EVALUATION OF MACULAR ATROPHY IN PATIENTS TREATED WITH MACULAR BUCKLE FOR MYOPIC TRACTION MACULOPATHY: Mid- and Long-Term Follow-Up.

PURPOSE: To evaluate the incidence, rate, and pattern of progression of myopic maculopathy in eyes operated with macular buckle (MB) for myopic traction maculopathy versus a control group without surgery to find out whether the progression varies due to the MB's indentation and to evaluate possible MB-related pigmentary changes or atrophy. METHODS: Eyes operated with MB with two good quality fundus images: one preoperative or early postoperative image and a second image at least 12 months apart; the control group comprised the contralateral eyes. Demographics, axial length, follow-up, stage of myopic traction maculopathy, and myopic maculopathy were reported. Progression results of groups and subgroups (mid- and long-term follow-up) were reported and compared. RESULTS: Overall, 116 eyes of 66 patients were included. Progression was found in 29 eyes (41.4%) and 23 eyes (50%) in the MB group and control group, respectively. The progression rate was 73 per 1,000 eye-years and 88.9 per 1,000 eye-years in the MB group and the control group, respectively. Axial length was found to predict progression (odds ratio [OR], 2.59; P = 0.02). CONCLUSION: Progression of myopic maculopathy was similar in both groups and was mildly greater in the control group. No MB-related pigmentary changes or atrophy was detected.

Adaptation of Proximal Femur to Mechanical Loading in Young Adults: Standard Vs Localized Regions Evaluated by DXA.

Regions of the proximal femur with less adaptive protection by mechanical loading may be at increased risk of structural failure. Since the size and location of these regions diverge from those defined by the dual-energy X-ray absorptiometry manufacturers the purpose of this study was to compare areal bone mineral density (aBMD) of different regions of the proximal femur considering impact loads from physical activity (PA). The participants were 134 young adults divided into 2 groups according to the impact of PA performed in the last 12 mo: high-impact PA and low-impact PA. The aBMD of the proximal femur was assessed by dual-energy X-ray absorptiometry at the standard femoral neck, intertrochanter, and trochanter, and at specific locations of the superolateral femoral neck and intertrochanteric region. The bone-specific physical activity questionnaire was used to estimate the impact load of PA. Comparisons between groups were adjusted for body height and body lean mass. Interaction analysis between sex and PA groups were conducted with analysis of variance. Comparisons of aBMD between bone regions were analyzed separately for men and women with repeated measures analysis of variance. In the high-impact PA group, men benefit more than women at all bone regions, except the aBMD at intertrochanteric region. Analyses of repeated measures did not reveal any significant interaction effect between bone regions (standard vs specific) and PA groups (low vs high-impact). In conclusion, aBMD differences due to mechanical loading were more pronounced in men than in women; the magnitude of the aBMD differences as a result of different levels of PA was similar between standard and localized regions.

Surgical management of glaucoma secondary to indirect carotid-cavernous fistula: A case report.

INTRODUCTION: Indirect carotid-cavernous fistula (CCF) can lead to secondary glaucoma, posing significant treatment challenges. This paper discusses a case where standard embolization failed, and an Ahmed FP7 valved glaucoma tube shunt was crucial for managing the increased intraocular pressure (IOP), highlighting the necessity for individualized surgical approaches. CASE PRESENTATION: A 48-year-old female presented in the emergency department with conjunctival hyperemia, proptosis and elevated IOP; initial imaging findings were indicative of orbital inflammatory disease. Further evaluation with cerebral CT angiography revealed a possible CCF. Subsequent angiography confirmed an indirect CCF type D, leading to the patient undergoing endovascular embolization. Final monitoring revealed a subtotal occlusion of the fistula. Although there was some improvement post-procedure, IOP remained elevated despite medication, and subsequent attempts of embolization were unsuccessful. Surgical intervention with a tube shunt was performed, allowing IOP to decreased to a normal range. Optic nerve head optical coherence tomography, standard automated perimetry, and best-corrected visual acuity remained stable during the 33-month follow-up. DISCUSSION: In managing glaucoma linked to CCF, a multidisciplinary approach is critical. Conservative methods are often adequate, with spontaneous CCF closure observed in a significant percentage. Endovascular embolization is reserved for refractory cases, with embolization showing a higher rate of IOP normalization compared to medication alone. Yet, when fistula closure is challenging or contraindicated, individualized management strategies like glaucoma surgery may be employed. CONCLUSIONS: When fistula closure is not achievable, the Ahmed FP7 valved tube shunt can successfully regulate IOP with minimal complications, providing an effective alternative for refractory cases.

Vismodegib for treatment of periocular basal cell carcinoma - 6-year experience from a tertiary cancer center.

BACKGROUND: The treatment of advanced periocular basal cell carcinomas becomes a challenge as surgery may involve highly mutilating procedures. Vismodegib is the first selective hedgehog inhibitor approved for the treatment of locally advanced tumors or metastatic disease. OBJECTIVE: Analyze the results of treatment with vismodegib for advanced periocular basal cell carcinomas in a real-life setting of a reference center between 2014 and 2020. METHODS: Retrospective longitudinal study. The patient's demographic profile, comorbidities, tumor characteristics, and treatment outcomes were analyzed. RESULTS: A total of 13 patients were included. Median follow-up and treatment duration were 15.9 and 10.5 months, respectively. Objective clinical response rate was 76.9%: 30.8% had a complete response and 46.2% a partial response. The median duration of response was 13 months. Progressive disease was observed in 38.5% of cases, with a median of 19 months after the beginning of treatment. Eighty-four percent of the patients had at least one adverse event, and 61.54% needed to interrupt treatment temporarily or permanently to increase tolerability. STUDY LIMITATIONS: Being a retrospective study in a real-life setting, the evaluation of objective clinical response was subjective to physician appreciation. CONCLUSION: Vismodegib is a safe and effective treatment for locally advanced basal cell carcinoma. To prevent recurrences, the drug should be used continually when tolerated. The role of neoadjuvant vismodegib before surgery is being investigated and might add an important step in searching for a definitive treatment for these cases.

Vismodegib for treatment of periocular basal cell carcinoma - 6-year experience from a tertiary cancer center

Abstract Background: The treatment of advanced periocular basal cell carcinomas becomes a challenge as surgery may involve highly mutilating procedures. Vismodegib is the first selective hedgehog inhibitor approved for the treatment of locally advanced tumors or metastatic disease. Objective: Analyze the results of treatment with vismodegib for advanced periocular basal cell carcinomas in a real-life setting of a reference center between 2014 and 2020. Methods: Retrospective longitudinal study. The patient's demographic profile, comorbidities, tumor characteristics, and treatment outcomes were analyzed. Results: A total of 13 patients were included. Median follow-up and treatment duration were 15.9 and 10.5 months, respectively. Objective clinical response rate was 76.9%: 30.8% had a complete response and 46.2% a partial response. The median duration of response was 13 months. Progressive disease was observed in 38.5% of cases, with a median of 19 months after the beginning of treatment. Eighty-four percent of the patients had at least one adverse event, and 61.54% needed to interrupt treatment temporarily or permanently to increase tolerability. Study limitations: Being a retrospective study in a real-life setting, the evaluation of objective clinical response was subjective to physician appreciation. Conclusion: Vismodegib is a safe and effective treatment for locally advanced basal cell carcinoma. To prevent recurrences, the drug should be used continually when tolerated. The role of neoadjuvant vismodegib before surgery is being investigated and might add an important step in searching for a definitive treatment for these cases.

Formation of type 4 resistant starch and maltodextrins from amylose and amylopectin upon dry heating: A model study.

Starch is one of the main components of human diet. During food processing, starch is submitted to high temperatures in the presence or absence of water. Thus, the main goal of this work was to identify structural modifications caused by dry heating in starch polysaccharides (amylose and amylopectin) and structurally related oligosaccharides, maltotetraose (M4) and glucosyl-maltotriose (GM3), simulating processing conditions. The structural modifications were evaluated by methylation analysis, electrospray mass spectrometry (ESI-MS), tandem mass spectrometry (ESI-MS/MS) and anionic chromatography after in vitro enzymatic digestion. Dry heating promoted dehydration, depolymerization, as well as changes in Glc glycosidic linkage positions and anomeric configuration. In oligosaccharides, polymerization was also observed. All these changes resulted in a lower in vitro digestibility, suggesting that dry heating of starch polysaccharides and related oligosaccharides may be associated with the formation of type 4 resistant starch and maltodextrins, non-digestible carbohydrates that are responsible for beneficial effects in human intestinal tract.

Análise da composição e disposição espacial de placas ateroscleróticas localizadas em bifurcaçöes das artérias coronárias epicárdicas de adultos / Analysis of the Composition and Spatial Disposition of Atherosclerotic Plaques Located in Bifurcation of Epicardical Coronary Arteries in Adults

PURPOSE--To analyze macro and microscopic features of atherosclerotic plaques located in bifurcation of coronary arteries, defining their spatial disposition in those sites. METHODS--We studied 38 bifurcations of coronary arteries of patients whose cause of death was related to coronary artery disease. Histologic sections of 0.5mm were sequentially made from the main artery to the secondary branches. They were stained with hematoxilin-eosin technique. Histological analysis evaluated: a) morphologic composition of the plaques, b) degree of obstruction and c) plaque's disposition. RESULTS--a) Plaque's composition: fibrolipid plaques constituted 80 per cent of the cases and mingled focal atrophy of the media at the base of the plaque in 61 per cent with spots of total destruction and rupture of the elastic layers in 30 per cent ; b) degree of obstruction: ranged from 20 per cent to 95 per cent , with average 60 +/- 28 per cent ; c) disposition of plaques: we verified morphologic variation along the plaque, most of them (71 per cent ) being eccentric at bifurcation and not reaching the beginning of flow divider walls. CONCLUSION--Atherosclerotic plaques located in bifurcation of coronary arteries of adults are often fibrolipid plaques, eccentric, and their spatial disposition on those sites spare the beginning of the inner walls, reaching the outer walls

Infarto do miocárdio: comparaçäo dos achados anátomo-patológicos em coraçäo com e sem aterosclerose coronária grave em 194 casos de necrópsia / Myocardial infarction: comparison of pathological findings from hearts with and without severe coronary atherrosclerosis in 194 necropsy cases

Objetivo ­ Comparar as características morfológicas do infarto do miocárdio (IM) de pacientes com aterosclerose coronária causando obstrução da luz superior (com aterosclerose grave ­ AG) e inferior a 70% (sem AG). Métodos ­ 194 corações obtidos em necrópsia consecutivas de pacientes gue morreram por IM com idade entre 21 e 82 (média 60) anos, sendo 174 com e 20 sem AG. Resultados ­ A idade média no grupo com Ag foi 56 e a mediana 59 anos; no outro grupo, a média foi de 60 e a mediana 61 anos, havendo diferença significativa na distribuição etária (p = 0,023), com maior quantidade de pacientes abaixo de 40 anos no grupo sem AG. Não houve diferença significativa quanto ao sexo (31,0% de mulheres no grupo com AG e 35,0% no grupo sem AG, p = 0,718), peso médio do coração (com AG 500 g, sem AG 560 g), distribuição dos casos conforme tendo infarto recente apenas, infarto antigo apenas ou ambos (com AG - 36,2%, 28,2% e 35,6% respectivamente; sem AG - 45,0%, 20,0% e 35,0% respectivamente; p = 0,666), paredes acometidas pelos IM (p = 0,715), incidência de infarto hemorrágico (com AG­8,6%, sem AG - 15,0%, p = 0,406), de ruptura de ventrículo esquerdo (com Ag­5,2%, sem AG­10,0%, p = 0,719) e de aneurisma dessa câmara (com AG - 12,1%, sem AG - 15%, p = 0,316). Encontrouse associação entre AG e trombose coronária (trombose antiga recanalizada­p < 0,0001; trombose recente­p = 0,046), que todavia existia quando se restringiu a comparação à trombose recente nos casos não-operados de IM agudo (p = 0,091). Conclusão O grau de obstrução coronária superior ou não a 70% não condicionou diferenças morfológicas significativas em casos fatais de IM. Este dado sugere que esse fator não altera de maneira importante a história natural do IM.

Purpose ­ To compare morphological features of myocardial infarction (MI) from patients with any epicardial coronary artery narrowed at some point more then 70% (severe coronary atherosclerosis­SCA) with those from patients with either no coronary atherosclerosis or only mild (less than 70%) atherosclerosis. Methods ­ Necropsy findings from 194 patients who died due to MI, 174 patients with and 20 without SCA. Ages ranged from 21 to 82 (mean 60) years. Results ­ Mean age was 60 years in the cases with SCA and 56 in the case without it; nevertheless, age distribution was different (p = 0,023), due to the existence of more patients under age 40 in the group without SCA. There was no significant difference concerning sex (31.0% of female patients in the group with SCA and 35,0% in the other group, p = 0.718), mean heart weight (500 g and 506 g), distibution of cases according to time of evolution of MI in recent only, old only or both (cases with SCA - 36.2%, 28.2% and 35.6%; cases without SCA - 45.0% and 20%; p = 0,666), left ventricular wall commited by the MI (p=0.715), incidence of hemorrhagic infarction (with SCA - 8.6%; without SCA - 15.0%; p = 0.406), left ventricular rupture (with SCa - 5.17%, without SCA - 10.0%; p = 0.719) and left ventricular aneurysms (with SCA­12.1%, without SCA - 15.0%; p = 0,316). An association was found between coronary ahterosclerosis and recent (p=0,046) and recanalized (p<0.001) thrombosis, but absent when only recent thrombosis and non-operated cases with recent MI were considered (p = 0.091). Conclusion Necropsy of fatal cases of MI were not signifícantly different in the presence or absence of severe atherosclerotic narrowing (>70%) of epicardial coronary arteries, suggesting that this factor does not modify the natural history of MI.