Quality of Life in Patients Suffering from Active Exudative Age-Related Macular Degeneration: The EQUADE Study.

PURPOSE: Age-related macular degeneration (AMD) is the main cause of visual loss in the elderly population. With the use of anti-vascular endothelial growth factor, the visual outcomes of exudative AMD patients have been improved. This study was aimed at assessing the quality of life (QoL) of exudative AMD patients treated with ranibizumab and at determining its drivers in a real-life setting. METHODS: We performed a national, cross-sectional, observational survey based on questionnaires sent to members of French associations relative to AMD between December 2012 and March 2013. Patients suffering from exudative AMD with at least one intravitreal injection of ranibizumab within the last 6 months were included. Demographics, AMD characteristics, visual acuity (VA) and past and ongoing treatments were collected. The 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was self-administered. A multivariate model was used to identify QoL drivers. RESULTS: 416 questionnaires fulfilled the complete criteria for both QoL and cost analyses. The mean age of exudative AMD patients was 78.0 years and bilateral involvement was reported in 60.4%. The overall mean QoL score was 53.4. Mental health, driving and role difficulties were the most widely affected domains. After bivariate analyses, long-term illness status, worse VA and higher number of unpaid aids were associated with worse QoL, with odds ratios of 2.4, 5.2 and 11.6, respectively. The mean cost per year and per patient was 1,741 EUR. The main components of costs were aids and services and the purchase of visual equipment. CONCLUSIONS: The main predictors of QoL in exudative AMD patients treated with ranibizumab are VA outcomes, home healthcare and social services provided to the patients.

Prognostic value of cardiovascular CT: is coronary artery calcium screening enough? The added value of CCTA.

Coronary artery disease (CAD) is the primary cause of death in adults in the United States. Only 50% of patients who present with a myocardial infarction have a prior history of CAD. Non-invasive cardiac imaging tests have been developed to diagnose CAD. Current guidelines and systematic reviews have tried to determine the prognostic value of the coronary artery calcium (CAC) scoring and the coronary computed tomography angiography (CCTA) for major adverse cardiovascular events. Several studies support the roles of CCTA and CAC scoring for the diagnosis of CAD in asymptomatic patients. Further studies are needed to confirm the superior role of CCTA over CAC scoring in symptomatic patients.

[Multidetector computed angiography: a new era in the evaluation of pulmonary thromboembolism]. / Angiotomografía computarizada multidetector: una nueva era en la evaluación de tromboembolia pulmonar.

Pulmonary embolism is a major cause of worldwide morbidity and mortality. It is a common cause of cardiovascular care, second only to ischemic heart disease and cerebrovascular events, with a prevalence of 3 to 15%, and its diagnosis remains crucial in the early hours of symptom onset. Given its clinical variability, it has become a diagnostic challenge in the emergency rooms, thus a fast and accurate paraclinical evaluation is needed. The aim of the present manuscript is to review the current role of imaging methods, in particular multidetector computed tomography, their advantages and limitations and the imaging findings of acute or chronic pulmonary thromboembolism. Finally, diagnostic algorithms based on the Thoracic Fleischner Society and the group of PIOPED II study investigators, are shown.

Angiotomografía computarizada multidetector: una nueva era en la evaluación de tromboembolia pulmonar / Multidetector computed angiography: a new era in the evaluation of pulmonary thromboembolism

El embolismo pulmonar es una importante causa de morbilidad y mortalidad en nuestro país y el mundo. Es una causa de atención médica cardiovascular frecuente, únicamente superada por la cardiopatía isquémica y los eventos vasculares cerebrales, con una prevalencia de 3% a 15%, siendo crucial su diagnóstico en las primeras horas de inicio de los síntomas. Dada la alta variabilidad en su presentación clínica, se ha convertido en un reto diagnóstico en las salas de urgencias, por lo que es indispensable contar con herramientas paraclínicas accesibles y rápidas para su diagnóstico. La presente revisión tiene como fin mostrar los métodos de imagen actuales, en particular a la tomografía computarizada multidetector, sus ventajas y limitaciones, así como los principales elementos de análisis para el diagnóstico de tromboembolismo pulmonar agudo y crónico. Asimismo, se mencionan algunos algoritmos de evaluación de acuerdo a la sociedad Fleischner del tórax y del grupo de investigadores del estudio PIOPED II, basados en la probabilidad pre-prueba del paciente y del resultado del dímero D.

Pulmonary embolism is a major cause of worldwide morbidity and mortality. It is a common cause of cardiovascular care, second only to ischemic heart disease and cerebrovascular events, with a prevalence of 3 to 15%, and its diagnosis remains crucial in the early hours of symptom onset. Given its clinical variability, it has become a diagnostic challenge in the emergency rooms, thus a fast and accurate paraclinical evaluation is needed. The aim of the present manuscript is to review the current role of imaging methods, in particular multidetector computed tomography, their advantages and limitations and the imaging findings of acute or chronic pulmonary thromboembolism. Finally, diagnostic algorithms based on the Thoracic Fleischner Society and the group of PIOPED II study investigators, are shown.

An efficient method for the synthesis of unsymmetrical 2,2'-bis(pyrrolyl)alkanes.

A new strategy for the preparation of unsymmetrical 2,2'-bis(pyrrolyl)alkanes has been developed. It involved the condensation of pyrrole derivatives onto N-benzylhydroxylamines in the presence of HCl. This two-step procedure provided access to a wide variety of 2,2'-dipyrromethanes (3a-m). It has also been extended to the synthesis of tripyrromethanes 4a-d and of N-confused dipyrromethanes 6a-d.

From N-triisopropylsilylpyrrole to an optically active C-4 substituted pyroglutamic acid: total synthesis of penmacric acid.

The stereoselective synthesis of penmacric acid, an optically active C-4 substituted pyroglutamic acid, has been efficiently achieved through an unusual 11-step sequence starting from simple N-triisopropylsilylpyrrole. The key-steps are the initial addition of the pyrrole nucleus onto a chiral nitrone and the obtention of the pyroglutamic acid moiety by reductive hydrogenation of the pyrrole followed by oxidation of the corresponding pyrrolidine into pyrrolidinone.

Efficient stereoselective nucleophilic addition of pyrroles to chiral nitrones.

Regioselective additions of pyrroles to a variety of optically active nitrones under smooth acidic conditions lead to chiral pyrrolic N-hydroxylamines in good to excellent yields. Depending on the position of the chirality on the nitrone partner, the addition products have been isolated with high diastereoselectivity levels. Reaction of glyoxylate based chiral nitrones either at the C-2 or at the C-3 position of the pyrrole nucleus afforded N-hydroxyamino esters in high yields as single diastereoisomers. These adducts allow access to enantio-enriched non proteinogenic 2'- and 3'-pyrrolylglycines (13 and 19 respectively).

Syntheses of S-enantiomers of hanishin, longamide B, and longamide B methyl ester from L-aspartic acid beta-methyl ester: establishment of absolute stereochemistry.

[reaction: see text] Total syntheses of enantiopure hanishin, longamide B, and longamide B methyl ester are described. Absolute configurations of these natural products have been established.

Meta-substituted aryl(thio)ethers as potent partial agonists (or antagonists) for the histamine H3 receptor lacking a nitrogen atom in the side chain.

4-(3-Aryloxypropyl)-1H-imidazoles, which possess a meta-positioned substituent in the aryl ring, have been synthesized and tested for activity at histamine H(3) receptors. The compounds having a CN, Me, or Br substituent were found to be antagonists, whereas CF(3), Et, i-Pr, t-Bu, COCH(3), or NO(2) substituents remarkably afforded partial agonists when tested in vitro on rat cerebral cortex synaptosomes for inhibition of [(3)H]histamine release. The compounds were also active in vivo, and furthermore, the CF(3)-substituted compound trifluproxim (UCL 1470, 7) acted as a potent full agonist in vivo, having ED(50) = 0.6 +/- 0.3 mg/kg per os in mice for inhibition of brain N(tau)-methylhistamine formation. Related structures have also been investigated; homologues 4-[4-(3-(trifluoromethyl)phenoxy)butyl]-1H-imidazole and 4-[2-(3-(trifluoromethyl)phenylthio)ethyl]-1H-imidazole are shown to be partial agonists, whereas the O isostere 4-[2-(3-(trifluoromethyl)phenoxy)ethyl]-1H-imidazole is an antagonist as is the S homologue 4-[3-(3-(trifluoromethyl)phenylthio)propyl]-1H-imidazole and its CH(2) isostere 4-[4-(3-(trifluoromethyl)phenyl)butyl]-1H-imidazole.