Development of feed composition tables using a statistical screening procedure.

Millions of feed composition records generated annually by testing laboratories are valuable assets that can be used to benefit the animal nutrition community. However, it is challenging to manage, handle, and process feed composition data that originate from multiple sources, lack standardized feed names, and contain outliers. Efficient methods that consolidate and screen such data are needed to develop feed composition databases with accurate means and standard deviations (SD). Considering the interest of the animal science community in data management and the importance of feed composition tables for the animal industry, the objective was to develop a set of procedures to construct accurate feed composition tables from large data sets. A published statistical procedure, designed to screen feed composition data, was employed, modified, and programmed to operate using Python and SAS. The 2.76 million data received from 4 commercial feed testing laboratories were used to develop procedures and to construct tables summarizing feed composition. Briefly, feed names and nutrients across laboratories were standardized, and erroneous and duplicated records were removed. Histogram, univariate, and principal component analyses were used to identify and remove outliers having key nutrients outside of the mean ± 3.5 SD. Clustering procedures identified subgroups of feeds within a large data set. Aside from the clustering step that was programmed in Python to automatically execute in SAS, all steps were programmed and automatically conducted using Python followed by a manual evaluation of the resulting mean Pearson correlation matrices of clusters. The input data set contained 42, 94, 162, and 270 feeds from 4 laboratories and comprised 25 to 30 nutrients. The final database included 174 feeds and 1.48 million records. The developed procedures effectively classified by-products (e.g., distillers grains and solubles as low or high fat), forages (e.g., legume or grass-legume mixture by maturity), and oilseeds versus meal (e.g., soybeans as whole raw seeds vs. soybean meal expellers or solvent extracted) into distinct sub-populations. Results from these analyses suggest that the procedure can provide a robust tool to construct and update large feed data sets. This approach can also be used by commercial laboratories, feed manufacturers, animal producers, and other professionals to process feed composition data sets and update feed libraries.

Seasonal and spatial evolution of trihalomethanes in a drinking water distribution system according to the treatment process.

This paper comparatively shows the influence of four water treatment processes on the formation of trihalomethanes (THMs) in a water distribution system. The study was performed from February 2005 to January 2012 with analytical data of 600 samples taken in Aljaraque water treatment plant (WTP) and 16 locations along the water distribution system (WDS) in the region of Andévalo and the coast of Huelva (southwest Spain), a region with significant seasonal and population changes. The comparison of results in the four different processes studied indicated a clear link of the treatment process with the formation of THM along the WDS. The most effective treatment process is preozonation and activated carbon filtration (P3), which is also the most stable under summer temperatures. Experiments also show low levels of THMs with the conventional process of preoxidation with potassium permanganate (P4), delaying the chlorination to the end of the WTP; however, this simple and economical treatment process is less effective and less stable than P3. In this study, strong seasonal variations were obtained (increase of THM from winter to summer of 1.17 to 1.85 times) and a strong spatial variation (1.1 to 1.7 times from WTP to end points of WDS) which largely depends on the treatment process applied. There was also a strong correlation between THM levels and water temperature, contact time and pH. On the other hand, it was found that THM formation is not proportional to the applied chlorine dose in the treatment process, but there is a direct relationship with the accumulated dose of chlorine. Finally, predictive models based on multiple linear regressions are proposed for each treatment process.

Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention.

OBJECTIVE: To study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS). STUDY DESIGN: Prospective, observational, multicenter registry. Centralized follow-up included survival status and, if possible, mode of death and Katz index. SETTING: Transnational registry in Spain. SUBJECTS: We included 928 patients aged ≥80 years with severe symptomatic AS. INTERVENTIONS: Aortic-valve replacement (AVR), transcatheter aortic-valve implantation (TAVI) or conservative therapy. MAIN OUTCOME MEASURES: All-cause death. RESULTS: Mean age was 84.2 ± 3.5 years, and only 49.0% were independent (Katz index A). The most frequent planned management was conservative therapy in 423 (46%) patients, followed by TAVI in 261 (28%) and AVR in 244 (26%). The main reason against recommending AVR in 684 patients was high surgical risk [322 (47.1%)], other medical motives [193 (28.2%)], patient refusal [134 (19.6%)] and family refusal in the case of incompetent patients [35 (5.1%)]. The mean time from treatment decision to AVR was 4.8 ± 4.6 months and to TAVI 2.1 ± 3.2 months, P < 0.001. During follow-up (11.2-38.9 months), 357 patients (38.5%) died. Survival rates at 6, 12, 18 and 24 months were 81.8%, 72.6%, 64.1% and 57.3%, respectively. Planned intervention, adjusted for multiple propensity score, was associated with lower mortality when compared with planned conservative treatment: TAVI Hazard ratio (HR) 0.68 (95% confidence interval [CI] 0.49-0.93; P = 0.016) and AVR HR 0.56 (95% CI 0.39-0.8; P = 0.002). CONCLUSION: Octogenarians with symptomatic severe AS are frequently managed conservatively. Planned conservative management is associated with a poor prognosis.

The effect of routine hoof trimming on locomotion score, ruminating time, activity, and milk yield of dairy cows.

The objective of this study was to quantify the effect of hoof trimming on cow behavior (ruminating time, activity, and locomotion score) and performance (milk yield) over time. Data were gathered from a commercial dairy farm in Israel where routine hoof trimming is done by a trained hoof trimmer twice per year on the entire herd. In total, 288 cows spread over 6 groups with varying production levels were used for the analysis. Cow behavior was measured continuously with a commercial neck activity logger and a ruminating time logger (HR-Tag, SCR Engineers Ltd., Netanya, Israel). Milk yield was recorded during each milking session with a commercial milk flow sensor (Free Flow, SCR Engineers Ltd.). A trained observer assigned on the spot 5-point locomotion scores during 19 nighttime milking occasions between 22 October 2012 and 4 February 2013. Behavioral and performance data were gathered from 1wk before hoof trimming until 1wk after hoof trimming. A generalized linear mixed model was used to statistically test all main and interactive effects of hoof trimming, parity, lactation stage, and hoof lesion presence on ruminating time, neck activity, milk yield, and locomotion score. The results on locomotion scores show that the proportional distribution of cows in the different locomotion score classes changes significantly after trimming. The proportion of cows with a locomotion score ≥3 increases from 14% before to 34% directly after the hoof trimming. Two months after the trimming, the number of cows with a locomotion score ≥3 reduced to 20%, which was still higher than the baseline values 2wk before the trimming. The neck activity level was significantly reduced 1d after trimming (380±6 bits/d) compared with before trimming (389±6 bits/d). Each one-unit increase in locomotion score reduced cow activity level by 4.488 bits/d. The effect of hoof trimming on ruminating time was affected by an interaction effect with parity. The effect of hoof trimming on locomotion scores was affected by an interaction effect with lactation stage and tended to be affected by interaction effects with hoof lesion presence, indicating that cows with a lesion reacted different to the trimming than cows without a lesion did. The results show that the routine hoof trimming affected dairy cow behavior and performance in this farm.

Cost analysis of next-generation imaging in high-risk prostate cancer staging.

INTRODUCTION AND OBJECTIVE: Next-generation imaging (NGI) tests, such as choline PET/CT and PSMA PET, have shown to increase sensitivity in the detection of nodal and metastatic disease in prostate cancer. However, their use implies an increase in diagnostic costs compared to conventional imaging (CI) tests such as CT and bone scan. The aim of our study was to determine which diagnostic pathway is more cost-effective in high-risk prostate cancer. MATERIAL AND METHOD: Cost-effectiveness analysis of the available imaging tests (CI, Choline/PSMA PET) for the staging of high-risk prostate cancer. Sensitivity and specificity were estimated based on published evidence, and costs were collected from the Management Department. In order to carry out a cost-effectiveness analysis, five diagnostic pathways were proposed estimating the accurate diagnoses. RESULTS: PSMA PET was the most accurate diagnostic option. The CI diagnostic workup was the most economical and CI+PSMA the most expensive. Analyzing the diagnostic cost-effectiveness ratio, CI+PSMA proved to be the most expensive (€5627.30 per correct diagnosis) followed by PET PSMA (€4987.11), choline (€4599.84) and CI (€4444.22). CONCLUSIONS: PSMA PET is the most accurate strategy in staging distant disease in patients with high-risk prostate cancer. Radiotracer uptake tests such as CI have been shown to be the most cost-effective option, followed by choline and PSMA.

Analysis of individual classification of lameness using automatic measurement of back posture in dairy cattle.

Currently, diagnosis of lameness at an early stage in dairy cows relies on visual observation by the farmer, which is time consuming and often omitted. Many studies have tried to develop automatic cow lameness detection systems. However, those studies apply thresholds to the whole population to detect whether or not an individual cow is lame. Therefore, the objective of this study was to develop and test an individualized version of the body movement pattern score, which uses back posture to classify lameness into 3 classes, and to compare both the population and the individual approach under farm conditions. In a data set of 223 videos from 90 cows, 76% of cows were correctly classified, with an 83% true positive rate and 22% false positive rate when using the population approach. A new data set, containing 105 videos of 8 cows that had moved through all 3 lameness classes, was used for an ANOVA on the 3 different classes, showing that body movement pattern scores differed significantly among cows. Moreover, the classification accuracy and the true positive rate increased by 10 percentage units up to 91%, and the false positive rate decreased by 4 percentage units down to 6% when based on an individual threshold compared with a population threshold.

Lameness detection based on multivariate continuous sensing of milk yield, rumination, and neck activity.

The objective of this study was to develop and validate a mathematical model to detect clinical lameness based on existing sensor data that relate to the behavior and performance of cows in a commercial dairy farm. Identification of lame (44) and not lame (74) cows in the database was done based on the farm's daily herd health reports. All cows were equipped with a behavior sensor that measured neck activity and ruminating time. The cow's performance was measured with a milk yield meter in the milking parlor. In total, 38 model input variables were constructed from the sensor data comprising absolute values, relative values, daily standard deviations, slope coefficients, daytime and nighttime periods, variables related to individual temperament, and milk session-related variables. A lame group, cows recognized and treated for lameness, to not lame group comparison of daily data was done. Correlations between the dichotomous output variable (lame or not lame) and the model input variables were made. The highest correlation coefficient was obtained for the milk yield variable (rMY=0.45). In addition, a logistic regression model was developed based on the 7 highest correlated model input variables (the daily milk yield 4d before diagnosis; the slope coefficient of the daily milk yield 4d before diagnosis; the nighttime to daytime neck activity ratio 6d before diagnosis; the milk yield week difference ratio 4d before diagnosis; the milk yield week difference 4d before diagnosis; the neck activity level during the daytime 7d before diagnosis; the ruminating time during nighttime 6d before diagnosis). After a 10-fold cross-validation, the model obtained a sensitivity of 0.89 and a specificity of 0.85, with a correct classification rate of 0.86 when based on the averaged 10-fold model coefficients. This study demonstrates that existing farm data initially used for other purposes, such as heat detection, can be exploited for the automated detection of clinically lame animals on a daily basis as well.

SEVERE NEAR REFLEX SPASM IN A HEALTHY TEENAGER. A CASE REPORT.

INTRODUCTION: Spasm of the near reflex usually includes accommodative spasm, esophoria/tropia, and different degrees of miosis. Patients usually refer to distance blurred and fluctuating vision, ocular discomfort, and headaches. The diagnosis is established with refraction with and without cycloplegia; most of the cases have a functional etiology. However, some cases require neurological conditions to be ruled out; cycloplegics have an important diagnostic and therapeutic role. PURPOSE: To describe a case of bilateral severe accommodative spasm in a healthy 14-year-old teenager. CASE PRESENTATION: A 14-year-old boy with progressive diminished visual acuity attended for YSP consultation. The diagnosis of bilateral spasm of the near reflex was made, based on a gap refraction of 9.75 D between retinoscopy with and without cycloplegia and esophoria with normal keratometry and axial length. The spasm was eliminated with 2 drops of cycloplegic in each eye separated by 15 days; no clear etiology was found other than the start of school. CONCLUSION: Clinicians should be aware of pseudomyopia, especially in children with acute changes in visual acuity, who are usually exposed to myopigenic environmental factors that induce overstimulation of the parasympathetic third cranial nerve's innervation.

VISUAL OUTCOMES, CONTRAST SENSITIVITY, AND SATISFACTION WITH MULTIFOCAL INTRAOCULAR LENS BLENDED TECHNIQUE: LATE MID-TERM RESULTS.

PURPOSE: To describe clinical visual outcomes, spectacle independence, and patient satisfaction after cataract surgery with blending implantation of ReSTOR (Alcon laboratories) multifocal intraocular lenses. MATERIAL AND METHODS: A single-arm, non-randomized prospective study assessed patients undergoing cataract surgery with ReSTOR® +2.50 intraocular lens in the dominant eye and +3.00 add in the fellow eye between January 2015 to January 2020. RESULTS: In total, 47 patients (94 eyes) were enrolled, 28 women and 19 men. The average age at surgery time was 64 ±8 years, average postoperative follow-up was 45.4 ±7.0 months, with a minimum of 18.9 months. Postoperative binocular uncorrected distance visual acuity (UDVA) was on average 0.07 logMar (Snellen 20/24), uncorrected binocular intermediate visual acuity at 65 cm was 0.07 logMar (20/24), uncorrected binocular near visual acuity at 40 cm was 0.06 logMar (20/23). Contrast sensitivity under photopic and scotopic conditions, with and without glare, remained at the upper limit of normality. 98% of patients were quite satisfied or very satisfied. 87% did not require glasses for any activities, either at distant vision, nor at near vision. CONCLUSIONS: Cataract surgery with ReSTOR® IOL blended vision showed medium-term satisfactory visual results, achieving spectacle independence and a high level of satisfaction.

Determination of Corneal Power after Refractive Surgery with Excimer Laser: A Concise Review.

Refractive surgery with excimer laser has been a very common surgical procedure worldwide during the last decades. Currently, patients who underwent refractive surgery years ago are older, with a growing number of them now needing cataract surgery. To establish the power of the intraocular lens to be implanted in these patients, it is essential to define the true corneal power. However, since the refractive surgery modified the anterior, but not the posterior surface of the cornea, the determination of the corneal power in this group of patients is challenging. This article reviews the different sources of error in finding the true corneal power in these cases, and comments on several approaches, including the clinical history method as described originally by Holladay, and a modified version of it, as well as new alternatives based on corneal tomography, using devices that are able to measure the actual anterior and posterior corneal curvatures, which have emerged in recent years to address this issue.

Cystoid Macular Edema after an uncomplicated Gonioscopy- Assisted Transluminal Trabeculotomy on a previously vitrec- tomized patient.

Purpose: The main purpose of this study was to report a case of cystoid macular edema (CME) after gonioscopy-assisted transluminal trabeculotomy (GATT). Methods: We describe the case of a 73-year-old woman with ocular hypertension and history of cataract surgery combined with posterior vitrectomy and epiretinal membrane peeling 2 years before, who developed CME after uncomplicated GATT procedure. Results: Uneventful GATT surgery was performed in an eye with ocular hypertension. A month after GATT surgery, the patient com-plained of blurry vision. Best corrected visual acuity had deteriorated from 20/20 on Snellen chart, to 20/70. The patient was diagnosed with CME. Treatment with topical non-steroidal anti-inflammatory drug (NSAID) and topical corticosteroids for one month, and oral carbonic anhydrase inhibitor for one week achieved a total CME regression with recovery of a normal macular and foveal architecture. Conclusions: Surgery-induced CME may occur following stand-alone microinvasive glaucoma surgery (MIGS) such as GATT. It would be worthwhile to conduct studies to explore whether the prophylactic use of NSAID and corticosteroids is justified.

Estimation of ocular axial length with optometric parameters is not accurate.

Myopia is a worldwide major public concern, aside from the visual disturbance needing optical correction, myopia may be associated with open angle glaucoma, retinal detachment and myopic maculopathy. The higher the myopia the higher the risk for retinal associated comorbidities, and the axial length is the more important measure to estimate risk of visual impairment. Recently a formula to predict axial length using spherical equivalent and keratometry was proposed, with the intention of categorizing the risk of visual impairment with Tideman et al. classification. PURPOSE: To evaluate the accuracy of an axial length prediction formula in a Colombian population 8-17 years old. METHODS: Children from MIOPUR study with optical biometer axial length measure (AL), manifest refraction and keratometry were included in the analysis. Predicted axial length (PAL) was calculated with the prediction formula. A Bland-Altman assessment was conducted, and the concordance correlation coefficient was measured. Proposed classification of AL to establish risk of visual loss was used with measured AL and with PAL. The percentage of eyes misclassified was then established. RESULTS: A total of 2129 eyes were included in the analysis. Mean difference of axial length (actual AL minus PAL) was -0.516 mm (-1.559 mm - 0.528 mm). Concordance correlation coefficient (CCC) of 0.656 (IC95 0.636-0.675) was found between the real AL and PAL. PAL differed from measured AL by 1 mm or more in 16.58 %, and by 2 mm or more, in 0.61 % of the eyes. In myopic eyes, PAL was in average 0.426 mm longer than the AL actually measured with CCC of 0.714 (IC95 0.666-0.761). PAL differed from measured AL by 1 mm or more in 21.92 %, and by 2 mm or more, in 0.45 % of the myopic eyes. The study revealed that 15.03 % of all eyes, and 29.81 % of myopic eyes, were misclassified when PAL was used. CONCLUSIONS: The proposed axial length prediction formula was not accurate, and it did not adequately classify risk of visual impairment in myopic eyes in a group of Colombian children. We consider that it is not possible to predict the axial length based only on optometric data, such as the corneal radius of curvature and the spherical equivalent. This is very possibly related to the variability of crystalline lens power within a population.

DETERMINATION OF FACTORS ASSOCIATED WITH LONG-TERM ENDOTHELIAL LOSS AND REFRACTIVE RESULT IN PATIENTS WITH ARTISAN PHAKIC LENS.

PURPOSE: To determine the changes in endothelial cell density, refractive results, and risk factors associated with endothelial loss in patients with irisclaw phakic intraocular lenses for myopia/myopic astigmatism (Artisan). METHODOLOGY: Data collection was obtained from an existing database with information on patients with a phakic Artisan lens implant between 1998 and 2011 at the Virgilio Galvis Ophthalmology Centre, with at least 5 years of follow-up. As a second stage, an analysis was carried out to identify the change in endothelial cell density and its potential associated factors. RESULTS: A total of 80 eyes with myopic errors were included with a follow-up of 11.9 + 3.48 years. The percentage of total loss of endothelial cells was greater than 25% of the preoperative density in 43.8% of the eyes. A postoperative annual loss > 1.6% was found in 47.0% of the eyes with that information available. 41 eyes (51%) had final endothelial density < 2000 cells/mm2, and 7 (8.8%) eyes had endothelial cell density < 1000 cells/mm2. Among the variables studied, no associated factors for long-term endothelial loss were found. During the course of the study, 8 (10%) phakic intraocular lenses were explanted, including 3 with accelerated endothelial loss, and another 2 with cataract associated and a significantly low endothelial density. The last mean spherical equivalent was -0.81 (±1.01 D), and the final uncorrected distance visual acuity was 0.45 logMar (Snellen 20/56). CONCLUSION: Artisan-type phakic lenses are a good alternative for the correction of high myopic defects, with predictable refractive results in the long term. However, there is an increased loss of endothelial cells in the long term in a high percentage of patients. Strict postoperative follow-up, including endothelial evaluation, is required, and further studies are warranted.

[Predictors of the duration of post-traumatic amnesia following traumatic brain injury]. / Variables predictoras de la duración de la amnesia postraumática tras un traumatismo craneoencefálico.

INTRODUCTION: The duration of post-traumatic amnesia (PTA) helps estimate the level of recovery following traumatic brain injury (TBI). Yet, little information is available about which sociodemographic and clinical variables influence its duration. This study aims to identify them and create a predictive model that makes it possible to estimate the time it takes for a patient to emerge from PTA. PATIENTS AND METHODS: The sample consisted of 40 adult patients with PTA admitted to a neurorehabilitation centre. A total of 89.7% had suffered a severe TBI, whereas the remaining 10.3% had had a moderate TBI. Cognitive status was assessed using the Galveston Orientation and Amnesia Test (GOAT) - a scale for determining at what point a patient can be considered to be emerging from PTA. RESULTS: A regression equation was found (F = 8.511; p < 0.001; R2 = 0.415), in which the following variables (ranked in order of importance) explained 41.5% of the variability observed in the duration of PTA: a) GOAT administered on arrival at the neurorehabilitation centre; b) years of formal education of the patient; and c) days with PTA prior to admission to the neurorehabilitation centre. The equation derived was as follows: 104.284 + (-0.708 x GOAT-initial) + (-4.124 x years formal education) + (0.219 x hospital acute-APT). CONCLUSIONS: The time it takes for a patient to emerge from PTA is conditioned by the score obtained in the first GOAT administered on admission to the neurorehabilitation centre, their level of education, and the number of days elapsed with PTA between occurrence of the TBI and admission to the neurorehabilitation centre.

TITLE: Variables predictoras de la duración de la amnesia postraumática tras un traumatismo craneoencefálico.Introducción. La duración de la amnesia postraumática (APT) ayuda a estimar el nivel de recuperación tras un traumatismo craneoencefálico (TCE). Sin embargo, apenas se dispone de información sobre qué variables sociodemográficas y clínicas influyen en su duración. Este estudio pretende identificarlas y crear un modelo predictivo que permita estimar el tiempo que un paciente tarda en emerger de la APT. Pacientes y métodos. La muestra estaba formada por 40 pacientes adultos en APT ingresados en un centro neurorrehabilitador. El 89,7% había sufrido un TCE grave; el 10,3% restante, un TCE moderado. Su estado cognitivo se valoró mediante el Galveston Orientation and Amnesia Test (GOAT) ­escala que permite determinar en qué momento se puede considerar que un paciente emerge de la APT­. Resultados. Se encontró una ecuación de regresión (F = 8,511; p menor de 0,001; R2 = 0,415), en la que las siguientes variables (clasificadas por su orden de importancia) explicaron el 41,5% de la variabilidad observada en la duración de la APT: a) GOAT administrado a la llegada al centro neurorrehabilitador; b) años de formación reglada del paciente; y c) días que estuvo en APT antes de ingresar en el centro neurorrehabilitador. La ecuación de regresión derivada fue la siguiente: 104,284 + (­0,708 × GOAT-inicial) + (­4,124 × años formación reglada) + (0,219 × APT-hospital agudos). Conclusiones. El tiempo que un paciente tarda en emerger de la APT está condicionado por la puntuación que obtiene en el primer GOAT administrado al ingresar en el centro neurorrehabilitador, el nivel de estudios, y los días que permanece en APT entre el momento del TCE y el ingreso en el centro neurorrehabilitador.

[Renal cell carcinoma metastatic to the duodenum and Vater ampulla: report of two cases]. / Metástasis de cáncer renal a duodeno y ámpula de Vater; informe de dos casos.

These two cases of metastatic renal cell carcinoma to the duodenum, adds to the limited experience reported in the literature. Both patients initially presented with upper gastrointestinal bleeding years after they had a nephrectomy. After an extensive diagnostic work-up, they were both submitted to a classic pancreaticoduodenectomy (Whipple's procedure). Only the final histopathological report revealed the diagnosis. Basic recommendations on diagnosis and treatment are discussed in this article and a review of the literature is given.

SPONTANEOUS REGRESSION OF A PRIMARY IRIS STROMAL CYST IN A PATIENT WITH KERATOCONUS. A CASE REPORT.

PURPOSE: To report the rare case of a 29-year-old male with a history of keratoconus, who presented with a primary iris stromal cyst which eventually showed spontaneous regression. METHODS: Description of the clinical findings in the case of a 29-year-old male with a prior history of keratoconus, but no eye surgery or trauma, who consulted for an iris cyst in the left eye, diagnosed 9 months earlier. CASE REPORT: Slit-lamp examination revealed mild dyscoria, and a large cyst in the inferior quadrant of the iris. Ultrasound biomicroscopy and anterior segment optical coherence tomography of the left eye confirmed the presence of a giant iris cyst with thin walls, in contact with the corneal endothelium. Corneal endothelial cell density in the inferior cornea (close to the cyst) was 1805 cells/mm2 and 2066 cells/mm2 in the central area. After considering the risk of anterior chamber epithelial downgrowth following any surgical procedure of the cyst, the patient received conservative management. In the following months, the patient presented with 3 episodes of anterior uveitis, managed with topical corticosteroids. Finally, at approx. 21 months after the initial diagnosis, the cyst presented spontaneous regression. Anterior segment optical coherence tomography confirmed the absence of fluid inside the cyst remnants and the final endothelial cell densities evidenced endothelial cell loss (inferior cornea 738 cells/mm2 and central cornea 1605 cells/mm2). CONCLUSION: Conservative management should be considered in patients with cysts that show slow progression and are distant from the visual axis, in order to minimise the risk of complications following any surgical procedure of the cyst. In addition, the present case is one of the few of primary stromal iris cysts with spontaneous regression reported in the literature.

PHOTOREFRACTIVE SURGERY WITH EXCIMER LASER AND ITS IMPACT ON THE DIAGNOSIS AND FOLLOW-UP OF GLAUCOMA. A REVIEW.

Excimer laser refractive surgery is a procedure performed worldwide to solve refractive errors and reduce dependence on glasses or contact lenses. There has been an increase in the number of procedures performed around the world. Myopia is the most common indication for corneal photorefractive surgery. Myopic patients have a higher risk of developing some type of glaucoma in their lifetime, such as primary open-angle glaucoma and others. Refractive surgery ablates central corneal stromal tissue, altering its thickness and biomechanics, which in turn makes it difficult to accurately measure intraocular pressure (IOP), since it underestimates it. This underestimation of IOP may delay the diagnosis of de novo glaucoma in patients with a history of refractive surgery. Each patient who wishes to undergo corneal refractive surgery should undergo a thorough glaucoma examination in order to monitor and detect the possible development and / or progression of glaucoma. A very useful practical approach is to perform a series of IOP measurements before and after surgery, when the eye is already stable, and the difference between the averages of the two sets of readings can then be used as a personalised correction factor for postoperative IOP monitoring in that eye. Also, if there is any suspicion of a possible glaucoma, paraclinical tests, such as coherent optical tomography of the retinal nerve fibre layer (RNFL), visual fields and photos of the optic nerve should be requested. All this data prior to refractive surgery should be provided to these patients, so that they can save it and give it to their treating ophthalmologists in the future.

Induction of glucocorticoid receptor-beta expression in epithelial cells of asthmatic airways by T-helper type 17 cytokines.

BACKGROUND: Corticosteroid insensitivity in asthmatics is associated with an increased expression of glucocorticoid receptor-beta (GR-beta) in many cell types. T-helper type 17 (Th17) cytokine (IL-17A and F) expressions increase in mild and in difficult-to-treat asthma. We hypothesize that IL-17A and F cytokines alone or in combination, induce the expression of GR-beta in bronchial epithelial cells. OBJECTIVES: To confirm the expression of the GR-beta and IL-17 cytokines in the airways of normal subjects and mild asthmatics and to examine the effect of cytokines IL-17A and F on the expression of GR-beta in bronchial epithelial cells obtained from normal subjects and asthmatic patients. METHODS: The expression of IL-17A and F, GR-alpha and GR-beta was analysed in bronchial biopsies from mild asthmatics and normal subjects by Q-RT-PCR. Immunohistochemistry for IL-17 and GR-beta was performed in bronchial biopsies from normal and asthmatic subjects. The expression of IL-6 in response to IL-17A and F and dexamethasone was determined by Q-RT-PCR using primary airway epithelial cells from normal and asthmatic subjects. RESULTS: We detected significantly higher levels of IL-17A mRNA expression in the bronchial biopsies from mild asthmatics, compared with normal. GR-alpha expression was significantly lower in the biopsies from asthmatics compared with controls. The expression of IL-17F and GR-beta in biopsies from asthmatics was not significantly different from that of controls. Using primary epithelial cells isolated from normal subjects and asthmatics, we found an increased expression of GR-beta in response to IL-17A and F in the cells from asthmatics (P< or =0.05). This effect was only partially significant in the normal cells. Dexamethasone significantly decreased the IL-17-induced IL-6 expression in cells from normal individuals but not in those from asthmatics (P< or =0.05). CONCLUSION: Evidence of an increased GR-beta expression in epithelial cells following IL-17 stimulation suggests a possible role for Th17-associated cytokines in the mechanism of steroid hypo-responsiveness in asthmatic subjects.

[Level of knowledge about insulinization by Primary Care physicians and its impact on diabetes control]. / Grado de conocimiento de insulinización por los médicos de atención primaria y su repercusión en el control de la diabetes.

OBJECTIVE: To determine the level of knowledge and current management of starting insulin treatment by Primary Care physicians, and its impact on metabolic control. MATERIALS AND METHODS: A mainly qualitative exploratory sequential study, with a phenomenological approach, followed by a quantitative phase. The study included 37 primary care physicians from the Andalusian Health Service. Socio-demographic and clinical care variables were analysed. Univariate and bivariate analyses were performed. RESULTS: There was a wide variability between Primary Care physicians in the level of knowledge of treatment with insulins (low knowledge: 13.5%; medium knowledge: 59.5%; high knowledge: 27.0%). There was a direct relationship between the level of knowledge and the attainment of HbA1c goals (as the level of knowledge increased, the metabolic control improved). The most common basal insulins prescribed were insulin glargine U-100 (56.8%), followed by insulin glargine U-300 (29.7%), and neutral protamine hagedorn (NPH) insulin (8.1%). There was a trend to show a different prescription pattern with basal insulins (as the level of knowledge decreased, the prescription of mixed and NPH insulins increased). More than one-third (35.1%) of primary care physicians did not know more complex patterns of treatment with insulins. CONCLUSIONS: Only 27% of Primary Care physicians had a high knowledge about treatment with insulins. There was a direct relationship between the level of knowledge about insulins and glycaemic control. It is necessary to improve the knowledge about insulin therapy in order to optimise metabolic control and reduce the risk of complications.

Effervescence-assisted spiral hollow-fibre liquid-phase microextraction of trihalomethanes, halonitromethanes, haloacetonitriles, and haloketones in drinking water.

A new analytical method was optimized to determine 18 disinfection by-products (DBPs) in drinking water, including four different chemical groups. For this purpose, spiral-shaped hollow-fibre liquid phase microextraction with 1-octanol as the acceptor solvent assisted by effervescence was applied using a homemade supporting device that was specifically designed for this application. The device was printed in a 3D printer and allows for an increased fibre surface even with a low sample volume, which significantly facilitates the extraction. The samples were analysed by gas chromatography coupled to both an electron capture detector and a mass spectrometer for the quantification and unequivocal identification of the analytes, respectively. Effervescence was generated using citric acid and bicarbonate at a molar ratio 1:2, which significantly improves the extraction efficiency and reduces mechanical operations, since stirring and modifiers are not required. The results showed enrichment factors ranging from 13.1 to 140.1. Satisfactory recoveries (80-113 %) were obtained, with relative standard deviations from 3 to 15 % and good linearity. The detection limits (ng L-1) ranged from 10 to 35 (trihalomethanes), 12 to 220 (halonitromethanes), 17 to 79 (haloacetonitriles) and 10 to 16 (haloketones). The applicability of the method was assessed in 6 local water distribution systems.