[Predictive Value of OCT-Controlled Early Response of Macular Edema Secondary to Retinal Vein Occlusion After Intravitreal Bevacizumab Therapy]. / Prognostischer Wert des frühen OCT-kontrollierten Ansprechens des konsekutiven Makulaödems der retinalen venösen Verschlüsse nach intravitrealer Gabe von Bevacizumab.

INTRODUCTION: The goal of this study was to examine the response of macular edema (ME) secondary to retinal vein occlusion (RVO) to predict macular edema course and re-injection intervals. MATERIAL AND METHODS: Twenty-four eyes from 24 patients with ME secondary to RVO, both central (CRVO) and branch (BRVO), were retrospectively included. All eyes received intravitreal bevacizumab therapy (1.25 mg/0.1 ml). Repetitive optical coherence tomography (OCT) examinations were performed to document the early macular edema response to treatment and the course of the disease during the first three monthly injections until the last follow-up 105 days after the first injection. RESULTS: A significant ME reduction is present as early as three hours after the first injection of bevacizumab. This significant reduction of central retinal thickness (CRT) is present until the third post-injection day. The greatest reduction occurs during the first 24 hours. Patients who reach a CRT less than 300 µm after 24 hours (day 1) have no recurrence after 30 days. Patients with a CRT over 300 µm on day 1 have a 50% rate of recurrence after 30 days. The favorable results of the first group are still present during the last follow-up examination, 105 days after the first injection. DISCUSSION AND CONCLUSION: An OCT examination, 24 hours after the first bevacizumab injection, has a prognostic value and can identify the patients that can tolerate longer intervals between injections, this results in fewer bevacizumab injections during the course of the disease. This way an individualization of the treatment, opposed to a fixed therapy pattern, can be implemented. Also, patients with poor prognosis can be identified early and treatment can be altered or intensified accordingly.

One minute static stretch of plantar flexors transiently increases H reflex excitability and exerts no effect on corticospinal pathways.

NEW FINDINGS: What is the central question of this study? What mediates neural responses following static stretching, and how long do these influences last? What is the main finding and its importance? This study shows that 1 min of static stretching inhibits the tendon tap reflex and facilitates the H reflex without influencing motor-evoked potentials. The results indicate that at least two different mechanisms mediate neural responses after static stretching. The purpose of this study was to determine whether the neural responses observed after static stretching are mediated by sensitivity of muscle spindles, spinal excitability or cortical excitability and how long these influences last. Nineteen volunteers (25.7 ± 5.6 years old) were tested for the tendon tap reflex (T-reflex), H reflex and motor-evoked potentials on ankle flexors and extensors immediately, 5 and 10 min after 1 min static stretching applied at individual maximal ankle dorsiflexion, as well as immediately, 5 and 10 min after a control period of the same duration. Comparison of measurements collected immediately after stretching or control conditions revealed that the T-reflex was weaker after stretching than after control (-59.2% P = 0.000). The T-reflex showed a slow recovery rate within the first 150 s after stretching, but 5 min after the inhibition had disappeared. The H reflex increased immediately after stretching (+18.3%, P = 0.036), showed a quick tendency to recover and returned to control values within 5 min from stretching. Motor-evoked potentials were not affected by the procedure. These results suggest that 1 min of static stretching primarily decreases muscle spindle sensitivity and facilitates the H reflex, whereas effects on the motor cortex can be excluded.

Prophylactic HPV vaccines in patients with HPV-associated diseases and cancer.

Individuals with human papillomavirus (HPV)-related disease remain at risk for subsequent HPV infection and related disease after treatment of specific lesions. Prophylactic HPV vaccines have shown benefits in preventing subsequent HPV-related disease when administered before or soon after treatment. Based on our understanding of the HPV life cycle and vaccine mechanism of action, prophylactic HPV vaccination is not expected to clear active persistent HPV infection or unresected HPV-associated dysplastic tissue remaining after surgery. However, vaccination may reasonably be expected to prevent new HPV infections caused by a different HPV type as well as re-infection with the same HPV type, whether from a new exposure to an infected partner or through autoinoculation from an adjacent or distant productively infected site. In this review, we describe the evidence for using prophylactic HPV vaccines in patients with HPV-associated disease before, during, or after treatment and discuss potential mechanisms by which individuals with HPV-associated disease may or may not benefit from prophylactic vaccines. We also consider how precise terminology relating to the use of prophylactic vaccines in this population is critical to avoid the incorrect implication that prophylactic vaccines have direct therapeutic potential, which would be counter to the vaccine's mechanism of action, as well as considered off-label. In other words, the observed effects occur through the known mechanism of action of prophylactic HPV vaccines, namely by preventing virus of the same or a different HPV type from infecting the patient after the procedure.