Highly dynamic gamma-ray emissions are common in tropical thunderclouds.

Thunderstorms emit fluxes of gamma rays known as gamma-ray glows1,2, sporadically observed by aircraft1,3-7, balloons8-11 and from the ground12-18. Observations report increased gamma-ray emissions by tens of percent up to two orders of magnitude above the background, sometimes abruptly terminated by lightning discharges1,3-5. Glows are produced by the acceleration of energetic electrons in high-electric-field regions within thunderclouds8 and contribute to charge dissipation3. Glows had been considered as quasi-stationary phenomena3,5,12, with durations up to a few tens of seconds and spatial scales up to 10-20 km. However, no measurements of the full extension in space and time of a gamma-ray-glow region and their occurring frequency have been reported so far. Here we show that tropical thunderclouds over ocean and coastal regions commonly emit gamma rays for hours over areas up to a few thousand square kilometres. Emission is associated with deep convective cores; it is not uniform and continuous but shows characteristic timescales of 1-10 s and even subsecond for individual glows. The dynamics of gamma-glowing thunderclouds strongly contradicts the quasi-stationary picture of glows and instead resembles that of a huge gamma-glowing 'boiling pot' in both pattern and behaviour.

Flickering gamma-ray flashes, the missing link between gamma glows and TGFs.

Two different hard-radiation phenomena are known to originate from thunderclouds: terrestrial gamma-ray flashes (TGFs)1 and gamma-ray glows2. Both involve an avalanche of electrons accelerated to relativistic energies but are otherwise different. Glows are known to last for one to hundreds of seconds, have moderate intensities and originate from quasi-stationary thundercloud fields2-5. TGFs exhibit high intensities and have characteristic durations of tens to hundreds of microseconds6-9. TGFs often show a close association with an emission of strong radio signals10-17 and optical pulses18-21, which indicates the involvement of lightning leaders in their generation. Here we report unique observations of a different phenomenon, which we call flickering gamma-ray flashes (FGFs). FGFs resemble the usual multi-pulse TGFs22-24 but have more pulses and each pulse has a longer duration than ordinary TGFs. FGF durations span from 20 to 250 ms, which reaches the lower boundary of the gamma-ray glow duration. FGFs are radio and optically silent, which makes them distinct from normal TGFs. An FGF starts as an ordinary gamma-ray glow, then suddenly increases exponentially in intensity and turns into an unstable, 'flickering' mode with a sequence of pulses. FGFs could be the missing link between the gamma-ray glows and conventional TGFs, whose absence has been puzzling the atmospheric electricity community for two decades.

XEN® 45 en el manejo quirúrgico del glaucoma en fases tempranas: estudio nacional de consenso según metodología Delphi / XEN-45 in the management of Early Glaucoma Surgery: A National Delphi Consensus Study

Antecedentes y objetivo: Las recomendaciones sobre el manejo general del glaucoma y el uso de cirugías mínimamente-invasivas y microincisionales en fases tempranas son limitadas. El objetivo de este estudio fue establecer un consenso sobre el manejo del glaucoma, centrándose en el implante XEN 45 (AbbVie Inc., North Chicago, IL, EE. UU.). Métodos: Se utilizó un método Delphi. El comité científico dirigió el estudio, identificó el panel de expertos y participó en la elaboración del cuestionario. Se invitó a 51 expertos a completar, en una escala Likert de 9 puntos, un cuestionario de 89 ítems que cubría 3 bloques temáticos. Se realizaron 2 rondas Delphi. Se logró consenso si≥66,6% de los expertos llegaron a un acuerdo o desacuerdo. Resultados: Los panelistas acordaron 84 ítems relacionados con la calidad de vida, el algoritmo terapéutico y el perfil del paciente, y el manejo quirúrgico pre y postoperatorio. Los panelistas consideraron el implante XEN idóneo para tratar el glaucoma en diferentes etapas y para diferentes perfiles de pacientes: pacientes jóvenes/ancianos/con comorbilidades-significativas, glaucoma-miópico, pacientes con fracaso quirúrgico previo y con postoperatorio complejo. El implante XEN se consideró un paso terapéutico previo a la cirugía filtrante clásica y una posible primera opción quirúrgica en pacientes ancianos con comorbilidades y presión intraocular descontrolada. El implante XEN permite al paciente retomar sus actividades diarias más rápidamente que las cirugías filtrantes convencionales y reducir y/o eliminar los tratamientos tópicos. Conclusiones: Este consenso según la metodología Delphi proporcionó una serie de recomendaciones generales para el tratamiento del glaucoma, incluidas aquellas relacionadas con la calidad de vida del paciente, el algoritmo terapéutico y el perfil del paciente, y específicas con respecto al uso del implante XEN.(AU)

Background and objective: Recommendations on general glaucoma management and the use of early minimally invasive and microincisional surgeries are limited. This study aimed to establish consensus regarding glaucoma management, focusing on the XEN-45 gel stent implant. Methods: A Delphi consensus-driven process was used. The scientific committee led the study, identified the expert panel, and participated in elaborating the questionnaire. Fifty-one panelists were invited to complete, on a nine-point Likert scale, an 89-item questionnaire covering three topic blocks. Two Delphi rounds were performed. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement. Results: Panelists agreed on 84 items related to the patients’ quality of life, the therapeutic algorithm and patient profile, and surgical and pre- and post-operative management. Panelists agreed on the suitability of XEN stent implants to treat glaucoma at different stages and for different patient profiles: young patients, elderly or with significant comorbidities, and with myopic glaucoma, patients who failed previous surgeries, and with previous poor post-operative experience. XEN surgery was considered a therapeutic step prior to classic filtering surgery and a possible first surgical option in elderly patients with comorbidities and uncontrolled intraocular pressure. XEN surgery allows the patient to return to routine daily activities faster than conventional filtering surgeries and to reduce and/or eliminate topical treatments. Conclusions: This Delphi-driven consensus resulted in a series of general recommendations for glaucoma management, including those related to patient quality of life, therapeutic algorithm, and patient profile, and specific ones regarding the use of XEN stent gel surgery.(AU)

XEN-45 in the management of early glaucoma surgery: A national Delphi consensus study.

BACKGROUND AND OBJECTIVE: Recommendations on general glaucoma management and the use of early minimally invasive and microincisional surgeries are limited. This study aimed to establish consensus regarding glaucoma management, focusing on the XEN-45 gel stent implant. METHODS: A Delphi consensus-driven process was used. The scientific committee led the study, identified the expert panel, and participated in elaborating the questionnaire. Fifty-one panelists were invited to complete, on a nine-point Likert scale, an 89-item questionnaire covering three topic blocks. Two Delphi rounds were performed. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement. RESULTS: Panelists agreed on 84 items related to the patients' quality of life, the therapeutic algorithm and patient profile, and surgical and pre- and post-operative management. Panelists agreed on the suitability of XEN stent implants to treat glaucoma at different stages and for different patient profiles: young patients, elderly or with significant comorbidities, and with myopic glaucoma, patients who failed previous surgeries, and with previous poor post-operative experience. XEN surgery was considered a therapeutic step prior to classic filtering surgery and a possible first surgical option in elderly patients with comorbidities and uncontrolled intraocular pressure. XEN surgery allows the patient to return to routine daily activities faster than conventional filtering surgeries and to reduce and/or eliminate topical treatments. CONCLUSIONS: This Delphi-driven consensus resulted in a series of general recommendations for glaucoma management, including those related to patient quality of life, therapeutic algorithm, and patient profile, and specific ones regarding the use of XEN stent gel surgery.

Evaluation of the dispersion properties of graphene oxide/cetyltrimethylammonium bromide for application in nanocomposite materials.

The properties of thermal diffusivity and Z potential of the GONPs/CTAB nanofluid were studied as a function of GO concentration (in the range between 4 and 12% w/v), temperature (35 and 50 °C) and time (30 and 60 min) under ultrasound. In turn, the structural properties of GONPs/CTAB were measured by XRD, Raman, SEM and TEM. The GO previously modified with CTAB was used to obtain a PLA/GO nanocomposite. It was found that the behavior of thermal diffusivity provides information in situ on the dispersion properties of the nanofluid, finding values from 0.0013 to 0.0024 cm2 s-1. The hydrodynamic diameter of the GONP dispersions was also determined to range from 75.83 to 360.3 nm with an increase in Z potential from 17 to 30 mV. The most stable GONPs/CTAB dispersion conditions were 6% w/v GO, 50 °C and 30 min. Under these conditions, the GONPs/CTAB materials present an increase in the spacing between GO layers, associated with a greater multilayer stacking of the GO and CTAB layers. The Raman spectrum allowed us to demonstrate that the modification with CTAB did not affect the crystallinity of GO, which was verified by the intensity ratio of the D band and the G band (ID/IG) for the GO/CTAB samples, with the exception of the GO 6% sample, where an increase in the ID/IG ratio (0.9) was observed compared to GO (0.82), associated with greater intercalation of CTAB between the GO sheets. Finally, an SEM analysis of the PLA/GO nanocomposite was carried out and the homogeneous distribution of GO in PLA was demonstrated when it is used as a filler in proportions of 0.1%. This treatment, in turn, contributed to improving the mechanical flexural properties of the nanocomposite materials.

Biomarcadores evolutivos de cáncer gástrico en Nariño / Evolutionary biomarkers of gastric cancer in Nariño

Objetivo: Dilucidar el papel de la coevolución del genoma humano y de Helicobacter pylori en la patogenesis gástrica en población de Nariño-Colombia. Materiales y Métodos: Se aisló Helicobacter pylori de biopsias gástricas obtenidas de 292 pacientes con enfermedad gástrica de Nariño. El diagnóstico histológico se realizó por la clasificación de Sydney. Se incluyeron 252 cepas de H. pylori para el análisis MLST, que las asignó a poblaciones ancestrales (hpAfrica1, hpAfrica2, hpEurope, hpEAsia). Para los análisis evolutivos humanos se utilizó Immunochip y el software ESTRUCTURE para determinar proporciones de ascendencia por comparación con 712 secuencias globales de base MLST de H. pylori (http://pubmlst.org/helicobacter). Resultados: Las cepas de H. pylori en Nariño se derivan de cuatro poblaciones ancestrales: Africa (AA1), Europea (AE1 y AE2) y Asia Oriental (AEA). Los aislamientos contenían fracciones sustanciales de ancestría africana AA1 en la costa, y europea, AE2 en la región montañosa. Debido a que la población de montaña tenía un mínimo de ancestría africana del huésped, nos preguntamos si AA1 aumentaba la gravedad de las lesiones gástricas en los sujetos con baja ancestría africana. Tal escenario podría significar una coadaptación interrumpida: disrupción de la coevolución humano-H. pylori. Cuando consideramos a las 56 personas con menos del 17,6% de ancestria africana, encontramos que todas las personas que portaban H. pylori con >19,8% de ancestría africana AA1, n = 20 tenían lesiones severas. Conclusión: Las relaciones coevolutivas humano-H. pylori son biomarcadores importantes de enfermedad gástrica, y la interrupción de estas relaciones desenlazan lesiones gástricas mas avanzadas en Nariño.

Objective: To elucidate the role of the coevolution of the human genome and Helicobacter pylori in gastric pathogenesis in a population from Nariño-Colombia. Materials and Methods: Helicobacter pylori was isolated from gastric biopsies obtained from 292 patients with Nariño gastric disease. The histological diagnosis was made by the Sydney classification. 252 H. pylori isolates were included for MLST analysis, which assigned them to ancestral populations (hpAfrica1, hpAfrica2, hpEurope, hpEAsia). Immunochip was used for human evolutionary analyses. STRUCTURE software to determine ancestry proportions by comparison with 712 global H. pylori MLST base sequences (http://pubmlst.org/helicobacter). Results: The H. pylori strains in Nariño derive from four ancestral populations: African (AA1), European (AE1 and AE2), and East Asian (AEA). The isolates contained substantial fractions of AA1 African ancestry on the coast, and AE2 European ancestry in the mountains. Because the mountain population had minimal African ancestry of the host, we wondered if AA1 increased the severity of gastric lesions in subjects of low African ancestry. Such a scenario could signify disrupted coadaptation: disruption of human-H. pylori coevolution. When we considered the 56 individuals with less than 17.6% African ancestry, we found that all individuals carrying H. pylori with >19.8% AA1 African ancestry, (n = 20) had severe lesions. Conclusion: Human and H. pylori coevolutionary relationships are important biomarkers of gastric disease, and disruption of these relationships results in more advanced gastric lesions in Nariño-Colombia.

Ancestros de Helicobacter pylori de una zona de Nariño con alto riesgo de cáncer gástrico / Helicobacter pylori ancestors from an area of Nariño with high risk of gastric cancer

Objetivo: Determinar la ancestría de Helicobacter pylori aislado de pacientes provenientes de una zona de alto riesgo de cáncer gástrico del departamento de Nariño. Materiales y Métodos: Se incluyeron 16 pacientes con síntomas de dispepsia e infectados con Helicobacter pylori. Se utilizaron biopsias gástricas para el cultivo de Helicobacter pylori y subsecuente secuenciación del genoma total por Illumina MiSeq, 2x300 pb. El ensamblaje y anotación de los genomas se procedió mediante el uso de los algoritmos SPAdes y RASTtk. Las proporciones ancestrales de Helicobacter pylori se determinaron por STRUCTURE con el modelo de mezcla. Las diferencias entre estas proporciones se establecieron con las pruebas H de Kruskal Wallis y post hoc. Resultados: La estructura de la población de Helicobacter pylori deriva de cuatro poblaciones ancestrales: Ancestral Europa (AE) (61.2%), Ancestral Africa1 (AA1) (35.7%), Ancestral Este de Asia (AEA) (3%) y Ancestral Africa2 (AA2) (0.1%), siendo significativas las diferencias entre las proporciones de los ancestros de Helicobacter pylori (p<0.05). Se identificaron diferencias estadísticamente significativas entre: AA2 y AEA (p=0.022); AA2 y AA1 (p<0.05); AA2 y AE (p<0.05); AEA y AA1 (p=0.014) y AEA con AE (p<0.05), sin embargo, no se encontró diferencias significativas entre AA1 y AE (p=0.098), evaluadas por post hoc. Conclusión: Helicobacter pylori que coloniza la mucosa gástrica de una población de alto riesgo de cáncer gástrico en Nariño, deriva su acervo genético principalmente de ancestros europeos y africanos, confiriéndole a la bacteria alta capacidad competitiva asociada al desarrollo de lesiones severas en nichos gástricos amerindios.

Objective: To determine the ancestry of Helicobacter pylori isolated from patients from a high-risk area for gastric cancer in the department of Nariño. Materials and Methods: Sixteen patients with dyspepsia symptoms and infected with Helicobacter pylori were included. Gastric biopsies were used for Helicobacter pylori culture and subsequent whole genome sequencing by Illumina MiSeq, 2x300 bp. Genome assembly and annotation proceeded by using the SPAdes and RASTtk algorithms. The ancestral proportions of Helicobacter pylori were determined by STRUCTURE with the mixture model. Differences between these proportions were established with Kruskal Wallis and post hoc H-tests. Results: The population structure of Helicobacter pylori derived from four ancestral populations: Ancestral Europe (AE) (61.2%), Ancestral Africa1 (AA1) (35.7%), Ancestral East Asia (AEA) (3%) and Ancestral Africa2 (AA2) (0.1%), with differences between the proportions of Helicobacter pylori ancestors being significant (p<0.05). Statistically significant differences were identified between: AA2 and AEA (p=0.022); AA2 and AA1 (p<0.05); AA2 and AE (p<0.05); AEA and AA1 (p=0.014) and AEA with AE (p<0.05), however, no significant differences were found between AA1 and AE (p=0.098), evaluated by post hoc. Conclusion: Helicobacter pylori colonizing the gastric mucosa of a population at high risk of gastric cancer in Nariño, derives its gene pool mainly from European and African ancestors, giving the bacterium highly competitive capacity associated with the development of severe lesions in Amerindian gastric niches.

Efficacy and safety of combined 27-G vitrectomy and Ahmed valve using same sclerotomy site for the tube placement: A case series.

We report a retrospective case series describing the feasibility and outcomes of combined 27-G minimally invasive vitrectomy surgery (MIVS) and Ahmed® Glaucoma Valve (AGV) placement. Four eyes of four patients underwent a combined MIVS using 27-G technology and AGV implantation with the tube placement in the vitreous cavity. Preoperative and postoperative data up to 12 months were collected including the type of glaucoma, intraocular pressure (IOP), glaucoma medications, and complications. All AGVs tubes were placed in the vitreous cavity using the same sclerotomy, although a slight wound enlargement was required. After one year, IOP and glaucoma medications were reduced (41.5 ±â€¯19.1-14.5 ±â€¯3.1 mmHg and from 3(3-3) to 1.5 (1.5-3.5). Three patients developed cystoid macular edema. The first-reported cases of combined MIVS-27-G and AGV showed a reduction of IOP and antiglaucoma medication. Placing the tube using the same sclerotomy location is feasible but a slight enlargement may be required.

Activity and stability of bifunctional perovskite/carbon-based electrodes for the removal of antipyrine by electro-Fenton process.

Bifunctional perovskite/carbon-black(CB)/polytetrafluoroethylene(PTFE) electrodes for electro-generation and catalytic decomposition of hydrogen peroxide to oxidizing hydroxyl radicals have been fabricated. These electrodes were tested for electroFenton (EF) removal of antipyrine (ANT) as a model antipyretic and analgesic drug. The influence of the binder loading (20 and 40 wt % PTFE) and type of solvent (1,3-dipropanediol and water) was studied for the preparation of CB/PTFE electrodes. The electrode prepared with 20 wt % PTFE and water exhibited a low impedance and remarkable H2O2 electro-generation (about 1 g/L after 240 min, a production rate of ca. 6.5 mg/h·cm2). The incorporation of perovskite on CB/PTFE electrodes was also studied following two different methods: i) direct deposition on the CB/PTFE electrode surface and ii) addition in the own CB/PTFE/water paste used for the fabrication. Physicochemical and electrochemical characterization techniques were used for the electrode's characterization. The dispersion of perovskite particles in the own electrode matrix (method ii) exhibited a higher EF performance than the immobilisation onto the electrode surface (method i). EF experiments at 40 mA/cm2 and pH 7 (non-acidified conditions) showed ANT and TOC removals of 30% and 17%, respectively. The increase of current intensity up to 120 mA/cm2 achieved the complete removal of ANT and 92% of TOC mineralisation in 240 min. The bifunctional electrode also proved high stability and durability after 15 h of operation.

Facile one-step synthesis of a versatile nitrogen-doped hydrochar from olive oil production waste, "alperujo", for removing pharmaceuticals from wastewater.

In line with the principles of zero waste and recycling, alperujo (AL) was used in this study to produce a value-added product: hydrochar (HC) with high adsorption capacity. An optimization of the hydrothermal carbonization (HTC) conditions, such as temperature, residence time, and water/solid ratio, was carried out to maximize the adsorption capacity. Eight HCs were obtained, and an in-depth comparative characterization, as well as adsorption tests of two pharmaceuticals with very different physicochemical properties (fluoxetine (FLX) and cefazolin (CFZ)), were performed. This first step allowed for elucidation of the best candidates to carry out nitrogen grafting on their surface, resulting in the HC obtained at a higher water/solid ratio and temperature, and longer residence time: 3-220°C-2.5 h with a maximum uptake of 4.6 and 0.4 mg/g for FLX and CFZ, respectively. After that, a facile one-step, one-pot synthesis of nitrogen-doped hydrochars (N-HC) was developed to prepare a versatile bio-adsorbent with enhanced adsorption capacity. Two N-HCs were prepared using urea (U-HC) and polyethyleneimine (PEI-HC) and were intensively characterized to shed light on the adsorption mechanism. In both cases, amide groups were formed, which favored the adsorption process. PEI-HC acquired an outstanding maximum adsorption capacity of 983.84 mg/g for CFZ, and 29.31 mg/g for FLX, and the process was well described by the Freundlich isotherm and pseudo-second-order kinetic model. A co-adsorption test was performed using PEI-HC for both pharmaceuticals, finding that the adsorption process occurs in different active sites because there was no interference between the pollutants. This fact corroborates the versatility of the new bio-adsorbent synthesized.

Glaucoma avanzado. Guía de práctica clínica / Advanced glaucoma. Clinical practice guideline

objetivo Realización de una guía de práctica clínica actualizada que sirva de orientación para la detección, el manejo y el tratamiento de pacientes con glaucoma avanzado en la edad adulta. Métodos Tras la definición de los objetivos y alcance de la guía se constituyó el grupo de trabajo que formuló las preguntas clínicas estructuradas siguiendo el formato PICO (Patient, Intervention, Comparison, Outcomes). Se realizó una revisión de la literatura publicada hasta el momento, incluyendo guías de práctica clínica internacionales, utilizándose las herramientas AMSTAR-2 (Assessment of Multiple systematic Rewiews) y «Risk of Bias» de Cochrane para la evaluación de la calidad de la información de forma independiente por, al menos, 2 revisores. El nivel de evidencia y la elaboración del grado de recomendación se establecieron siguiendo la metodología del Scottish Intercollegiate Guidelines Network (SIGN). Resultados Se presentan recomendaciones con sus correspondientes niveles de evidencia que pueden ser de utilidad para la detección, el seguimiento y el tratamiento de pacientes con glaucoma avanzado en la edad adulta. Conclusiones A pesar de que la evidencia científica existente es escasa y el nivel de evidencia para muchas de las preguntas planteadas no es muy alto, esta guía de práctica clínica ofrece una revisión actualizada de las recomendaciones existentes para el manejo del glaucoma avanzado en el adulto (AU)

Objective To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. Methods After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR-2 (Assessment of Multiple systematic Rewiews) and Cochrane «Risk of bias» tools by at least 2 reviewers, recommendations were formulated following the Scottish Intercollegiate methodology Guideline Network (SIGN). Results Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. Conclusions Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma (AU)

Progresión en glaucoma. Guía de práctica clínica / Glaucoma progression. Clinical practice guide

Objetivo Ofrecer una serie de recomendaciones generales que sirvan de orientación en la evaluación y el manejo de la progresión glaucomatosa en la práctica clínica diaria a partir de la evidencia clínica de calidad existente. Métodos Tras la definición de los objetivos y del alcance de la guía se constituyó el grupo de trabajo que formuló las preguntas clínicas estructuradas siguiendo el formato PICO (Patient, Intervention, Comparison, Outcomes). Una vez evaluada toda la evidencia clínica existente con las herramientas AMSTAR2 (Assessment of Multiple systematic Rewiews) y Risk of bias de Cochrane de forma independiente por al menos dos revisores, se pasó a la formulación de recomendaciones siguiendo la metodología del Scottish Intercollegiate Guideline Network (SIGN). Resultados Se presentan recomendaciones con sus correspondientes niveles de evidencia que pueden ser de utilidad para la detección y el seguimiento de la progresión glaucomatosa con los distintos métodos disponibles y para el tratamiento de los pacientes. Conclusiones A pesar de que para muchas de las preguntas el nivel de evidencia científica disponible no es muy alto, esta guía de práctica clínica ofrece una revisión actualizada de los diferentes aspectos existentes relacionados con la evaluación y el manejo de la progresión glaucomatosa (AU)

Objective To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence. Methods After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR2 (Assessment of Multiple Systematic Reviews) and Cochrane «Risk of bias» tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology. Results Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented. Conclusions Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression (AU)

Advanced glaucoma. Clinical practice guideline.

OBJECTIVE: To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. METHODS: After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple systematic Rewiews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate methodology. Guideline Network (SIGN). RESULTS: Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. CONCLUSIONS: Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma.

Glaucoma progression. Clinical practice guide.

OBJECTIVE: To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence. METHODS: After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple Systematic Reviews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology. RESULTS: Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented. CONCLUSIONS: Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression.

Proliferation of osteoblast precursor cells on the surface of TiO2 nanowires anodically grown on a ß-type biomedical titanium alloy.

Studies have shown that anodically grown TiO2 nanotubes (TNTs) exhibit excellent biocompatibility. However, TiO2 nanowires (TNWs) have received less attention. The objective of this study was to investigate the proliferation of osteoblast precursor cells on the surfaces of TNWs grown by electrochemical anodization of a Ti-35Nb-7Zr-5Ta (TNZT) alloy. TNT and flat TNZT surfaces were used as control samples. MC3T3-E1 cells were cultured on the surfaces of the samples for up to 5 days, and cell viability and proliferation were investigated using fluorescence microscopy, colorimetric assay, and scanning electron microscopy. The results showed lower cell proliferation rates on the TNW surface compared to control samples without significant differences in cell survival among experimental conditions. Contact angles measurements showed a good level of hydrophilicity for the TNWs, however, their relatively thin diameter and their high density may have affected cell proliferation. Although more research is necessary to understand all the parameters affecting biocompatibility, these TiO2 nanostructures may represent promising tools for the treatment of bone defects and regeneration of bone tissue, among other applications.

Stability and reproducibility of 6013 deep inspiration breath-holds in left-sided breast cancer.

PURPOSE: Patients with left-sided breast cancer frequently receive deep inspiration breath-hold (DIBH) radiotherapy to reduce the risk of cardiac side effects. The aim of the present study was to analyze intra-breath-hold stability and inter-fraction breath-hold reproducibility in clinical practice. MATERIAL AND METHODS: Overall, we analyzed 103 patients receiving left-sided breast cancer radiotherapy using a surface-guided DIBH technique. During each treatment session the vertical motion of the patient was continuously measured by a surface guided radiation therapy (SGRT) system and automated gating control (beam on/off) was performed using an audio-visual patient feedback system. Dose delivery was automatically triggered when the tracking point was within a predefined gating window. Intra-breath-hold stability and inter-fraction reproducibility across all fractions of the entire treatment course were analyzed per patient. RESULTS: In the present series, 6013 breath-holds during beam-on time were analyzed. The mean amplitude of the gating window from the baseline breathing curve (maximum expiration during free breathing) was 15.8 mm (95%-confidence interval: [8.5-30.6] mm) and had a width of 3.5 mm (95%-CI: [2-4.3] mm). As a measure of intra-breath-hold stability, the median standard deviation of the breath-hold level during DIBH was 0.3 mm (95%-CI: [0.1-0.9] mm). Similarly, the median absolute intra-breath-hold linear amplitude deviation was 0.4 mm (95%-CI: [0.01-2.1] mm). Reproducibility testing showed good inter-fractional reliability, as the maximum difference in the breathing amplitudes in all patients and all fractions were 1.3 mm on average (95%-CI: [0.5-2.6] mm). CONCLUSION: The clinical integration of an optical surface scanner enables a stable and reliable DIBH treatment delivery during SGRT for left-sided breast cancer in clinical routine.

Ultrasonic processes for the advanced remediation of contaminated sediments.

Sediments play a fundamental role in the aquatic environment, so that the presence of contaminants poses severe concern for the possible negative effects on both environmental and human health. Sediment remediation is thus necessary to reduce pollutant concentrations and several techniques have been studied so far. A novel approach for sediment remediation is the use of Advanced Oxidation Processes, which include ultrasound (US). This paper focuses on the study of the ultrasonic effects for the simultaneous reduction of both organic and inorganic contaminants from sediments. To this end, the US technology was investigated as a stand-alone treatment as well as in combination with an electro-kinetic (EK) process, known to be effective in the removal of heavy metals from soil and sediments. The US remediation resulted in higher organic compound degradation, with an average 88% removal, but promising desorption yields (47-84%) were achieved for heavy metals as well. The combined EK/US process was found to be particularly effective for lead. Experimental outcomes highlighted the potential of the ultrasonic technology for the remediation of contaminated sediments and addressed some considerations for the possible scale-up.

Cannabidiol Administration Prevents Hypoxia-Ischemia-Induced Hypomyelination in Newborn Rats.

Neonatal hypoxia-ischemia (HI) is a risk factor for myelination disturbances, a key factor for cerebral palsy. Cannabidiol (CBD) protects neurons and glial cells after HI insult in newborn animals. We hereby aimed to study CBD's effects on long-lasting HI-induced myelination deficits in newborn rats. Thus, P7 Wistar rats received s.c. vehicle (HV) or cannabidiol (HC) after HI brain damage (left carotid artery electrocoagulation plus 10% O2 for 112 min). Controls were non-HI pups. At P37, neurobehavioral tests were performed and immunohistochemistry [quantifying mature oligodendrocyte (mOL) populations and myelin basic protein (MBP) density] and electron microscopy (determining axon number, size, and myelin thickness) studies were conducted in cortex (CX) and white matter (WM). Expression of brain-derived neurotrophic factor (BDNF) and glial-derived neurotrophic factor (GDNF) were analyzed by western blot at P14. HI reduced mOL or MBP in CX but not in WM. In both CX and WM, axon density and myelin thickness were reduced. MBP impairment correlated with functional deficits. CBD administration resulted in normal function associated with normal mOL and MBP, as well as normal axon density and myelin thickness in all areas. CBD's effects were not associated with increased BDNF or GDNF expression. In conclusion, HI injury in newborn rats resulted in long-lasting myelination disturbance, associated with functional impairment. CBD treatment preserved function and myelination, likely as a part of a general neuroprotective effect.

Selecting the best piping arrangement for scaling-up an annular channel reactor: An experimental and computational fluid dynamics study.

This study is focused on the selection of the best piping arrangement for a pilot scale annular channel reactor intended for the remediation of waters and wastewaters. Two annular channel reactors composed of a single UV lamp and distinct piping arrangements were considered: (i) a novel reactor with tangential inlet/outlet pipes - the FluHelik reactor, and (ii) a conventional Jets reactor. These two reactors were manufactured at lab scale and characterized in terms of residence time distribution (RTD), radiant power and ability to degrade aqueous solutions spiked with a model compound - 3-amino-5-methylisoxazole (AMI) - by H2O2/UVC and UVC processes. Computational fluid dynamics (CFD) simulations were used to assess the hydrodynamics, RTD and UV radiation intensity distribution of both reactors at pilot scale. In general, experimental results at lab scale revealed quite similar RTDs, radiant powers and AMI degradation rates for both reactors. On the other hand, CFD simulations at pilot scale revealed the generation of a helical motion of fluid around the UVC lamp in the FluHelik reactor, inducing: (i) a longer contact time between fluid particles and UV light, (ii) more intense dynamics of macromixing as a result of larger velocity gradients, turbulent intensities and dispersion of RTD values around the peak, and (iii) a more homogeneous UV radiation distribution. In addition, the design of the FluHelik reactor can favor the implementation of various reactors in series, promoting its application at industrial scale. The FluHelik reactor was chosen for scaling-up. A pre-pilot scale treatment unit containing this reactor was constructed and its feasibility was proven.