Post-Ureteroscopic Lesion Scale: limitaciones en su aplicabilidad clínica / Post-Ureteroscopic Lesion Scale to determine ureteral wall damage, not so easy to employ

Objetivo Analizar el nivel de concordancia de la Post-Ureteroscopic Lesion Scale (PULS), y examinar las consecuencias de su aplicación en la práctica clínica con datos estadísticos más fiables que los utilizados en el trabajo original. Métodos Se realizaron 14 ureteroscopias (URS) y 14 micro-ureteroscopias (micro-URS) en 14 cerdos hembra. Todos los procedimientos se grabaron en vídeo y se realizó un análisis anatomopatológico en cada uréter. Dieciséis urólogos (9 endourólogos y 7 urólogos generales) y 4 médicos internos residentes evaluaron las lesiones ureterales según la escala PULS, con grados 0, 1 y ≥2. La concordancia se calculó mediante porcentajes, el Coeficiente W de Kendall, el índice kappa de Fleiss y el alfa de Krippendorff. La concordancia entre evaluadores se calculó con la Correlación de Spearman y el Coeficiente kappa de Cohen. Resultados El porcentaje de concordancia fue del 11,1%. Los coeficientes se clasificaron como bajos o muy bajos, y encontramos una mayor concordancia entre los evaluadores más inexpertos. Por otro lado, no hubo acuerdo entre el 50% de los evaluadores. Conclusiones La baja concordancia entre evaluadores, la especificidad de la PULS y la correlación clínico/patológica sugieren dificultades del uso de esta escala y una curva de aprendizaje probablemente larga. (AU)

Objective To analyze the level of agreement of the Post-Ureteroscopic Lesion Scale (PULS) and the consequences on its application in clinical practice with more reliable statistical data than the one used in the original work. Methods 14 URS and 14 micro-URS were performed in 14 female porcine model. All the procedures were video recorded and an anatomopathological analysis was performed in each ureter. Sixteen urologists (9 endourologists and 7 general urologists) and 4 residents evaluated the ureteral lesions according to the PULS, with degrees 0, 1 and ≥2. The agreement was calculated with percentages, Kendall's W coefficient and the indicators Fleiss’ Kappa and Krippendorff's Alpha, while the inter-rater agreement was calculated with Spearman's correlation and Cohen's Kappa. Results The percent of agreement was 11.1%. The coefficients were likewise classified as low or very low, with the greatest agreement found among the inexperienced. Also, 50% of the raters did not agree with the rest. Conclusions The low inter-rater agreement, the specificity of the PULS and the clinical-pathological correlation suggests that this scale is not simple, and probably has a long learning curve. (AU)

Post-Ureteroscopic Lesion Scale to determine ureteral wall damage, not so easy to employ.

OBJECTIVE: To analyze the level of agreement of the Post-Ureteroscopy Lesion Scale (PULS) and the consequences on its application in clinical practice with more reliable statistical data than the one used in the original work. METHODS: 14 URS and 14 micro-URS were performed in 14 female porcine model. All the procedures were video recorded and an anatomopathological analysis was performed in each ureter. Sixteen urologists (9 endourologists and 7 general urologists) and 4 residents evaluated the ureteral lesions according to the PULS, with degrees 0, 1 and ≥2. The agreement was calculated with percentages, Kendall's W coefficient and the indicators Fleiss' Kappa and Krippendorff's Alpha, while the inter-rater agreement was calculated with Spearman's correlation and Cohen's Kappa. RESULTS: The percent of agreement was 11.1%. The coefficients were likewise classified as low or very low, with the greatest agreement found among the inexperienced. Also, 50% of the raters did not agree with the rest. CONCLUSIONS: The low inter-rater agreement, the specificity of the PULS and the clinical-pathological correlation suggests that this scale is not simple, and probably has a long learning curve.

Desarrollo y validación de un nuevo simulador para endourología / The development and validation of a new simulator for endourology

Introducción La simulación en medicina ha evolucionado sustancialmente en las últimas décadas. Actualmente hay una gran variedad de simuladores disponibles, especialmente diseñados para la práctica de procedimientos quirúrgicos. Debido a las largas curvas de aprendizaje de las técnicas endourológicas mínimamente invasivas, la rama de la endourología se puede ver muy beneficiada por el uso de estos simuladores. Material y métodos Se diseñó un simulador de baja fidelidad para la práctica de técnicas endourológicas que utilizan cistoscopia. En el proceso de validación participaron 5 expertos y 19 no expertos. Los expertos eran profesionales médicos de un Departamento de Urología con experiencia de al menos 100 procedimientos de cistoscopia flexible. Los no expertos eran residentes en medicina interna sin experiencia en ningún tipo de técnica endoscópica. Se recogió información sobre la validez aparente y de contenido mediante escalas de Likert con puntuación de 1 a 5. Para evaluar la validez de constructo, se midió el tiempo para completar dos tareas, para lo cual se evaluó el procedimiento mediante la escala de evaluación global OSATS. Resultados El nuevo simulador se fabricó satisfactoriamente de acuerdo con su diseño. En todos los aspectos evaluados de la validez de constructo hubo una diferencia significativa (p<0,05) entre el grupo de expertos y el de no expertos. La validez de contenido fue puntuada con 4,66 (desviación estándar [DE] ±0,56) por los expertos y con 4,41 (DE±0,71) por los no expertos. En el cuestionario de validez aparente, la puntuación media fue de 4,14 (DE±0,94), y la pregunta que recibió la puntuación más alta (4,6 [DE±0,84]) evaluaba la inmersión en el procedimiento. Conclusión El simulador presentado es válido tanto para el entrenamiento de nuevos endourólogos como para el perfeccionamiento de las técnicas de los médicos expertos (AU)

Introduction Simulation in medicine has developed a lot in the last few decades. There is a broad range of simulators available, above all for training in surgical procedures. Endourology can benefit much from simulation because the minimally-invasive procedures of endourology frequently have long learning curves, which can be reduced by training with simulators. Material and methods A low-fidelity simulator was designed for practicing endourology techniques that use cystoscopy. The process of validation involved 5 experts and 19 non-experts. Experts comprised medical professionals working in a department of urology who had performed at least 100 flexible cystoscopy procedures. Non-experts were residents in internal medicine without experience in any type of endoscopy. Information about face and content validity was collected by means of Likert scales from 1 to 5. To evaluate construct validity, we measured the time to complete two tasks, for which the procedure was evaluated by means of the OSATS global evaluation scale. Results New simulator was successfully built according to its design. For all evaluated aspects of construct validity, there was a significant difference (P<.05) between the group of experts and the group of non-experts. Content validity was scored 4.66 (standard deviation±0.56) by the experts and 4.41 (±0.71) by the non-experts. In the face validity questionnaire, the average score was 4.14 (±0.94), the question receiving the highest score: 4.6 (±0.84) concerned immersion in the procedure. Conclusion The simulator presented is valid both for training up new urologists in endourology technique and for experts seeking to perfect their skills (AU)

The development and validation of a new simulator for endourology.

INTRODUCTION: Simulation in medicine has developed a lot in the last few decades. There is a broad range of simulators available, above all for training in surgical procedures. Endourology can benefit much from simulation because the minimally-invasive procedures of endourology frequently have long learning curves, which can be reduced by training with simulators. MATERIALS AND METHODS: A low-fidelity simulator was designed for practicing endourology techniques that use cystoscopy. The process of validation involved 5 experts and 19 non-experts. Experts comprised medical professionals working in a department of urology who had performed at least 100 flexible cystoscopy procedures. Non-experts were residents in internal medicine without experience in any type of endoscopy. Information about face and content validity was collected by means of Likert scales from 1 to 5. To evaluate construct validity, we measured the time to complete two tasks, for which the procedure was evaluated by means of the OSATS global evaluation scale. RESULTS: New simulator was successfully built according to its design. For all evaluated aspects of construct validity, there was a significant difference (p<0.05) between the group of experts and the group of non-experts. Content validity was scored 4.66 (standard deviation ±0.56) by the experts and 4.41 (±0.71) by the non-experts. In the face validity questionnaire, the average score was 4.14 (±0.94), the question receiving the highest score: 4.6 (±0.84) concerned immersion in the procedure. CONCLUSION: The simulator presented is valid both for training up new urologists in endourology technique and for experts seeking to perfect their skills.

Biomarcadores de OCT-angiografía en la neovascularización coroidea tipo1 tras tratamiento con aflibercept durante 1 año / OCT angiography biomarkers in type1 choroidal neovascularisation after one year of aflibercept treatment

Objetivos: Evaluar la actividad de los biomarcadores, mediante OCT-angiografía (OCTA), en la neovascularización coroidea (NVC) secundaria a degeneración macular asociada a la edad (DMAE) tratada con aflibercept. Como objetivos secundarios se estudiaron la agudeza visual (AV) y la relación existente entre biomarcadores y pronóstico visual. Material y métodos: Estudio prospectivo en el que se estudiaron 33 ojos de 40 pacientes naïve diagnosticados de NVC tipo1 secundaria a DMAE y que habían sido tratados con aflibercept, según ficha técnica, durante 1año. Los pacientes fueron evaluados en el momento del diagnóstico, a los 4, a los 8 y a los 12meses. Resultados: La ganancia media de AV a los 12meses fue de 15,2±3,3 letras. El área de lesión disminuyó 1,2±1,0mm2 en el cuarto mes (p<0,0001), permaneciendo estable después. La presencia de capilares finos, anastomosis y halo hipointenso perilesional se redujo en el 85, el 70 y el 25%, respectivamente, a los 12meses de seguimiento. La arcada vascular periférica cambió de morfología, pasando de tener un aspecto frondoso a tener un aspecto afilado en el 90% de los casos. El tamaño de la lesión y la presencia/ausencia de halo hipointenso perilesional se asociaron, de manera independiente, a la AV final, de tal forma que las lesiones de mayor tamaño y la ausencia de halo hipointenso perilesional en la visita basal se asociaron a menor ganancia de AV. Conclusiones: La OCTA se trata de una herramienta útil, no invasiva, que nos aporta información cuantitativa y cualitativa del remodelado de la red vascular de la NVC tras terapia antiangiogénica. (AU)

Objective: To assess the activity of biomarkers, through OCT angiography (OCTA), of choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD) treated with aflibercept. As secondary endpoints, visual acuity (VA) and the relationship between biomarkers and visual prognosis were also studied. Material and methods: Prospective study that examined 33 eyes of 40 naïve patients with type1 CNV secondary to AMD, who had been treated with aflibercept, according to summary of product characteristics, for one year. The patients were evaluated at the time of diagnosis, and at 4, 8 and 12months. Results: The mean VA gain at 12months was 15.2±3.3 letters. The area of lesion decreased 1.2±1.0mm2 in the 4th month (P<.0001), remaining stable afterwards. The presence of tiny capillaries, anastomosis and perilesional hypointense halo was reduced by 85%, 70% and 25%, respectively, at 12 months of follow-up. The peripheral vascular arcade changed morphology, from having a leafy appearance to having a sharp appearance in 90% of cases. The size of the lesion and the presence/absence of perilesional hypointense halo were independently associated with the final VA, in such a way that larger lesions and the absence of a perilesional hypointense halo at the baseline visit were associated with less VA gain. Conclusions: The OCTA is a useful, non-invasive tool that provides quantitative and qualitative information on the remodelling of the CNV vascular network after antiangiogenic therapy. (AU)

Eficacia del implante de dexametasona intravítreo en el manejo del «síndrome de Vogt-Koyanagi-Harada-like» secundario a la inhibición de la vía MAP quinasa / Usefulness of intravitreal dexamethasone implant in the management of «Vogt-Koyanagi-Harada-like syndrome» secondary to map kinase pathway inhibition

Mujer de 58 años, con antecedentes personales de melanoma metastásico en tratamiento con trametinib y dabrafenib, que presentaba disminución de agudeza visual bilateral. En la exploración se podía observar uveítis anterior, vitritis, desprendimiento de retina seroso, vasculitis y edema de disco en ambos ojos; se la diagnosticó de síndrome de Vogt-Koyanagi-Harada-like secundario a inhibición de la vía MAP quinasa. Además de la retirada de los fármacos oncológicos, se pautaron corticoides sistémicos y tópicos, pero este tratamiento consiguió solo una mejoría parcial del cuadro cuando se reintrodujo la terapia biológica; se añadió, por tanto, un implante de dexametasona intravítreo bilateral que consiguió una evolución favorable en su sintomatología y en los hallazgos de las pruebas complementarias. La inflamación intraocular es una complicación descrita tras el tratamiento con trametinib y dabrafenib. Un diagnóstico preciso unido al tratamiento corticoideo, tanto sistémico como intravítreo, nos llevó a obtener óptimos resultados

The case is presented of a 58-year-old woman with a personal history of metastatic melanoma under treatment with trametinib and dabrafenib, as well as a decrease in bilateral visual acuity. On examination, it was observed that she had an anterior uveitis, vitritis, serous retinal detachment, vasculitis and disc oedema in both eyes. She was diagnosed with a Vogt-Koyanagi-Harada-like syndrome secondary to MAP kinase pathway inhibition. In addition to the withdrawal of the oncology drugs, systemic and topical corticosteroids were prescribed, but this treatment only achieved a partial improvement of the disease when biological therapy was re-introduced. Therefore, a bilateral intravitreal dexamethasone implant was added, which led to a favourable progression in her symptomatology, as well as in the findings of complementary tests. Intraocular inflammation is a complication described after treatment with trametinib and dabrafenib. An accurate diagnosis, added to corticosteroid treatment, systemic and intravitreal, led us to obtain optimal results

Usefulness of intravitreal dexamethasone implant in the management of «Vogt-Koyanagi-Harada-like syndrome¼ secondary to map kinase pathway inhibition. / Eficacia del implante de dexametasona intravítreo en el manejo del «síndrome de Vogt-Koyanagi-Harada-like¼ secundario a la inhibición de la vía MAP quinasa.

The case is presented of a 58-year-old woman with a personal history of metastatic melanoma under treatment with trametinib and dabrafenib, as well as a decrease in bilateral visual acuity. On examination, it was observed that she had an anterior uveitis, vitritis, serous retinal detachment, vasculitis and disc oedema in both eyes. She was diagnosed with a Vogt-Koyanagi-Harada-like syndrome secondary to MAP kinase pathway inhibition. In addition to the withdrawal of the oncology drugs, systemic and topical corticosteroids were prescribed, but this treatment only achieved a partial improvement of the disease when biological therapy was re-introduced. Therefore, a bilateral intravitreal dexamethasone implant was added, which led to a favourable progression in her symptomatology, as well as in the findings of complementary tests. Intraocular inflammation is a complication described after treatment with trametinib and dabrafenib. An accurate diagnosis, added to corticosteroid treatment, systemic and intravitreal, led us to obtain optimal results.

Linfoma y proliferación melanocítica uveal difusa unilateral: cuando ambas entidades coexisten en el ojo / Lymphoma and unilateral diffuse uveal melanocytic proliferation: when both conditions co-exist in the eye

Varón de 60 años que presenta disminución de agudeza visual rápida y progresiva en su ojo izquierdo (OI). En la exploración funduscópica se pueden observar alteraciones pigmentarias asociadas a placas anaranjadas subretinianas que, mediante autofluorescencia, aparecen como múltiples puntos hipoautofluorescentes en el polo posterior. A los 3 meses, el paciente desarrolla una importante vitritis asociada a grandes placas blanco-amarillentas subretinianas en el polo posterior del OI; el ojo derecho no presenta alteraciones. El coeficiente intravítreo IL-10/IL-6 fue de 0,87 y la resonancia nuclear magnética cerebral evidenció una lesión densa en el lóbulo frontal, sugestiva de linfoma. Se diagnosticó al paciente un linfoma primario del sistema nervioso central, con afectación ocular de su OI, que se asoció a una proliferación melanocítica uveal difusa del mismo ojo. La proliferación melanocítica uveal difusa se trata de un proceso paraneoplásico bilateral que ocurre como consecuencia de procesos tumorales carcinomatosos, aunque no siempre cumple estas características

The case is presented of a 60 year-old male with decreased visual acuity in his left eye (LE). In the funduscopic examination, pigmentary alterations associated with sub-retinal orange plaques could be observed that, in autofluorescence, manifested as hypoautofluorescent spots. Subsequently, the patient subsequently developed significant vitritis with large white sub-retinal plaques on the posterior pole of his LE, with no alterations in the right eye. The IL-10/IL-6 coefficient was 0.87, and a lesion suggestive of a lymphoma in the frontal lobe could be seen on brain magnetic resonance scan. The patient was diagnosed with primary lymphoma of the central nervous system with ocular involvement of the LE and associated unilateral diffuse uveal melanocytic proliferation of the same eye. Diffuse uveal melanocytic proliferation is a bilateral para-neoplastic process that occurs as a consequence of carcinomatous tumour processes, although it does not always meet these characteristics

Lymphoma and unilateral diffuse uveal melanocytic proliferation: when both conditions co-exist in the eye. / Linfoma y proliferación melanocítica uveal difusa unilateral: cuando ambas entidades coexisten en el ojo.

The case is presented of a 60 year-old male with decreased visual acuity in his left eye (LE). In the funduscopic examination, pigmentary alterations associated with sub-retinal orange plaques could be observed that, in autofluorescence, manifested as hypoautofluorescent spots. Subsequently, the patient subsequently developed significant vitritis with large white sub-retinal plaques on the posterior pole of his LE, with no alterations in the right eye. The IL-10/IL-6 coefficient was 0.87, and a lesion suggestive of a lymphoma in the frontal lobe could be seen on brain magnetic resonance scan. The patient was diagnosed with primary lymphoma of the central nervous system with ocular involvement of the LE and associated unilateral diffuse uveal melanocytic proliferation of the same eye. Diffuse uveal melanocytic proliferation is a bilateral para-neoplastic process that occurs as a consequence of carcinomatous tumour processes, although it does not always meet these characteristics.

Neovascularización coroidea secundaria a coroiditis serpiginosa: valor de la OCT-angiografía en el diagnóstico y en la respuesta al tratamiento con aflibercept / Choroidal neovascularisation secondary to serpiginous choroiditis: The value of OCT-angiography in diagnosis and response to therapy with aflibercept

Varón de 61 años, con antecedentes personales de coroiditis serpiginosa (CS), que presentó metamorfopsia y disminución de agudeza visual (AV) en su ojo derecho (OD). En la exploración, mediante Swept-Source OCT-angiografía (SS OCT-A), se pudo observar una hemorragia peripapilar secundaria a una neovascularización coroidea (NVC). El paciente fue tratado mediante aflibercept intravítreo, presentando una evolución favorable en su sintomatología y en los hallazgos de la SS OCT-A. La NVC es una complicación que puede aparecer hasta en el 25% de los casos tras CS. Un diagnóstico preciso, mediante SS OCT-A, unido al tratamiento precoz con aflibercept, nos llevó a obtener unos óptimos resultados, tanto clínicos como anatómicos

A case is presented of a 61 year-old man with a personal history of serpiginous choroiditis (SC), who presented with metamorphopsia and decreased visual acuity (VA) in his right eye (RE). In the examination, using Swept Source OCT-angiography (SS OCT-A), peripapillary haemorrhage secondary to a choroidal neovascularisation (CNV) was observed. The patient was treated with intravitreal aflibercept, having a favourable outcome on his symptomatology and in the SS OCT-A findings. CNV is a complication that can appear in up to 25% of cases after SC. An accurate diagnosis using SS OCT-A, with early treatment with aflibercept, led us to obtain optimal clinical and anatomical results

Choroidal neovascularisation secondary to serpiginous choroiditis: The value of OCT-angiography in diagnosis and response to therapy with aflibercept. / Neovascularización coroidea secundaria a coroiditis serpiginosa: valor de la OCT-angiografía en el diagnóstico y en la respuesta al tratamiento con aflibercept.

A case is presented of a 61 year-old man with a personal history of serpiginous choroiditis (SC), who presented with metamorphopsia and decreased visual acuity (VA) in his right eye (RE). In the examination, using Swept Source OCT-angiography (SS OCT-A), peripapillary haemorrhage secondary to a choroidal neovascularisation (CNV) was observed. The patient was treated with intravitreal aflibercept, having a favourable outcome on his symptomatology and in the SS OCT-A findings. CNV is a complication that can appear in up to 25% of cases after SC. An accurate diagnosis using SS OCT-A, with early treatment with aflibercept, led us to obtain optimal clinical and anatomical results.

Eplerenona, un nuevo tratamiento para un viejo problema: retinosis pigmentaria asociada a edema macular recalcitrante / Eplerenone, a new treatment for an old problem: Retinitis pigmentosa with recalcitrant macular edema

CASO CLÍNICO: Varón de 35 años, con antecedentes personales de retinosis pigmentaria, que presentó un edema macular quístico bilateral asociado a membrana epirretiniana bilateral resistente a tratamiento con acetazolamida oral y bevacizumab intravítreo. El tratamiento con eplerenona oral fue capaz de mejorar la agudeza visual y el grosor macular de este paciente. DISCUSIÓN: Se han propuesto numerosos tratamientos para el manejo del edema macular quístico asociado a retinosis pigmentaria, con resultados variables. El tratamiento con eplerenona oral podría ser una buena opción para el control de esta entidad

CASE REPORT: The case involves a 35-year-old man, with a history of retinitis pigmentosa, who presented with a bilateral cystoid macular oedema associated with bilateral epiretinal membrane, which was resistant to treatment with oral acetazolamide and intravitreal bevacizumab. The treatment with oral eplerenone was able to improve the visual acuity and macular thickness of this patient. DISCUSSION: A variety of treatments have been proposed for the management of cystoid macular oedema, associated with retinitis pigmentosa, with variable results. The treatment with oral eplerenone might be a good option for the control of this condition

Cochlear obliteration following a translabyrinthine approach and its implications in cochlear implantation.

The most frequent sequelae following a translabyrinthine approach for vestibular schwannoma resection is complete hearing loss on the affected side. Such patients could benefit from a cochlear implant, provided that two essential requisites are met before surgery: a preserved cochlear nerve and a patent cochlea to accommodate the electrode array. The goal of our study is to determine the prevalence and extent of cochlear ossification following a translabyrinthine approach. Postoperative MRI of 41 patients were retrospectively reviewed. Patients were classified according to the degree of cochlear obliteration into three groups (patent cochlea, partially obliterated cochlea and totally obliterated cochlea). The interval between surgery and the first MRI was studied as well as its relationship with the rate of cochlear ossification. At first postoperative MRI (mean interval of 20 months), 78% of patients showed some degree of cochlear ossification. Differences were found in the time interval between surgery and first MRI for each group, showing a smaller interval of time the patent cochlea group (p > 0.05). When MRI was performed before the first year after surgery, a larger rate of patent cochlea was found (p > 0.05). The present study suggests that cochlear ossification is a time-depending process, whose grounds are still to be defined.

A multiplex reverse transcription PCR and automated electronic microarray assay for detection and differentiation of seven viruses affecting swine.

Microarray technology can be useful for pathogen detection as it allows simultaneous interrogation of the presence or absence of a large number of genetic signatures. However, most microarray assays are labour-intensive and time-consuming to perform. This study describes the development and initial evaluation of a multiplex reverse transcription (RT)-PCR and novel accompanying automated electronic microarray assay for simultaneous detection and differentiation of seven important viruses that affect swine (foot-and-mouth disease virus [FMDV], swine vesicular disease virus [SVDV], vesicular exanthema of swine virus [VESV], African swine fever virus [ASFV], classical swine fever virus [CSFV], porcine respiratory and reproductive syndrome virus [PRRSV] and porcine circovirus type 2 [PCV2]). The novel electronic microarray assay utilizes a single, user-friendly instrument that integrates and automates capture probe printing, hybridization, washing and reporting on a disposable electronic microarray cartridge with 400 features. This assay accurately detected and identified a total of 68 isolates of the seven targeted virus species including 23 samples of FMDV, representing all seven serotypes, and 10 CSFV strains, representing all three genotypes. The assay successfully detected viruses in clinical samples from the field, experimentally infected animals (as early as 1 day post-infection (dpi) for FMDV and SVDV, 4 dpi for ASFV, 5 dpi for CSFV), as well as in biological material that were spiked with target viruses. The limit of detection was 10 copies/µl for ASFV, PCV2 and PRRSV, 100 copies/µl for SVDV, CSFV, VESV and 1,000 copies/µl for FMDV. The electronic microarray component had reduced analytical sensitivity for several of the target viruses when compared with the multiplex RT-PCR. The integration of capture probe printing allows custom onsite array printing as needed, while electrophoretically driven hybridization generates results faster than conventional microarrays that rely on passive hybridization. With further refinement, this novel, rapid, highly automated microarray technology has potential applications in multipathogen surveillance of livestock diseases.

Eplerenone, a new treatment for an old problem: Retinitis pigmentosa with recalcitrant macular edema. / Eplerenona, un nuevo tratamiento para un viejo problema: retinosis pigmentaria asociada a edema macular recalcitrante.

CASE REPORT: The case involves a 35-year-old man, with a history of retinitis pigmentosa, who presented with a bilateral cystoid macular oedema associated with bilateral epiretinal membrane, which was resistant to treatment with oral acetazolamide and intravitreal bevacizumab. The treatment with oral eplerenone was able to improve the visual acuity and macular thickness of this patient. DISCUSSION: A variety of treatments have been proposed for the management of cystoid macular oedema, associated with retinitis pigmentosa, with variable results. The treatment with oral eplerenone might be a good option for the control of this condition.

Hemangioma capilar retiniano yuxtapapilar bilateral: utilidad de aflibercept en el manejo de sus complicaciones / Bilateral juxtapapillary retinal capillary haemangioma: Usefulness of aflibercept in the management of its complications

Caso clínico: Varón de 45 años, con antecedentes personales de feocromocitoma suprarrenal, que presenta una hemorragia subretiniana yuxtapapilar en el ojo izquierdo y un pequeño tumor vascular asintomático en el ojo contralateral. Con los hallazgos mencionados, el paciente fue diagnosticado de hemangioma capilar retiniano bilateral en el contexto de una enfermedad de von Hippel Lindau y se pautó aflibercept intravítreo, con una buena evolución del cuadro. Discusión: Se han propuesto múltiples tratamientos para el manejo del hemangioma capilar retiniano yuxtapapilar, con unos resultados variables. El aflibercept intravítreo puede ser un tratamiento de utilidad, con un buen perfil de seguridad (AU)

Case report: A 45 year-old man with a history of adrenal phaeochromocytoma presented with a subretinal juxtapapillary haemorrhage on his left eye and a small asymptomatic vascular tumour in the contralateral eye. With the mentioned findings, the patient was diagnosed with bilateral retinal capillary haemangioma in the context of a von Hippel Lindau disease. Intravitreal aflibercept was prescribed, with a good outcome of the disease. Discussion: Many treatments have been proposed for the management of juxtapapillary retinal capillary haemangioma with variable results. Intravitreal aflibercept can be a useful treatment with a good safety profile (AU)

BIlateral juxtapapillary retinal capillary haemangioma: Usefulness of aflibercept in the management of its complications. / Hemangioma capilar retiniano yuxtapapilar bilateral: utilidad de aflibercept en el manejo de sus complicaciones.

CASE REPORT: A 45 year-old man with a history of adrenal phaeochromocytoma presented with a subretinal juxtapapillary haemorrhage on his left eye and a small asymptomatic vascular tumour in the contralateral eye. With the mentioned findings, the patient was diagnosed with bilateral retinal capillary haemangioma in the context of a von Hippel Lindau disease. Intravitreal aflibercept was prescribed, with a good outcome of the disease. DISCUSSION: Many treatments have been proposed for the management of juxtapapillary retinal capillary haemangioma with variable results. Intravitreal aflibercept can be a useful treatment with a good safety profile.

Fluorescent FYVE Chimeras to Quantify PtdIns3P Synthesis During Autophagy.

Autophagy is the major cellular process of degradation and is modulated by several signaling pathways. Phosphatidylinositol 3-kinase (PtdIns3K) class III (Vps34) and PtdIns3K class I regulate the autophagy pathway positively and negatively, respectively. Both classes of PtdIns3K participate in the synthesis of phosphatidylinositol 3-phosphate (PtdIns3P), which plays a crucial role in autophagosome biogenesis and membrane traffic. PtdIns3P is a membrane phospholipid that is associated with endogenous FYVE domain-containing proteins. Indeed, such interactions facilitate autophagosome fusion with lysosomes and subsequent cargo degradation. During starvation-induced autophagy, the expression of FYVE domain-containing proteins increases, and their binding to PtdIns3P is strengthened. Nonetheless, not all FYVE domain proteins are related to the induction of autophagy. This method report presents the quantification of PtdIns3P synthesis by using cells either transiently transfected with or stably expressing FYVE-dsRed.

Turnover of Lipidated LC3 and Autophagic Cargoes in Mammalian Cells.

Macroautophagy (usually referred to as autophagy) is the most important degradation system in mammalian cells. It is responsible for the elimination of protein aggregates, organelles, and other cellular content. During autophagy, these materials (i.e., cargo) must be engulfed by a double-membrane structure called an autophagosome, which delivers the cargo to the lysosome to complete its degradation. Autophagy is a very dynamic pathway called autophagic flux. The process involves all the steps that are implicated in cargo degradation from autophagosome formation. There are several techniques to monitor autophagic flux. Among them, the method most used experimentally to assess autophagy is the detection of LC3 protein processing and p62 degradation by Western blotting. In this chapter, we provide a detailed and straightforward protocol for this purpose in cultured mammalian cells, including a brief set of notes concerning problems associated with the Western-blotting detection of LC3 and p62.

Field-Deployable Reverse Transcription-Insulated Isothermal PCR (RT-iiPCR) Assay for Rapid and Sensitive Detection of Foot-and-Mouth Disease Virus.

Foot-and-mouth disease (FMD) is a highly contagious viral disease of cloven-hoofed animals, which can decimate the livestock industry and economy of countries previously free of this disease. Rapid detection of foot-and-mouth disease virus (FMDV) is critical to containing an FMD outbreak. Availability of a rapid, highly sensitive and specific, yet simple and field-deployable assay would support local decision-making during an FMDV outbreak. Here we report validation of a novel reverse transcription-insulated isothermal PCR (RT-iiPCR) assay that can be performed on a commercially available, compact and portable POCKIT™ analyser that automatically analyses data and displays '+' or '-' results. The FMDV RT-iiPCR assay targets the 3D region of the FMDV genome and was capable of detecting 9 copies of in vitro-transcribed RNA standard with 95% confidence. It accurately identified 63 FMDV strains belonging to all seven serotypes and showed no cross-reactivity with viruses causing similar clinical diseases in cloven-hoofed animals. The assay was able to identify FMDV RNA in multiple sample types including oral, nasal and lesion swabs, epithelial tissue suspensions, vesicular and oral fluid samples, even before the appearance of clinical signs. Clinical sensitivity of the assay was comparable or slightly higher than the laboratory-based real-time RT-PCR assay in use. The assay was able to detect FMDV RNA in vesicular fluid samples without nucleic acid extraction. For RNA extraction from more complex sample types, a commercially available taco™ mini transportable magnetic bead-based, automated extraction system was used. This assay provides a potentially useful field-deployable diagnostic tool for rapid detection of FMDV in an outbreak in FMD-free countries or for routine diagnostics in endemic countries with less structured laboratory systems.