, and water content on bacterial abundance and diversity in soils collected from Mediterranean, semi-arid, and arid sites receiving approximately 400, 300, and 100 mm annual precipitation, respectively. Bacterial diversity was evaluated by terminal restriction fragment length polymorphism and clone library analyses and the patterns obtained varied with the climatic regions. Over 75% of the sequenced clones were unique to their environment, while ∼2% were shared by all sites, yet, the Mediterranean and semi-arid sites had more common clones (∼9%) than either had with the arid site (4.7% and 6%, respectively). The microbial abundance, estimated by phospholipid fatty acids and real-time quantitative PCR assays, was significantly lower in the arid region. Our results indicate that although soil bacterial abundance decreases with precipitation, bacterial diversity is independent of precipitation gradient. Furthermore, community composition was found to be unique to each ecosystem.

Mathematical model for analysis of recirculating vertical flow constructed wetlands.

The recirculating vertical flow constructed wetland (RVFCW) was developed for the treatment of domestic wastewater (DWW). In this system, DWW is applied to a vertical flow bed through which it trickles into a reservoir located beneath the bed. It is then recirculated back to the root zone of the bed. In this study, a compartmental model was developed to simulate the RVFCW. The model, which addresses transport and removal kinetics of total suspended solids, 5-day biological oxygen demand and nitrogen, was fitted to kinetical results obtained from pilot field setups and a local sensitivity analysis was performed on the model parameters and operational conditions. This analysis showed that after 5h of treatment water quality is affected more by stochastic events than by the model parameter values, emphasizing the stability of the RVFCW system to large variations in operational conditions. Effluent quality after 1h of treatment, when the sensitivity analysis showed the parameter impacts to be largest, was compared to model predictions. The removal rate was found to be dependent on the recirculation rate. The predictions correlated well with experimental observations, leading to the conclusion that the proposed model is a satisfactory tool for studying RVFCWs.

Evaluating amplified rDNA restriction analysis assay for identification of bacterial communities.

Amplified ribosomal DNA restriction analysis (ARDRA) and restriction fragment length polymorphism were originally used for strain typing and for screening clone libraries to identify phylogenetic clusters within a microbial community. Here we used ARDRA as a model to examine the capacity of restriction-based techniques for clone identification, and the possibility of deriving phylogenetic information from ARDRA-based dendrograms. ARDRA was performed in silico on 48,759 sequences from the Ribosomal Database Project, and it was found that the fragmentation profiles were not necessarily unique for each sequence in the database, resulting in different species sharing fragmentation profiles. Although ARDRA-based clusters separated clones into different genera, these phylogenetic clusters did not overlap with trees constructed according to sequence alignment,calling into question the intra-genus ARDRA based phylogeny. It is thus suggested that the prediction power of ARDRA clusters in identifying clone phylogeny be regarded with caution.

The feasibility and risk of early colonoscopy in acute diverticulitis: a prospective controlled study.

BACKGROUND AND STUDY AIM: Following acute diverticulitis, colonoscopy is advised to rule out malignancy. Commonly, the colonoscopy is postponed to avoid the potential risk of perforation. In a previous pilot, noncontrolled study, we showed that early colonoscopy is feasible in patients with acute diverticulitis. This randomized controlled trial compared early and late colonoscopy in hospitalized patients with acute diverticulitis. PATIENTS AND METHODS: 154 patients diagnosed with acute diverticulitis were hospitalized between January 2004 and June 2006. Of these, 35 patients were excluded because of either free perforation or pericolic air on computed tomography (CT), and another 18 because they had undergone colonoscopy in the previous year. The remaining 101 patients were offered the possibility of participating in the study, with random allocation to either early in-hospital colonoscopy or late colonoscopy, 6 weeks later. Randomization was refused by 15 patients, and 86 were included in the study. RESULTS: 45 patients were randomly allocated for early colonoscopy and 41 for late colonoscopy. Three and 10 did not present for the examination, in the early and late group respectively. The cecum could not be reached in eight and three patients from the early and late groups, respectively. The colonoscopy revealed polyps in five patients, two in the early group and three in the late group. No malignancy was detected. There were no complications in either group. CONCLUSIONS: Early colonoscopy in acute diverticulitis is feasible and safe in the absence of pericolic air on CT, and has greater compliance. However, no added value is apparent compared with the CT scan currently used.

A novel per-oral insulin formulation: proof of concept study in non-diabetic subjects.

AIMS: The aim of our study was to examine the absorption of insulin from the gastrointestinal (GI) tract, using a novel oral formulation-adding a delivery agent SNAC (sodium N-[8-(2-hydroxybenzoyl)amino] caprylate) in combination with insulin. METHODS: Capsules containing insulin and SNAC, in various combinations, were administered orally, as a single dose, to 12 non-diabetic subjects and four control subjects (receiving SNAC or insulin only) in order to assess its biological effect and safety. Plasma glucose levels, insulin and C-peptide concentrations, as well as SNAC levels, were determined, at timed intervals up to 4 h. RESULTS: In all cases, a glucose-lowering effect was demonstrated, preceded by an increase in plasma insulin levels. The nadir of plasma glucose levels appeared after 30-50 min, following the ingestion of the mixture. The plasma insulin levels were found to parallel the blood SNAC levels. Plasma C-peptide levels were suppressed by the lowered glucose levels achieved concurrent with the increasing amount of exogenous insulin absorbed, indicating that the secretion of endogenous hormone was partially abolished. There were no biological effects regarding blood glucose levels upon administration of SNAC or insulin when given alone. No adverse effects were detected during the trial or several weeks after the trial. CONCLUSIONS: Insulin in combination with a novel delivery agent, SNAC, given orally, is absorbed through the GI tract in a biologically active form. This was demonstrated by a glucose lowering effect of the mixture as well as a suppression of an endogenous insulin secretion.

Amelioration of steroid-resistant chronic graft-versus-host-mediated liver disease via tacrolimus treatment.

Liver disease associated with chronic graft-versus-host disease (cGVHD) is a major cause of mortality and morbidity. Steroids and cyclosporin (CSA), which are the standard therapy, give rather disappointing results, and toxicity is high. Tacrolimus (FK506) is a potent macrolide lactone immunosuppressant that is used in the prevention of solid organ rejection. This study evaluated the therapeutic role of FK506 in the treatment of severe cGVHD-mediated liver disease that did not respond to combined steroids and CSA therapy. Fifteen patients with various hematological disorders who underwent allogeneic stem cell transplantation were enrolled in the study. All patients had severe cholestatic liver disease disturbances and underwent liver biopsy, which was compatible with cGVHD-mediated liver disease. All the patients were negative for markers of chronic liver disease, including viral serology. They received FK506 orally (4-20 mg/day according to serum levels), and were evaluated biweekly by physical examination and liver function tests. Patients were followed for a median of 12 months (range 3-24 months). FK506 treatment ameliorated liver functions in 9 of 15 patients (60%), 5 of whom demonstrated complete normalization of liver enzymes (33%). In 5 patients, no major effect was observed, and 1 patient showed deterioration of his liver functions. Mean GGT levels decreased from 171.5 to 55.6 within 6 months of treatment. Median time to response was 3 months (range 1-11). Side effects were generally transient. Treatment with FK506 was found to be effective in the majority of patients with steroid and CSA-resistant cGVHD-associated liver disease, with manageable side effects. In view of these findings, FK506 may yet evolve into first line therapy for cGVHD induced liver toxicity.

Assessing quality of life among adults with mental retardation living in various settings.

Fifty-eight Israeli adults with mild to moderate mental retardation, living in Jerusalem, either in a residential institution, various sheltered apartments or in their parents' home, were studied with respect to their quality of life. Quality of life was evaluated through the assessment of individual's satisfaction with different elements of life. The results are presented in this article. Overall, significant differences were found in satisfaction with: current residence, friends and free time, and total lifestyle satisfaction. Residents of sheltered apartments expressed the most satisfaction in these three domains. Persons living in the residential institution expressed the least satisfaction with current residence, and people living in their parents' home expressed the least satisfaction with friends and free time and with total lifestyle satisfaction. The three groups differ significantly on the three domains of life satisfaction even after controlling for background and environmental characteristics such as: age, health limitations, adaptive behaviour, participation in leisure activities, and opportunity to choose and decide.

[Clinical characteristics of Crohn's disease in children and adults].

There are few reports contrasting the clinical characteristics of Crohn's disease in different age groups. We therefore compared retrospectively children and adults with Crohn's disease. 23 children (mean age: 12.8 +/- 2.5 years) and 66 adults (mean age: 27.0 +/- 4.0 years) were studied. Presenting symptoms of abdominal pain and diarrhea were significantly more common in adults, while in children anorexia and weight loss were more frequent. Children tended to present with extra-gastrointestinal tract symptoms as well, mainly anemia and joint involvement. Common symptoms during active disease did not differ between groups, except that weight loss, evident in all children, was found in only 70% of adults. Anemia was present during active disease in all pediatric cases but in only 62% of adults. There were no significant differences between groups regarding disease location, gastrointestinal complications and extra-intestinal manifestations. We conclude that in children Crohn's disease may differ significantly, mainly presenting with nonclassical symptoms, such as anemia and joint involvement. The primary care physician should be aware of these differences.

Double seton--a new modified approach to high transsphincteric anal fistula.

Despite the fact that complicated extrasphincteric anal fistulas have been recognized and treated for many years, there is still a lack of consensus among colorectal surgeons as to the optimum surgical approach. We have devised a modification of the seton technique, which we used in 23 patients without complications or recurrence.