Macular hole Delphi consensus statement (MHOST).

PURPOSE: To derive a Delphi method-based consensus for the surgical management of Full Thickness Macular Hole (FTMH) and Lamellar Macular Hole (LMH). METHODS: 37 expert VR surgeons from 21 mainly European countries participated in Delphi method-based questionnaire for diagnosis and treatment of FTMHs and LMHs. RESULTS: A total of 36 items were rated in round 1 by 37 participants, of which 10 items achieved consensus: intraoperative verification of PVD; clinical superiority of OCT-based FTMH classification; practical ineffectiveness of ocriplasmin; circular 360° ILM peeling for small macular holes; use of regular surgical technique for the size of the hole in concomitant retinal detachment; performing complete vitrectomy; SF6 gas as preferred tamponade; cataract surgery if crystalline lens is mildly/moderately opaque; removal of both ILM and LHEP in LMH surgery. In round 2, 18 items with moderate consensus (45-70% agreement) in round 1 were rated by 35 participants. Final consensus was reached in 35% of questions related to both diagnosis and surgical procedures. CONCLUSIONS: This Delphi study provides valuable information about the consensus/disagreement on different scenarios encountered during FTMH and LMH management as a guide tosurgical decision-making. High rate of disagreement and/or variable approaches still exist for treating such relatively common conditions.

Modelling of Fatigue Microfracture in Porous Sintered Steel Using a Phase-Field Method.

Porosity in sintered materials negatively affects its fatigue properties. In investigating its influence, the application of numerical simulations reduces experimental testing, but they are computationally very expensive. In this work, the application of a relatively simple numerical phase-field (PF) model for fatigue fracture is proposed for estimation of the fatigue life of sintered steels by analysis of microcrack evolution. A model for brittle fracture and a new cycle skipping algorithm are used to reduce computational costs. A multiphase sintered steel, consisting of bainite and ferrite, is examined. Detailed finite element models of the microstructure are generated from high-resolution metallography images. Microstructural elastic material parameters are obtained using instrumented indentation, while fracture model parameters are estimated from experimental S-N curves. Numerical results obtained for monotonous and fatigue fracture are compared with data from experimental measurements. The proposed methodology is able to capture some important fracture phenomena in the considered material, such as the initiation of the first damage in the microstructure, the forming of larger cracks at the macroscopic level, and the total life in a high cycle fatigue regime. However, due to the adopted simplifications, the model is not suitable for predicting accurate and realistic crack patterns of microcracks.

Post-COVID-19 Syndrome in Neurology Patients: A Single Center Experience.

Our aim was to determine the frequency and characteristics of neurological post-COVID-19 syndrome and the diagnostic and therapeutic measures that were used for the treatment of these patients. Data were collected for 243 patients examined during the period of 11 May 2021 to 22 June 2022. The inclusion criteria were COVID-19 illness and neurological symptoms associated with COVID-19. The exclusion criteria were non-neurological symptoms, patients who did not suffer from COVID-19, and symptoms that occurred after vaccination against the SARS-CoV-2 virus. Data for 227 patients with neurological post-COVID-19 symptoms were analyzed. Most patients presented with multiple symptoms, most often headache, cognitive impairment, loss of smell, paresthesia, fatigue, dizziness, and insomnia. Patients were most often referred for consultative examinations, neuroradiological imaging, and EEG. The therapy was mostly symptomatic. Most patients had no change in their symptoms on follow-up visits (53.21%), while positive outcome was found in 44.95% of patients. This study found that neurological post-COVID-19 syndrome appears to be more common in women, and generally, the most common symptoms are headache and cognitive impairment. The gender distribution of symptoms was clearly visible and should be further investigated. There is a need for longitudinal follow-up studies to better understand the disease dynamic.

The effects of microbiota abundance on symptom severity in Parkinson's disease: A systematic review.

Introduction: Parkinson's disease (PD) is neurodegenerative disease with a multifactorial etiopathogenesis with accumulating evidence identifying microbiota as a potential factor in the earliest, prodromal phases of the disease. Previous research has already shown a significant difference between gut microbiota composition in PD patients as opposed to healthy controls, with a growing number of studies correlating gut microbiota changes with the clinical presentation of the disease in later stages, through various motor and non-motor symptoms. Our aim in this systematic review is to compose and assess current knowledge in the field and determine if the findings could influence future clinical practice as well as therapy in PD. Methods: We have conducted a systematic review according to PRISMA guidelines through MEDLINE and Embase databases, with studies being selected for inclusion via a set inclusion and exclusion criteria. Results: 20 studies were included in this systematic review according to the selected inclusion and exclusion criteria. The search yielded 18 case control studies, 1 case study, and 1 prospective case study with no controls. The total number of PD patients encompassed in the studies cited in this review is 1,511. Conclusion: The link between gut microbiota and neurodegeneration is a complex one and it depends on various factors. The relative abundance of various microbiota taxa in the gut has been consistently shown to have a correlation with motor and non-motor symptom severity. The answer could lie in the products of gut microbiota metabolism which have also been linked to PD. Further research is thus warranted in the field, with a focus on the metabolic function of gut microbiota in relation to motor and non-motor symptoms.

Phase-Field Modeling of Fused Silica Cone-Crack Vickers Indentation.

In this paper, a 3D phase-field model for brittle fracture is applied for analyzing the complex fracture patterns appearing during the Vickers indentation of fused silica. Although recent phase-field models for the fracture caused by the indentation loading have been verified by some simpler academic axis-symmetric examples, a proper validation of such models is still missing. In addition, heavy computational costs, and a complicated compression stress field under the indenter, which demands different energy decompositions, have been identified as the most important impediments for the successful application of the phase-field method for such problems. An adaptive strategy is utilized for reducing the computational costs, and some modifications are introduced, which enable an accurate simulation of the Vickers indentation fracture. Here, the fracture initiation ring outside the contact zone is detected by using different energy decompositions, and the dominant cone-crack formation under the Vickers indenter is observed. Different contact conditions are investigated. The proposed model is validated by experimental measurements, and a quantitative and qualitative comparison between experimental and numerical results is conducted.

Global and Public Mental Health Promotion for Empathic Civilisation: the Role of Political Psychocultures.

This article draws attention to the relationship between neuroethics, neuropolitics, political psycho-cultures and public and global mental health. In the hegemonic culture of neoliberalism the purpose of life has been reduced to the self-realization in economic and consumerism terms that promotes the hypercompetitive narcissistic or manic self, indifferent to the fate and suffering of others and accommodated to commodification of morals, mental health and well-being. The real public and global mental health promotion is strongly associated with creating a more empathic, less selfish individual and collective mind where people put a greater emphasis on common interests and bioethical values.

Treatment of anti-vascular endothelial growth factor-resistant diabetic macular edema with dexamethasone intravitreal implant.

PURPOSE: To investigate the efficiency of intravitreal dexamethasone implant in patients with chronic diabetic macular edema nonresponsive to three consecutive monthly intravitreal injections of anti-vascular endothelial growth factor administered previously. METHODS: Fifteen patients (16 eyes) were included in this 4-month prospective clinical trial. Main observed outcomes were the changes between initial and monthly visits in best-corrected visual acuity, central foveal thickness, and intraocular pressure (IOP). Patients included had central foveal thickness of >225 µm (measured by optical coherence tomography) and were nonresponsive to previously administered 3 consecutive monthly intravitreal injections of 1.25-mg bevacizumab. Administration of intravitreal dexamethasone implant was performed at baseline, and patients were followed-up monthly. RESULTS: Statistically significant changes from baseline were observed in best-corrected visual acuity (at 2 months), central foveal thickness (at 1, 2, and 3 months), and IOP (at Months 1, 2, and 3) as follows: mean best-corrected visual acuity significantly increased from 0.29 Snellen lines at baseline to 0.39 lines after 2 months (P = 0.0381). At Months 1, 2, and 3, the mean central foveal thickness significantly decreased, from 462 µm at baseline, to 366 µm (P = 0.0343), 346 µm (P = 0.0288), and 355 µm (P = 0.0370), respectively. When compared with baseline IOP of 15.38 mmHg (12-19 mmHg), IOP increased significantly at Months 1, 2, and 3: 18.93 mmHg (range, 16-24 mmHg; P = 0.0003), 19.5 mmHg (range, 16-27 mmHg; P = 0.0003), and 17.5 mmHg (range, 15-21 mmHg; P = 0.0048), respectively. CONCLUSION: Dexamethasone intravitreal implant may present an alternative option in the treatment of chronic diabetic macular edema nonresponsive to three consecutive monthly bevacizumab injections administered previously. However, IOP measures were only slightly increased. It seems that the effect of dexamethasone may last till 4 months after initial injection.

Time to consider a new treatment protocol for aggressive posterior retinopathy of prematurity?

PURPOSE: To discuss treatment modalities for aggressive posterior retinopathy of prematurity (AP-ROP). METHODS: The medical charts of all infants with AP-ROP at Uppsala University Hospital, Sweden, during a 2-year period (2009 and 2010) were reviewed. Eight infants (16 eyes) with a mean gestational age of 23.8 weeks and a mean birth weight of 592 g were treated with laser and/or intravitreal injections of bevacizumab (0.4 and 0.625 mg). RetCam photography was used to document the retinal appearance before and after treatment. RESULTS: All infants (16 eyes) had AP-ROP in zone I. Mean time at initial treatment was 34 weeks postmenstrual age. Two eyes (one infant) were only treated with laser, and six eyes (three infants) were treated with laser therapy or cryopexy and, because of lack of regression, with bevacizumab as salvage therapy. Eight eyes (four infants) were treated with a first-line bevacizumab injection and four of these eyes (two infants) with additional laser ablation for continued disease progression in zone II. Macular dragging occurred in one eye of one infant primarily treated with laser. CONCLUSIONS: Given the high complication rate of the extensive laser treatment for zone I ROP, it is worth considering anti-vascular endothelial growth factor treatment as an alternative therapy. Further knowledge concerning side effects and long-term ocular and systemic outcome is warranted before this drug becomes general clinical practice.

Parallel stacking interactions in square-planar transition-metal complexes containing fused chelate and C6-aromatic rings.

Stacking interactions in the crystal structures of square-planar transition metal complexes from the Cambridge Structural Database with five- and six-membered chelate rings fused with C(6-arom) rings (arom = aromatic) were analyzed. The distribution of distances between the closest C(6-arom)-C(6-arom) and C(6-arom)-chelate contacts shows that in a large fraction of the intermolecular interactions the C(6-arom) ring of one molecule is closer to the chelate than to the C(6-arom) ring of the other molecule. These results indicate a possible preference of the C(6-arom) ring to form stacking contacts with the chelate rings. The preference is ubiquitous and does not depend on the metal type.

New image of psychiatry, mass media impact and public relations.

The mass media has a powerful impact on public attitudes about mental health and psychiatry. The question of identity of psychiatry as a medical profession as well as of the future of psychiatry has been the subject of much controversial discussion. Psychiatry today has the historical opportunity to shape the future of mental health care, medicine and society. It has gained in scientific and professional status by the tremendous increase of knowledge and treatment skills. Psychiatry should build up new transdisciplinary and integrative image of a specialized profession, promote it and make it public. Good public relations are very important for the future of psychiatry.

Anti-VEGF in treatment of central retinal vein occlusion.

Macular edema along with macular ischemia is responsible for decreased visual acuity in central retinal vein occlusion. Bevacizumab (Avastin, Genentech) blocks vascular endothelial growth factor (VEGF) induced hyperpermeability of blood vessels. In this prospective case series we investigated the efficacy of anti-VEGF treatment in reduction of central retinal thickness (CRT) and improvement in visual acuity (VA). 25 patients were followed up for 12 months and treated monthly with intravitreal bevacizumab. VA and CRT were measured at each visit. Treatment was discontinued as the peak improvement of either parameter was reached and reinstituted in case of deterioration/recurrence of edema. Study endpoints included: VA using ETDRS charts, CRT and number of injections at 12 months. Mean VA from all 25 patients increased by 3.1 logMAR lines (p < 0.05 compared to baseline). The improvement of VA after bevacizumab injection was in correlation with a decrease in CRT In subgroup analyses, patients receiving bevacizumab injection within the first 3 months after CRVO showed an average VA gain of 4.2 logMAR lines. Mean of 4.5 injections was needed to control the disease during the follow-up period. Bevacizumab treatment was effective in VA and reducing CRT. It appears from subgroup analysis that initiation of treatment early in the course of disease produced better functional outcome. Several injections were needed to control the disease. Regular OCT examinations and retreatment are advised in order to maintain initially reached VA.

Recurrent transient global amnesia at high altitude.

We report the case of a 57-year-old man who experienced recurrent episodes of memory loss that resemble transient global amnesia (TGA). The first episode lasted 20 minutes, and the second was 8 hours long.

Combined phacoemulsification and pars plana vitrectomy for macular hole treatment.

PURPOSE: To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy and intraocular lens (IOL) implantation in eyes with macular hole. METHODS: A retrospective study was conducted in 38 eyes (36 patients) after combined phacoemulsification, insertion of a posterior capsule IOL and pars plana vitrectomy. RESULTS: The macular hole was successfully closed in 32 of the 38 eyes (84%). In six eyes (16%) the hole failed to close and one eye underwent a second operation. Vision improved by two or more Snellen lines in 29 eyes (73%), there was no change in seven eyes (18%), and visual acuity decreased in two eyes (5%). Intraoperative and postoperative complications included retinal tears in nine eyes (24%), posterior capsule rupture in two eyes (5%), transient postoperative increase of intraocular pressure in eight eyes (21%), and posterior capsule opacification in five eyes (13%). CONCLUSION: Combining phacoemulsification, IOL insertion and pars plana vitrectomy for macular hole repair can reduce the need for cataract surgery in the future, decrease costs, shorten postoperative recovery time and allow for clearer intraoperative visualization, making the procedure safer and more effective.

Make love to forget: two cases of transient global amnesia triggered by sexual intercourse.

Transient global amnesia (TGA) is characterized by a sudden onset and by a typical resolution within several hours. Several precipitating events have been proposed: physical exertion, emotional experiences, etc. The aim of this paper was to present two cases of TGA triggered by sexual intercourse and to suggest a possible mechanism for the development of TGA. In both patients, clinical examination revealed elevated blood pressure. Laboratory examinations and brain CTs were normal. EEG demonstrated diffuse dysrhythmia and slow spike-waves, respectively. SPECT revealed hypoperfusion in the left frontal and right medial temporal regions. Various explanations of the mechanism of TGA are discussed. Based on the observed hypoperfusion in the medial temporal regions, a new hypothesis is advanced, suggesting the possibility that TGA occurs due to a pathologically changed or less adaptable anterior chorioid artery, initially constricted by hypotension following a blood shift from the center towards periphery.

Tris(3,5-dimethyl-1H-pyrazole-1-thiocarboxamidato-kappa(2)N(2),N)cobalt(III).

In the crystal structure of the title complex, [Co(C(6)H(8)N(3)S)(3)], the Co(III) atom is octahedrally coordinated by three monodeprotonated bidentate 3,5-dimethyl-1H-pyrazole-1-thiocarboxamide ligands with two thiocarboxamide N atoms in axial positions. The asymmetric unit contains two molecules (A and B) and these molecules are arranged in chains in an alternating fashion connected by N-H...S interactions.

Transition metal complexes with thiosemicarbazide-based ligands. XLIII. Chlorobis(3-methylisoemicarbazide-kappa(2)N(1),N(4))zinc(II) chloride.

In the title compound, [ZnCl(C(2)H(7)N(3)S)(2)]Cl, the Zn(II) ion is five-coordinated in a distorted trigonal-bipyramidal arrangement, with the hydrazine N atoms located in the apical positions. The structure is stabilized by N[bond]H...Cl hydrogen bonds, which involve both the Cl atoms and all the hydrogen donors, except for one of the two thioamide N atoms. A comparison of the geometry of thiosemicarbazide and S-methylisothiosemicarbazide complexes with Zn(II), Cu(II) and Ni(II) shows the pronounced influence of the hydrogen-bond network on the coordination geometry of Zn(II) compounds.