Intraocular foreign bodies in children: A retrospective case series.

INTRODUCTION: Open globe injuries are a major cause of visual impairment in children, related to the severity of the trauma or secondary to induced amblyopia. Intraocular foreign bodies (IOFB) have been reported in approximately one third of cases of open globe injuries. As clinical presentation and management may differ between adults and children, data is lacking about IOFBs in children under 18years of age. The purpose of this study was to assess the clinical characteristics and visual prognosis of ocular trauma associated with intraocular foreign bodies in children. MATERIALS AND METHODS: This single-center retrospective study included patients under 18years of age treated for ocular trauma with IOFB. Demographic characteristics, complete initial and final ophthalmological examination, imaging data and details of medical and surgical management were collected. RESULTS: Fourteen patients were included (78.6% boys), with a mean age of 10.3years (min 7months-max 17years). In 92.9% of cases, patients were found to have a single IOFB, mostly metallic (71.4%). Posterior segment IOFBs were found in 50% of cases, anterior segment IOFBs in 28.6% and orbital IOFBs in 21.4%. The clinical examination permitted detection of the IOFBs in 50% of cases, while they were visible on CT scan in all cases. The mean initial visual acuity was 20/320, and the mean final visual acuity was 20/125. Endophthalmitis occurred in 2 cases (14%). DISCUSSION: Open globe injuries associated with IOFB are severe and sight-threatening. Localization of the IOFB in the posterior segment has a worse prognosis. CT scan is mandatory, especially in children, as the trauma history is often missing. Retinal detachment and endophthalmitis appear to be the main prognostic factors requiring urgent specialized pediatric ophthalmology management.

The impact of COVID-19 pandemic on breast surgery in Italy: a multi-centric retrospective observational study.

COVID-19 pandemic had an impact on surgical activities. The aim of this multi-centric, retrospective study was to evaluate the impact of the COVID-19 pandemic on breast surgery. The patients who operated during the pre-pandemic year 2019 were compared to those operated in 2020. Fourteen Breast Care Units provided data on breast surgical procedures performed in 2020 and 2019: total number of breast-conserving surgery (BCS), number of 1st level oncoplastic breast surgery (OBS), number of 2nd level OBS; total number of mastectomies, mastectomies without reconstruction, mastectomies with a tissue expander, mastectomies with direct to implant (DTI) reconstruction, mastectomies with immediate flap reconstruction; total number of delayed reconstructions, number of expanders to implant reconstructions, number of delayed flap reconstructions. Overall 20.684 patients were included: 10.850 (52.5%) operated during 2019, and 9.834 (47.5%) during 2020. The overall number of breast oncologic surgical procedures in all centers in 2020 was 8.509, compared to 9.383 in 2019 (- 9%). BCS decreased by 744 cases (- 13%), the overall number of mastectomies decreased by 130 cases (- 3.5%); mastectomy-BCS ratio was 39-61% in 2019, and 42-58% in 2020. Regarding immediate reconstructive procedures mastectomies with DTI reconstruction increased by 166 cases (+ 15%) and mastectomies with immediate expander reconstruction decreased by 297 cases (- 20%). Breast-delayed reconstructive procedures in all centers in 2020 were 142 less than in 2019 (- 10%). The outburst of the COVID-19 pandemic in 2020 determined an implemented number of mastectomies compared to BCS, an implemented number of immediate breast reconstructions, mainly DTI, and a reduction of expander reconstruction.

[Efficacy of botulinum toxin in infantile esotropia]. / Efficacité de la toxine botulique dans l'estropie de l'enfant.

INTRODUCTION AND OBJECTIVE: Botulinum toxin (BT) is used in a variety of therapeutic applications, including the treatment of strabismus. Two injection techniques coexist - transconjunctival injection and open sky injection. The goal of this study was to evaluate the results of BT injections in esotropia in children under 10 years of age and to compare the two techniques. PATIENTS AND METHOD: This is a retrospective, monocentric study, including children who received BT injections to treat their strabismus by the aforementioned techniques between 2014 and 2017. The results of these injections were recorded, and subgroup analyses (injection technique, age, degree of deviation, type of strabismus) were performed. The primary endpoint was the optimal success rate defined as residual strabismus less than or equal to 10 Δ. RESULTS: The study included 68 children with a mean age of 28.9 months and a mean deviation angle of 34.7 Δ. Patients received 1.2 BT injections. The success rate was 38% at 6 months, 35% at 12 months, and 35% at 24 months. There was 33% transient ptosis and 5% consecutive exotropia. There was no evidence of significant difference in success rate between the transconjunctival and open sky injection methods, baseline angles, age of injection, or type of strabismus. CONCLUSION: BT injection is effective and safe in pediatric esotropia, regardless of the injection method.

[Assessment of ophthalmological surgical training in Île-de-France: Results of a survey on 89 residents]. / Formation chirurgicale en ophtalmologie en Île-de-France : résultats d'une enquête sur 89 internes.

OBJECTIVE: This study aims to evaluate surgical training in ophthalmology through feedback from residents. MATERIALS AND METHODS: An anonymous questionnaire was created, including 20 items which assessed the number of complete or partial surgical procedures performed during a semester, self-assessment of surgical skills, use of surgical simulators, an overall rating of the surgical training received and some suggestions to improve surgical training. It was sent by email to all residents in training in Île-de-France (DES Île-de-France and Inter-CHU), France. RESULTS: From October 23 to November 7, 2021, 89/137 residents responded to the questionnaire (65%). Since the beginning of their residency, ninety percent of the residents received training using simulators. Over 90% performed all of the technical steps of a "standard" cataract surgery at least once during the semester, and 60% 10 times or more. The least performed technical steps or procedures also received the lowest self-assessment: management of expulsive hemorrhage, open-globe or lacrimal laceration wound suturing, capsular tension ring injection, and intraocular lens explantation. Residents gave an overall average rating of 6.6/10 to their training and suggested some feedback on videos of resident surgeries (67%) and theoretical courses dealing with surgical techniques (61%). DISCUSSION: The increasing use of simulators should improve surgical training. Residents express the need for training regarding surgical complications and emergencies as well as improvement of their technical skills via improved feedback. CONCLUSION: Surgical teaching appears suitable for learning cataract surgery but seems less effective for the management of emergencies and intraoperative complications.

Locally advanced breast implant-associated anaplastic large-cell lymphoma: a combined medical-surgical approach.

OBJECTIVE: Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin's T-cell lymphoma that develops around breast implants. CASE PRESENTATION: This report illustrates the case of a patient affected by a locally advanced BIA-ALCL which infiltrated the thoracic wall (stage T4N0M0) following implant-based reconstruction after left mastectomy. Given the initial inoperability due to the patient's poor general condition, the treatment plan provided for a primary cycle of systemic neoadjuvant immunotherapy/chemotherapy, surgical removal of the mass, and subsequent systemic chemotherapy/immunotherapy. This resulted in complete remission - the patient remained disease-free even over a year later - without the need for adjuvant radiotherapy. CONCLUSIONS: Our real-life case shows how the existing guidelines can be successfully adapted as part of an individualized approach to advanced and/or difficult cases.

Postsurgical antithrombotic therapy in microsurgery: our protocol and literature review.

OBJECTIVE: Despite the improvements reached by microsurgeons in the last 30 years, postoperative complications still occur and most of them are the result of venous thrombosis at the pedicle anastomosis. Primary prevention of thrombosis is mandatory and anticoagulant therapy in the preoperative and postoperative period is widely used. Still, there is a lack of consensus in the literature about the best postoperative protocol for microsurgical reconstruction. The authors aimed to review the postoperative antithrombotic regimens described in literature focusing on their effects and risks, and moreover, share their experience. MATERIALS AND METHODS: The authors performed a literature review of postsurgical antithrombotic protocols applied in reconstructive microsurgery. Research on PubMed server was performed typing the terms "antithrombotic", "postoperative", "microsurgery", "free flap pedicle", "anticlotting", "anticoagulant". RESULTS: The authors described the postoperative standardized pro-weight pharmacological protocol applied in their unit: a combination of dextran and heparin. They inhibit more than one pattern of coagulation in order to stop platelet aggregation and thrombin action and, in the meantime, contending fluid loss with plasma expansion. CONCLUSIONS: Nowadays, a non-standardized practice, based on experience, is applied by microsurgeons in postsurgical care; the authors performed a review of the combined antithrombotic therapies described in the literature. A standardized pro-weight pharmacological protocol is proposed; it allows to increase blood flow by volume expander action (Dextran) and thrombin inhibition (Heparin). Still, coagulation cascade and platelet function have a wide variability among humans, as well as the effect of drugs. Achieving an optimal antithrombotic effect and minimizing adverse reactions meantime remains a challenge.

Algorithm for predicting threshold retinopathy of prematurity is insufficient and fundus examinations are still needed before 31 weeks.

AIM: We evaluated the weight, insulin-like growth factor-1, neonatal, retinopathy of prematurity (WINROP) algorithm for very premature infants. METHOD: Infants born before 32 weeks who had undergone fundus examinations in the neonatal intensive care unit at the University Hospital of Nancy were included in this French retrospective cohort study from July 2012 to July 2016. We evaluated how well the WINROP software predicted threshold retinopathy of prematurity (ROP). RESULTS: We studied 570 infants with a mean gestational age of 28.7 ± 1.8 weeks and a mean birth weight of 1110 ± 297 g: 28.1% had ROP and 1.2% had threshold ROP. The overall WINROP sensitivity was 57.1%, specificity was 46.0%, predictive positive value was 1.3% and predictive negative value was 98.9%. At more than 30 weeks of gestation or 1250 g, these figures rose to a respective specificity of 100% and 95.7% and respective predictive negative value of 100% and 100%. There were independent associations between the severity of ROP and the Apgar score at five minutes, the duration of oxygen therapy and non-invasive ventilation. CONCLUSION: WINROP worked better on preterm infants born from 31 weeks onwards or weighing over 1250 g. Fundus examinations remain necessary for infants born earlier or lighter.

Tuning the sensitivity of lanthanide-activated NIR nanothermometers in the biological windows.

Lanthanide-activated SrF2 nanoparticles with a multishell architecture were investigated as optical thermometers in the biological windows. A ratiometric approach based on the relative changes in the intensities of different lanthanide (Nd3+ and Yb3+) NIR emissions was applied to investigate the thermometric properties of the nanoparticles. It was found that an appropriate doping with Er3+ ions can increase the thermometric properties of the Nd3+-Yb3+ coupled systems. In addition, a core containing Yb3+ and Tm3+ can generate light in the visible and UV regions upon near-infrared (NIR) laser excitation at 980 nm. The multishell structure combined with the rational choice of dopants proves to be particularly important to control and enhance the performance of nanoparticles as NIR nanothermometers.

[Pigmented perivenous chorioretinal atrophy: Report of two cases]. / Atrophie choriorétinienne périveineuse pigmentée : à propos de deux cas.

Pigmented perivenous chorioretinal atrophy is a rare condition, the etiology of which is still unknown, with approximately one hundred cases described in the literature. The lesion is characterized by chorioretinal atrophy with retinal pigment in a bony spicule distribution along the retinal veins. These pigmentations are small round lesions, which are in a pattern similar to the appearance of osteoblastic cells. This condition is often bilateral and asymmetric. It appears to be sporadic most of the time. The atrophic areas do not affect the macula; therefore visual acuity is not disturbed. Optical coherence tomography shows an alteration of the external layers of the perivenous retina. Fluorescein angiography reveals a hyperfluorescence of the perivenous retina. Visual field measurement reveals a paracentral scotoma. This condition appears to be localized and self-limited, yet our knowledge is still limited because of the small number of cases reported. The present work reports two cases of pigmented perivenous chorioretinal atrophy in children. Our descriptions correspond to the data reported in the literature.

Laser-induced disaggregation of TiO2 nanofillers for uniform nanocomposites.

Exploiting the intrinsic photosensitivity of TiO2 nanoparticles, we demonstrated how ultraviolet (UV) pulsed laser irradiation of acrylate polymer nanocomposite solutions can separate the initial clusters of these colloidal semiconductor nanorods into clearly distinct units. From the irradiated solutions, optically clear nanocomposite films are obtained which exhibit enhanced optical properties with respect to the nanocomposites obtained without previous UV treatment.

[Examination and clinical signs in infancy]. / Examen et sémiologie générale du nourrisson.

The first 2 years of life are essential to visual development. The ophthalmological examination of a baby is different from that of an adult, in terms of both methodology and clinical signs. The specifics of examination at this age require a rigorous history taking as a first step: personal and family medical history, first sign of the disease and its progression. Cycloplegic refraction and fundus exam are both critical regardless of the reason for consultation. In addition, fundus exam must be performed at the first visit in cases of strabismus, nystagmus, or abnormal visual function, in order to rule out underlying retinoblastoma. Gross inspection of the patient can offer much information: malformations, visual behavior, oculomotor abnormalities. Quantification of vision and refraction is age-specific. It cannot be based solely on visual behavior, it cannot be just an approximation, and it often needs to be repeated. Lastly, examination of the anterior and posterior segments may require specialized equipment, special techniques, and may reveal pathology specific to the infant. Throughout the examination, patience and gentleness help greatly to insure a reliable diagnosis.

Characterization of Acinetobacter baumannii from intensive care units and home care patients in Palermo, Italy.

In this study 45 isolates of Acinetobacter baumannii identified from patients in intensive care units of three different hospitals and from pressure ulcers in home care patients in Palermo, Italy, during a 3-month period in 2010, were characterized. All isolates were resistant to at least three classes of antibiotics, but susceptible to colistin and tygecycline. Forty isolates were non-susceptible to carbapenems. Eighteen and two isolates, respectively, carried the bla(OXA-23-like) and the bla(OXA-58-like) genes. One strain carried the VIM-4 gene. Six major rep-PCR subtype clusters were defined, including isolates from different hospitals or home care patients. The sequence type/pulsed field gel electrophoresis group ST2/A included 33 isolates, and ST78/B the remaining 12. ST2 clone proved to be predominant, but a frequent involvement of the ST78 clone was evident.

[Pseudomonas aeruginosa unilateral endogenous endophthalmitis in a preterm infant: a case report]. / Endophtalmie endogène unilatérale à Pseudomonas aeruginosa chez un prématuré: à propos d'un cas.

Endogenous endophthalmitis is a rare eye disease, affecting vulnerable subjects (such as preterm or older elderly subjects), with reserved visual and sometimes vital prognosis. We present a preterm boy, born at 35 weeks and 2 days gestation, who developed a right eye Pseudomonas aeruginosa endogenous endophthalmitis secondary to a left-foot peripherical catheter-infection-associated bacteremia. He had a first intravenous antibiotic therapy associating third-generation cephalosporin and fluoroquinolone, then Ceftazidime® by intravitreous injection and a subconjunctival injection of betamethasone. Because of the development of vitreoretinal retraction, phacophagia and vitrectomy were performed. We point and discuss the severity of this disease, associated with poor visual and vital prognosis, and the importance of prompt biological diagnosis so that the appropriate intravenous antibiotic therapy is chosen. Treatment is also discussed, especially the interest value of antibiotic intravitreous injection in preterm infants.

Capecitabine in combination with oxaliplatin or irinotecan in elderly patients with advanced colorectal cancer: results of a randomized phase II study.

BACKGROUND: To determine the efficacy and tolerability of capecitabine combined with oxaliplatin (CAPOX) or irinotecan (CAPIRI) as first-line treatment in patients with advanced/metastatic colorectal cancer aged > or =70 years. PATIENTS AND METHODS: Patients aged > or =70 years were randomly assigned to receive CAPOX [oxaliplatin 65 mg/m(2) intravenously (i.v.) days 1 and 8 and capecitabine 1000 mg/m(2) orally b.i.d. days 1-14; q21d] or CAPIRI (irinotecan 80 mg/m(2) i.v. days 1 and 8 and capecitabine 1000 mg/m(2) orally b.i.d. days 1-14; q21d). The primary study end point was overall response rate (ORR). RESULTS: Ninety-four patients were enrolled. In an intent-to-treat analysis, 2 complete responses (CRs) and 16 partial responses (PRs) were reported with CAPOX (ORR 38%), and 2 CRs and 15 PRs with CAPIRI (ORR 36%; P = 0.831). Median time to progression was 8 months for CAPOX and 7 months for CAPIRI (P = 0.195), with median survival times of 19.3 months and 14.0 months (P = 0.165), respectively. Global health status was improved in 45% and in 21% of patients in the CAPOX and CAPIRI arms, respectively. The most common treatment-related grade 3-4 adverse events in CAPIRI versus CAPOX patients were diarrhea (32% versus 15%; P = 0.052) and neutropenia (23% versus 6%; P = 0.021). CONCLUSION: CAPOX and CAPIRI had similar efficacy in elderly patients, although CAPOX seemed to be better tolerated.

Patterned structures of in situ size controlled CdS nanocrystals in a polymer matrix under UV irradiation.

A method of in situ formation of patterns of size controlled CdS nanocrystals in a polymer matrix by pulsed UV irradiation is presented. The films consist of Cd thiolate precursors with different carbon chain lengths embedded in TOPAS polymer matrices. Under UV irradiation the precursors are photolyzed, driving to the formation of CdS nanocrystals in the quantum size regime, with size and concentration defined by the number of incident UV pulses, while the host polymer remains macroscopically/microscopically unaffected. The emission of the formed nanocomposite materials strongly depends on the dimensions of the CdS nanocrystals, thus, their growth at the different phases of the irradiation is monitored using spatially resolved photoluminescence by means of a confocal microscope. X-ray diffraction measurements verified the existence of the CdS nanocrystals, and defined their crystal structure for all the studied cases. The results are reinforced by transmission electron microscopy. It is proved that the selection of the precursor determines the efficiency of the procedure, and the quality of the formed nanocrystals. Moreover it is demonstrated that there is the possibility of laser induced formation of well-defined patterns of CdS nanocrystals, opening up new perspectives in the development of nanodevices.