Relationship of intercapillary area with visual acuity in diabetes mellitus: an optical coherence tomography angiography study.

AIM: To examine the correlation of best-corrected visual acuity (BCVA) with intercapillary area (ICA) measured from optical coherence tomography angiography (OCT-A) in patients with diabetes, and to compare the strength of associations between BCVA with ICA and other OCT-A metrics. METHODS: A cross-sectional study involved 447 eyes from 299 patients with diabetes. All participants underwent OCT-A with a swept-source OCT (Triton DRI-OCT, Topcon, Tokyo, Japan). An automated customised MATLAB programme was used to quantify ICA (the mean of the 10 largest areas including foveal avascular zone (FAZ) area (ICA10_FAZ) and excluding FAZ area (ICA10_excFAZ)) and other OCT-A metrics (FAZ area, FAZ circularity and vessel density) from the macular OCT-A images. BCVA was measured using Snellen chart for the patients and then converted to logarithm of the minimum angle of resolution (logMAR) VA. We further defined 'good VA' as Snellen >0.7 and 'poor VA' as Snellen ≤0.7 as a binary VA outcome for logistic regression analysis. RESULTS: In univariate regression analysis, increased ICA10_FAZ and ICA10_excFAZ were significantly correlated with logMAR (p values <0.05). In multivariate regression analysis, only the association between ICA10_FAZ and logMAR persisted (ß=0.103, p=0.024). In multivariable logistic regression analysis, increased ICA10_FAZ (OR=1.300, 95% CI 1.076 to 1.679, p=0.044) and FAZ circularity (OR=1.285, 95% CI 1.031 to 1.603, p=0.026) showed significant associations with poor VA. CONCLUSIONS: Increased ICA measured from OCT-A, describing enlargement of capillary rarefaction or closure at macular area, is independently associated with BCVA, suggesting that ICA is a potential marker to quantify retinal microvascular abnormalities relating to vision among individuals with diabetes.

Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: Results of a multicenter cohort with long-term follow-up.

BACKGROUND: Does the dogma of nephron sparing surgery (NSS) still stand for large renal masses? Available studies dealing with that issue are considerably biased often mixing imperative with elective indications for NSS and also including less malignant variants or even benign renal tumors. Here, we analyzed the oncological long-term outcomes of patients undergoing elective NSS or radical tumor nephrectomy (RN) for non-endophytic, large (≥7cm) clear cell renal carcinoma (ccRCC). METHODS: Prospectively acquired, clinical databases from two academic high-volume centers were screened for patients from 1980 to 2010. The query was strictly limited to patients with elective indications. Surgical complications were retrospectively assessed and classified using the Clavien-Dindo-classification system (CDS). Overall survival (OS) and cancer specific survival (CSS) were analyzed using the Kaplan-Meier-method and the log-rank test. RESULTS: Out of in total 8664 patients in the databases, 123 patients were identified (elective NSS (n = 18) or elective RN (n = 105)) for ≥7cm ccRCC. The median follow-up over all was 102 months (range 3-367 months). Compared to the RN group, the NSS group had a significantly longer median OS (p = 0.014) and median CSS (p = 0.04). CONCLUSIONS: In large renal masses, NSS can be performed safely with acceptable complication rates. In terms of long-term OS and CSS, NSS was at least not inferior to RN. Our findings suggest that NSS should also be performed in patients presenting with renal tumors ≥7cm whenever technically feasible. Limitations include its retrospective nature and the limited availability of data concerning long-term development of renal function in the two groups.

Role of intertube interactions in double- and triple-walled carbon nanotubes.

Resonant Raman spectroscopy studies are performed to access information about the intertube interactions and wall-to-wall distances in double- and triple-walled carbon nanotubes. Here, we explain how the surroundings of the nanotubes in a multiwalled system influence their radial breathing modes. Of particular interest, the innermost tubes in double- and triple-walled carbon nanotube systems are shown to be significantly shielded from environmental interactions, except for those coming from the intertube interaction with their own respective host tubes. From a comparison of the Raman results for bundled as well as individual fullerene-peapod-derived double- and triple-walled carbon nanotubes, we observe that metallic innermost tubes, when compared to their semiconducting counterparts, clearly show weaker intertube interactions. Additionally, we discuss a correlation between the wall-to-wall distances and the frequency upshifts of the radial breathing modes observed for the innermost tubes in individual double- and triple-walled carbon nanotubes. All results allow us to contemplate fundamental properties related to DWNTs and TWNTs, as for example diameter- and chirality-dependent intertube interactions. We also discuss differences in fullerene-peapod-derived and chemical vapor deposition grown double- and triple-walled systems with the focus on mechanical coupling and interference effects.

Characterization of bundled and individual triple-walled carbon nanotubes by resonant Raman spectroscopy.

The optical characterization of bundled and individual triple-walled carbon nanotubes was studied for the first time in detail by using resonant Raman spectroscopy. In our approach, the outer tube of a triple-walled carbon nanotube system protects the two inner tubes (or equivalently the inner double-walled carbon nanotube) from external environment interactions making them a partially isolated system. Following the spectral changes and line-widths of the radial breathing modes and G-band by performing laser energy dependent Raman spectroscopy, it is possible to extract important information as regards to the electronic and vibrational properties, tube diameters, wall-to-wall distances, radial breathing mode, and G-band resonance evolutions as well as high-curvature intertube interactions in isolated double- and triple-walled carbon nanotube systems.

Current concepts in tibial plateau fractures.

Tibial plateau fractures can range from a simple lateral split pattern to very complex bicondylar injuries that can be a sour- ce of great disability. these fractures can provide a challenge for both junior as well as for senior surgeons alike. careful evaluation of the mechanism of injury and fracture pattern plays a crucial part in the operative planning. Assessment of the soft tissues should be performed carefully and adequate imaging is mandatory to allow a more detailed evaluation of the fracture architecture and pre-operativeplanning. Timely accurate reduction and fixation is the goal. Over the last decade the surgical approach chosen has been largely determined by the fracture pattern. Internal plate osteosynthesis through antero-lateral and postero-medial incisions is the most commonly utilised technique for complex bi-condylar fractures. An early range of motion with special attention to full knee extension is essential for a successful functional outcome. Application of the principles mentioned is a pre-requisite to achieve the best result. New fixation techniques, such as locking plates, have not changed those principles but helped to apply them more reliably.

Pulmonary-renal syndrome due to hemorrhagic fever with renal syndrome: an unusual manifestation of puumala virus infection in France.

The authors report about a patient who presented with acute respiratory failure, bilateral alveolar infiltrates, without signs of fluid overload, and acute renal failure. Percutaneous renal biopsy revealed acute interstitial nephritis with medulla hemorrhages. Serologic tests for Puumala virus infection were positive. Hemorrhagic fever with renal syndrome should be considered when patients present with pulmonary-renal syndrome.