Pseudomelanoma diagnosis in a tertiary ophthalmologic centre in Spain.

BACKGROUND: The purpose of this study was to determine the types and frequency of lesions that can be misdiagnosed as choroidal or ciliary body melanomas (posterior uveal tract melanoma [PUM]). METHODS: This is a retrospective, descriptive study examining data from patients referred to Hospital La Paz in Madrid with the diagnosis of possible PUM between January 2005 and March 2020. All patients referred for PUM were studied. In collaboration with an oncology-specialized ophthalmologic centre, each patient underwent a full ophthalmic examination, ultrasonography, and optical coherence tomography, with agreed clinical criteria used to differentiate melanomas from pseudomelanomas. RESULTS: In our cohort of 715 patients, 48.9% had pseudomelanomas. Thirty-five different conditions were misdiagnosed as melanomas. The 5 most common conditions were choroidal nevus (40.5%), peripheral exudative hemorrhagic chorioretinopathy (12%), choroidal hemangioma (10.5%), choroidal metastasis (8%), and age-related macular degeneration (4%). CONCLUSIONS: Altering the diagnosis and changing the treatment and prognosis for patients can be difficult for a referral centre. Herein we present the largest European cohort investigated and highlight the importance of identifying the correct diagnosis to prevent mistreatment and possible overtreatment. These misdiagnoses can have an emotional effect on patients and their families, which could be avoided with a correct diagnosis. We analyze the most common pseudomelanoma diagnoses to help physicians better diagnose patients in their care.

Recurrent pterygium resection associated to fibrin membrane graft: report of two cases / Resseção do pterígio recorrente associada ao enxerto de membrana fibrina: relato de dois casos

ABSTRACT We propose a novel surgical technique in cases of aggressive recurrent pterygium non-subsidiary of treatment with conjunctival autografts or antimetabolites. Two presented cases were treated with surgical excision and a sutured plasma rich in growth factors membrane (mPRGF) followed by rich in growth factors (PRGF) eye drops treatment. After surgery, dexamethasone, tobramycin and PRGF eye drops were prescribed for 6 weeks. After a 12-month and 3-year post-surgical follow-up respectively, treated eyes with mPRGF did not present relapse, and visual acuity improved in both cases. No ocular complications, pain, eye discomfort nor other symptoms were observed. The combined use of PRGF eye drops and mPRGF seems an effective and safe therapy for recurrent pterygium.

RESUMO Nós propomos uma nova técnica cirúrgica em casos de pterígio agressivo recorrente não subsidiário de tratamento com autoenxertos conjuntivais ou antimetabólitos. Dois casos foram tratados com excisão cirúrgica e um plasma suturado rico em membrana de fatores de crescimento (mPRGF), seguido de tratamento com colírios ricos em fatores de crescimento (PRGF). Após a cirurgia, foram prescritos colírios de dexametasona, tobramicina e PRGF por 6 semanas. Após 12 meses e 3 anos de acompanhamento pós-cirúrgico respectivamente, os olhos tratados com mPRGF não apresentaram recidiva e a acuidade visual melhorou nos dois casos. Não foram observadas complicações oculares, dor, desconforto ocular ou outros sintomas. O uso combinado de colírios de PRGF e mPRGF parece uma terapia eficaz e segura para o pterígio recorrente.

New insights into developing antibiofouling surfaces for industrial photobioreactors.

The biofouling formation of the marine microalga Nannochloropsis gaditana on nontoxic surfaces was quantified on rigid materials, both coated (with fouling release coatings and nanoparticle coatings) and noncoated, to cover a wide range of surface properties from strongly hydrophobic to markedly hydrophilic under conditions similar to those prevailing in outdoor massive cultures of marine microalgae. The effect of seawater on surfaces that presented the best antibiofouling properties was also evaluated. The adhesion intensity on the different surfaces was compared with the predictions of the biocompatibility theories developed by Baier and Vogler using water adhesion tension (τ0 ) as the quantitative parameter of surface wettability. For the most hydrophobic surfaces, τ0 ≤ 0, the microalgae adhesion density increased linearly with τ0 , following the Baier's theory trend. However, for the rest of the surfaces, τ0 ≥ 0, a tendency toward minimum adhesion was observed for amphiphilic surfaces with a τ0 = 36 mJ/m2 , a value close to that which minimizes cell adhesion according to Vogler's theory. The understanding and combination of the two biocompatibility theories could help to design universal antibiofouling surfaces that minimize the van der Waals forces and prevent foulant adsorption by using a thin layer of hydration.

Biofouling in photobioreactors for marine microalgae.

The economic and/or energetic feasibility of processes based on using microalgae biomass requires an efficient cultivation system. In photobioreactors (PBRs), the adhesion of microalgae to the transparent PBR surfaces leads to biofouling and reduces the solar radiation penetrating the PBR. Light reduction within the PBR decreases biomass productivity and, therefore, the photosynthetic efficiency of the cultivation system. Additionally, PBR biofouling leads to a series of further undesirable events including changes in cell pigmentation, culture degradation, and contamination by invasive microorganisms; all of which can result in the cultivation process having to be stopped. Designing PBR surfaces with proper materials, functional groups or surface coatings, to prevent microalgal adhesion is essential for solving the biofouling problem. Such a significant advance in microalgal biotechnology would enable extended operational periods at high productivity and reduce maintenance costs. In this paper, we review the few systematic studies performed so far and applied the existing thermodynamic and colloidal theories for microbial biofouling formation in order to understand microalgal adhesion on PBR surfaces and the microalgae-microalgae cell interactions. Their relationship to the physicochemical properties of the solid PBR surface, the microalgae cell surfaces, and the ionic strength of the culture medium is discussed. The suitability and the applicability of such theories are reviewed. To this end, an example of biofouling formation on a commercial glass surface is presented for the marine microalgae Nannochloropsis gaditana. It highlights the adhesion dynamics and the inaccuracies of the process and the need for further refinement of previous theories so as to apply them to flowing systems, such as is the case for PBRs used to culture microalgae.

Recomendaciones para el uso de metotrexato en artritis reumatoide establecida: monoterapia y combinación con otros fármacos modificadores de la enfermedad sintéticos o biológicos / Recommendations for the use of methotrexate in established rheumatoid arthritis: monotherapy and combination with other synthetic or biological DMARDs

El metotrexato, utilizado a dosis bajas semanales, es actualmente el tratamiento de referencia en la artritis reumatoide. No se conoce con exactitud el mecanismo de acción en esta enfermedad, pero se han descrito diversas acciones antiproliferativas, antiinflamatorias e inmunorreguladoras que pueden contribuir a su efecto terapéutico. Diversos ensayos clínicos demostraron en la década de los ochenta del siglo pasado su eficacia clínica, así como su efecto enlentecedor del daño anatómico. En los últimos años se ha visto además que llegar a dosis más altas de las inicialmente utilizadas, entre 25 y 30 mg/semanales, puede maximizar sus efectos. En pacientes resistentes, el metotrexato también puede ser útil en terapia combinada con otros fármacos modificadores de la enfermedad, sintéticos o biológicos. Habitualmente, el metotrexato es bien tolerado, pero puede tener efectos adversos a diversos niveles (hematológico, digestivo, hepático, neurológico o pulmonar), alguno de los cuales pueden ser graves, por lo que requiere una cuidadosa monitorización clínica y analítica (AU)

The aim of this document is to describe the optimal use of: a) methotrexate (MTX) monotherapy in established RA in readministration after a previous effective cycle, and b) MTX combination with synthetic and biological DMARD. Clinical questions were proposed and a systematic literature search was conducted. Recommendations were developed and then discussed and validated in a working session with fifteen experts. After an effective cycle, MTX will be restarted with the same dose and route of administration than previously, following an intensive strategy if the dose were insufficient or the patient had poor prognostic factors. When sustained remission, MTX may be reduced gradually, with a close monitoring of the patient. Before starting a combination therapy with other synthetic or biologic DMARD, full doses of MTX should be reached and the use of the parenteral route evaluated. In established RA, when starting the combination of MTX with a biological DMARD, the same dose and route of administration of MTX than previously used should be maintained. In patients in remission for at least 6 months and in combination therapy with a biological, it is recommended to reduce the dose of the biological agent or increase its administration period before reducing the dose of MTX, unless side effects due to MTX. This document pretends to solve some frequent clinical questions on the use of MTX in monotherapy and/or in combination therapy with other synthetic or biological DMAR (AU)