Comparability of input parameters in the German Retina.net ROP registry and the EU-ROP registry - An exemplary comparison between 2011 and 2021

PURPOSE

The German Retina.net ROP registry and its Europe-wide successor, the EU-ROP registry, collect data from patients treated for ROP. This analysis compares input parameters of these two registries to establish a procedure for joint analyses of different registry data using exemplary datasets from the two registries.

METHODS

Exemplary datasets from the two databases over a 1-year period each (German Retina.net ROP Registry, 2011, 22 infants; EU-ROP Registry, 2021, 44 infants) were compared. The parameters documented in the two databases were aligned and analysed regarding demographic parameters, treatment modalities, complications within first 24 h and retreatments.

RESULTS

The current analysis showed that data can be aligned for joint analyses with some adjustments within the data structure. The registry with more detailed data collection (EU-ROP) needs to be reduced regarding granularity in order to align the different registries, as the registry with lower granularity determines the level of analyses that can be performed in a comparative approach. In the exemplary datasets, we observed that the overall most common ROP severity in both registries was zone II, 3+ (2011: 70.5%; 2021: 65%), with decreasing numbers of clock hours showing preretinal neovascularisations (2011: 10-12 clock hours in 29% of cases, 2021: 4-6 clock hours in 38%). The most prevalent treatment method was laser coagulation in 2011 (75%) and anti-VEGF therapy in 2021 (86.1%). Within the anti-VEGF group, all patients were treated with bevacizumab in 2011 and with ranibizumab in 2021. Retreatment rates were comparable in 2011 and 2021.

CONCLUSION

Data from two different ROP registries can be aligned and jointly analysed. The analysis reveals a paradigm shift in treatment modalities, from predominantly laser to anti-VEGF, and within the anti-VEGF group from bevacizumab to ranibizumab in Germany. In addition, there was a trend towards earlier treatment in 2021.

Impact of Caffeine Intake Strategies on Heart Rate Variability During Post-Exercise Recovery: A Systematic Review and Meta-Analysis

OBJECTIVES

The objective of this systematic review and meta-analysis is to evaluate the influence of caffeine (CAF) intake strategies, taking into account their form, timing, and dosage, on heart rate variability (HRV) indices in the post-exercise recovery period.

METHODS

The meta-analysis adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and is registered in the PROSPERO database (CRD42023425885). A comprehensive literature search was carried out across MEDLINE, Web of Science, LILACS, and SCOPUS, concluding in May 2023. We concentrated on randomized clinical trials comparing CAF supplementation effects to placebo on HRV indices post-exercise in active adults aged 18 and above. The primary endpoint was the assessment of HRV indices, measured both prior to and following exercise.

RESULTS

Of the 10 studies included, 7 were used for the meta-analysis, and all contributed to the systematic review. The research explored a variety of CAF strategies, spanning different forms (capsule, drink, gum), times (10, 45, 60 min) and doses (2.1 to 6.0 mg/kg). The outcomes revealed no substantial variations between the placebo and CAF conditions in terms of both the square root of the average of successive squared differences between adjacent RR intervals (RMSSD) (standardized mean difference (SMD) -0.03, 95% CI -0.265 to 0.197, p=0.77) and high frequency (HF) index (SMD -0.061, 95% CI -0.272 to 0.150, p=0.57). Furthermore, metaregression analysis, employing a fixed-effects model and accounting for the administered CAF doses, revealed no significant correlation between caffeine doses and HRV indices (p>0.05).

CONCLUSION

In conclusion, there is moderate-certainty evidence suggesting that different CAF intake strategies, encompassing aspects such as form, time, and dose, do not have a significant impact on HRV indices recovery post-exercise (i.e., vagal modulation).

[Long-term outcome of macular neovascularization secondary to choroidal osteoma with and without intravitreal anti-VEGF(vascular endothelial growth factor)- treatment]

BACKGROUND

Choroidal osteoma (CO) is a benign ossifying ocular tumor, which is unilateral in most cases. The CO may cause severe visual impairment, especially in the case of a secondary macular neovascularization (MNV).

OBJECTIVE

Based on a case series of patients with MNV secondary to CO, the variability of the clinical course with and without intravitreal anti-vascular endothelial growth factor (VEGF) treatment is presented.

METHODS

All patients diagnosed with secondary MNV due to CO between 2007 and 2023 were retrospectively assessed with respect to the clinical course.

RESULTS

In this study 7 eyes of 5 patients (4 women, 1 man) were diagnosed with secondary MNV due to CO. Intravitreal anti-VEGF treatment was carried out in 2 patients with unilateral MNV and 1 patient was treated in both eyes for bilateral MNV. In another case with bilateral MNV, only 1 eye was treated because of fibrosis in the other eye. A further case with unilateral CO and MNV scars at the initial diagnosis was left untreated. Overall, in 3 out of 5 eyes treated with intravitreal VEGF inhibition stabilization or improvement of visual acuity could be achieved.

CONCLUSION

In our case series intravitreal anti-VEGF treatment attained a functional stabilization or improvement in 3 out of 5 treated eyes. In one case of CO-associated MNV fibrosis rapidly developed without treatment. Therefore, the clarification for patients with CO about the lifelong risk for development of a secondary MNV is essential in individual cases for early treatment. As no standardized treatment scheme for intravitreal VEGF antibodies for CO-related MNV exists, the treatment is planned on an individual basis.

Plant stem cell extract from Coffea canephora shows antioxidant, anti-inflammatory, and skin regenerative properties mediated by suppression of nuclear factor-κB

Plant cell cultures have become a promising production platform of bioactive compounds for biomedical and cosmetic uses in the last decades. However, the success so far has been limited. The study aimed to evaluate the effectiveness of this unique biotechnology process to obtain a bioactive stem cell extract of Coffea canephora (SCECC) with antioxidant, anti-inflammatory, and regenerative properties. Total phenolic and flavonoid contents were determined in the SCECC by spectrophotometry. The chemical composition of the extracts was characterized by mass spectrometry. Antioxidant activity was evaluated using the colorimetric methods of free radical scavenging 2,2'-azinobis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS) and the ferric reducing ability of plasma (FRAP). The anti-inflammatory activity was determined in lipopolysaccharide-stimulated RAW 264.7 macrophages through the production of superoxide anion (O2•-), nitric oxide (NO), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and the activity of nuclear factor kappa B (NF-κB). Moreover, the ability of SCECC to stimulate the proliferation and migration of fibroblasts was assessed. Five compounds were tentatively identified, two flavonoids, two phenolic acids, and one sugar. High phenolic content and antioxidant activity were observed in the SCECC. SCECC promoted the proliferation and migration of fibroblasts and suppressed the pro-inflammatory mediators O2•-, NO, TNF-α, and IL-6 in a dose-dependent manner. Moreover, SCECC inhibited the NF-κB transcription factor. Therefore, we obtained evidence that the extract from C. canephora stem cells can be used as a natural agent against skin damage. Hence, it could be of interest in cosmetics for preventing skin aging.

Unexplained visual loss after primary pars-plana-vitrectomy with silicone oil tamponade in fovea-sparing retinal detachment

BACKGROUND

To investigate the incidence and clinical characteristics of unexplained visual loss in patients with fovea-sparing rhegmatogenous retinal detachment (RRD) during or after silicone oil (SO) tamponade.

METHODS

The medical charts of all patients with macula-on RRDs, who underwent pars-plana-vitrectomy (ppV) with SO tamponade were retrospectively assessed regarding unexplained visual loss (UVL) of ≥ 3 Snellen lines and alterations on optical coherence tomography (OCT) during or after SO tamponade. The clinical data analysed included visual acuity, surgical parameters, OCT images, duration of SO tamponade and the time point of visual decline. Cases with re-detachment or secondary causes of visual loss such as SO emulsification, epiretinal membranes or macular edema were excluded.

RESULTS

Over a 15-year-period, 22 cases with macula-on RRD, which had primarily been treated with ppV and SO tamponade, met the inclusion criteria. In most eyes (n = 20; 91%), the RRD was caused by a giant retinal tear (GRT). In 11 of these 22 cases (50%), best-corrected visual acuity (BCVA) had dropped by at least 3 lines for no apparent reason. In these 11 cases, mean preoperative logMAR BCVA was 0.2 (SD 0.13; range 0-0.5), equal to Snellen's VA of 0.63, and mean postoperative logMAR BCVA 1.0 (SD 0.24; range 0.5-1.3), equal to Snellen's VA of 0.10. Visual decline occurred about 12 weeks postoperatively (SD 6.2; range 3-20 ) and comprised 8 lines (SD 2.3; range -11 to -4). SO was removed on average 139 (SD 50.0; range 88-271) days after the first ppV. In 9 cases visual decline occurred while the SO was in-situ. In 2 patients, BCVA decline was noted 2 weeks after SO removal. In all eyes, preoperative central foveal thickness (CFT) was 254 μm (SD 24.2), which decreased to 224 μm (SD 29.6) during SO tamponade and increased to 247 μm (SD 29.2) after SO removal, irrespective of the presence of UVL. The mean follow-up time was 20 months (SD 30.6) after SO removal.

CONCLUSION

UVL after SO tamponade for macula-on RRD is more frequent than expected. The incidence in our case series was 50%. The mechanism of this phenomenon is still unknown. In general, vitreoretinal surgeons should thoroughly question the need for SO tamponade, inform their patients of possible UVL and remove SO as early as possible.

TRIAL REGISTRATION

The study was approved by the local ethics committee on 6th of May 2022 (Ethikkommission der Universität Regensburg, Votum 22-2925-104) and was conducted in accordance with the ethical standards of the Declaration of Helsinki.

Changes in Inpatient and Day Patient Treatment during the COVID-19 Pandemic: Insights and Outlook Results of a Study in an Adult Psychiatry Clinic in Germany

Introduction

Possible effects of pandemic-related restrictions and adjustments in psychiatric treatment are currently the focus of interest. This article addresses developments in this respect in our clinic.

Objectives

Changes in clinical practice that occurred during the COVID-19 pandemic are to be analysed with regard to possible risks for affected patients.

Methods

A clinic-internal analysis was carried out, focusing on comparing a period during the COVID-19 pandemic (01.11.2020-30.04.2021) and a pre-pandemic reference period (01.11.2018-30.04.2019).

Results

Following trends were observed during the pandemic period: a. Day patient treatment: - The treatment volume fell to 44%. Notable reductions in the number of treatment cases with main diagnoses [ICD-10] F10.- and F30-F39 by >65% were measured. b. Inpatient treatment: - no significant changes regarding socio-demographic patient data and concerning the type of admission and discharge, - detection of coronavirus SARS-CoV-2 by PCR test in 4.7% of the cases, - a decline in the treatment volume to 87% due to 8% decrease in the number of cases and 5% decrease in the ALOS, with patients with the main diagnosis [ICD-10] F10.- were most affected, - increases regarding the percentage of cases with the main diagnosis [ICD-10] F40-F48 (p<0.05) and in the ALOS of this patient group (by 31%), - a significant rise (p< 0.01) in the ratio of restrained treatment cases.

Conclusions

Related to the decrease in treatment volume, the increase in psychiatric intensive treatment and possible risks in terms of the care situation for patients with the main diagnoses [ICD-10] F10.-, F30-F39 and F40-F48 should be discussed in particular.

Disclosure

No significant relationships.

[Anti-VEGF-therapy of fibrovascular and serous-vascularized pigment epithelial detachment in neovascular AMD : A retrospective five-year-analysis]

BACKGROUND

Neovascular age-related macular degeneration (nAMD) is the most frequent cause of pigment epithelial detachment (PED). In the clinical routine the treatment of fibrovascular PED (fPED) and serous vascularized PED (svPED) with intravitreal vascular endothelial growth factor (VEGF) inhibitors has a restricted prognosis.

OBJECTIVE

There are limited data on the long-term outcome of PED under anti-VEGF therapy. Therefore, this study recorded the course of treated PEDs in nAMD eyes over a period of 5 years.

METHODS

All eyes with fPED or svPED that underwent anti-VEGF medication between 2006 and 2015 were retrospectively analyzed regarding the clinical course and the morphology seen on optical coherence tomography (OCT). The inclusion criteria were the detection of a PED on OCT, the angiographic verification of nAMD, a documented clinical history over 5 years and a good image quality.

RESULTS

A total of 23 eyes from 22 patients met the inclusion criteria. After 5 years a significant deterioration of visual acuity (VA) was seen in all eyes (p = 0.007) and in the subgroup of cases with fPED (p = 0.045). In the eyes with svPED the decline of VA was not significant (p = 0.097). In the collective study group a statistically significant reduction of PED height (p = 0.006) and an increase of PED diameter was measured (p = 0.002). In the subgroup analysis the decrease of PED height and increase of PED diameter were significant for cases with svPED (p = 0.004, p = 0.013, respectively) but were not statistically significant for fPED eyes (height: p = 0.616; diameter: p = 0.097). In 17 (74%) eyes fibrosis or atrophy were seen on the final assessment of OCT images.

DISCUSSION

After 5 years of anti-VEGF therapy for nAMD-associated PED the VA declined in half of the eyes and the OCT showed an unfavorable morphology in 3/4 of the cases. The average number of visits and injections was distinctly lower than in clinical trials and other real-life analyses. In summary, we observed an undertreatment with a worse functional and anatomical outcome in our clinical routine compared to other studies.

Chemical profile of Stachytarpheta schottiana by LC-HRMS/MS dereplication and molecular networking

Abstract Restingas are extreme environments present in the Atlantic Rainforest biome. These ecosystems show peculiar characteristics, like sandy soil, high salinity, and high solar exposure, which brings scientific interest to their native species. Stachytarpheta schottiana is an endemic Brazilian species found in Jurubatiba Restinga, and just like other species of the genus Stachytarpheta, is used in folk medicine. In this paper, we describe, for the first time, 28 secondary metabolites from S. schottiana polar extract, among them iridoids, flavonoids, lignans and phenylethanoids, with the use of LC-HRMS/MS dereplication and molecular networking methodologies. Many of these compounds have not been described yet for the genus Stachytarpheta, like astragalin, taxifolin, lamiide and the lignans secondary metabolites class. Also, in this paper, High Speed Counter-Current Chromatography (HSCCC) isolation and Nuclear Magnetic Resonance (NMR) of two compounds were used to correct a misidentification in the dereplication procedure and to create seeds for molecular networking. Some of the suggested known compounds found in this work have had their biological activities described in the literature, such as the hepatoprotective activity of verbascoside, that matches those already related for the genus Stachytarpheta and for the folk use of Stachytarpheta schottiana itself.

Natural products from Vitex polygama and their antimycobacterial and anti-inflammatory activity

Tuberculosis (TB) remains a worldwide public health threat because of the emergence of resistant strains and subsequent inappropriate response to current therapy. We have been studying the restinga plants' antimycobacterial and anti-inflammatory potential. Dichloromethane fraction (DCM) from Vitex polygama Cham. showed high activity against Mycobacterium tuberculosis (Mtb) H37Rv. In this context, DCM fraction and isolated compounds were investigated against Mtb H37Rv and M299 (MDR strain) and for their immunomodulatory and cytotoxicity actions. Orientin showed the best antimycobacterial effect against Mtb M299 MDR strain (MIC₅₀ 15.4 ± 1.6 µg/mL), capacity of inhibiting NO production by macrophages (IC₅₀ 6.5 ± 1.2 µg/mL) and no significant cytotoxicity. The antimycobacterial effect of orientin was also observed on Mtb H37Rv intracellular growth in RAW 264.7 macrophages (MIC₅₀ 3.5 ± 1.1 and MIC₉₀ 9.1 ± 1.0 µg/mL). This is the first report describing the antimycobacterial effect of orientin, in both extra- and intracellular growth.

Pharmacopoeial HPLC methodology improvement: A case study of piroxicam

In the present study, a simple, stability-indicating and cost-effective reversed-phase high performance liquid chromatography (HPLC) method was developed and validated for the determination of piroxicam in commercial and masterful formulation capsules as an alternative to existing methods. The improved HPLC method was carried out on a C18 column (150 mm x 4.6 mm i.d., 5 μm), maintained at 30 °C. The mobile-phase consisted of a solution of triethylamine 0.3% pH 5.0 and acetonitrile (70:30; v/v), run at a flow rate of 1.0 mL/min and using photodiode array (PDA) detection at 248 nm. The chromatographic separation is obtained with retention time of 6.8 min, presenting adequate system suitability parameters for HPLC analysis. Validation parameters such as the specificity, linearity, matrix effect, precision, accuracy and robustness were evaluated in accordance with the ICH Q2(R1) and Brazil RDC 166/17 requirements, giving satisfactory results within the acceptable range. The proposed method was successfully validated and applied for piroxicam analysis, contributing to improve the quality control, and can be used as easy, accurate, low time-consuming alternative to pharmacopeial quantification methodology of drug.

[Unilateral retinal hemorrhage in infants-two cases of shaken baby syndrome?]

Ein 2,5 Monate alter Junge und ein 2 Monate altes Mädchen wurden wegen schwerer Bewusstseinstrübung pädiatrisch behandelt. Bei beiden Kindern fanden sich Subduralhämatome. Bei Verdacht auf nichtakzidentelles Schädel-Hirn-Trauma (NAHI) erfolgte eine Untersuchung des Augenhintergrundes, bei der sich bei beiden Säuglingen unilaterale Netzhautblutungen zeigten. Nach intensiver Differenzialdiagnostik wurde in beiden Fällen der Verdacht auf ein NAHI gestellt und eine rechtsmedizinische Begutachtung initiiert. Wichtig an dieser Fallserie ist, dass die Einseitigkeit von Netzhautblutungen ein NAHI nicht ausschließt.

Biomechanical aspects of the posteromedial split in bicondylar tibial plateau fractures-a finite-element investigation

PURPOSE

To gain principal insight into fixation techniques of a posteromedial split fragment in bicondylar tibial plateau fractures.

METHODS

A computer simulation was performed, applying the finite-element method (FEM) to compare four methods of fixation of the posteromedial split fragment: lateral plate (model 1), lateral plate and kickstand screw (model 2), lateral plate and two antero-posterior lag screws (model 3), and lateral and posteromedial plate (model 4). The displacement of the fragment and material stresses in implants and bone under 2500 N axial load were analyzed.

RESULTS

Maximal displacement of the posteromedial split fragment of 2.8 mm was found with a sole lateral plate. An added kickstand screw decreased the displacement to 1.46 mm. Added lag screws improved stability by a factor 4, with a maximal displacement of 0.76 mm. The double-plate configuration revealed 0.27 mm, a decrease of the displacement by a factor 10 compared to model 1. An additional analysis of posteromedial fragment displacements with osteoporotic bone, simulated by dividing the elastic modulus of the bone by a factor 2, turned out to be of relevant impact. For model 1, the calculations did not converge. The influence of bone quality was found to be 70% in model 2, 60% in model 3, and 40% in model 4.

CONCLUSIONS

The results indicate that the additional fixation of a posteromedial split fracture by plate osteosynthesis might be advantageous in bicondylar tibial plateau fractures treated with lateral plating. This might be even more important in patients with low bone quality.

Caffeine Supplementation for 4 Days Does Not Induce Tolerance to the Ergogenic Effects Promoted by Acute Intake on Physiological, Metabolic, and Performance Parameters of Cyclists: A Randomized, Double-Blind, Crossover, Placebo-Controlled Study

The present study investigated whether the caffeine supplementation for four days would induce tolerance to the ergogenic effects promoted by acute intake on physiological, metabolic, and performance parameters of cyclists. A double-blind placebo-controlled cross-over design was employed, involving four experimental trials; placebo (4-day)-placebo (acute)/PP, placebo (4-day)-caffeine (acute)/PC, caffeine (4-day)-caffeine (acute)/CC and caffeine (4-day)-placebo (acute)/CP. Fourteen male recreationally-trained cyclists ingested capsules containing either placebo or caffeine (6 mg∙kg-1) for 4 days. On day 5 (acute), capsules containing placebo or caffeine (6 mg∙kg-1) were ingested 60 min before completing a 16 km time-trial (TT). CC and PC showed improvements in time (3.54%, ES = 0.72; 2.53%, ES = 0.51) and in output power (2.85%, ES = 0.25; 2.53%, ES = 0.20) (p < 0.05) compared to CP and PP conditions, respectively. These effects were accompanied by increased heart rate (2.63%, ES = 0.47; 1.99%, ES = 0.34), minute volume (13.11%, ES = 0.61; 16.32%, ES = 0.75), expired O2 fraction (3.29%, ES = 0.96; 2.87, ES = 0.72), lactate blood concentration (immediately after, 29.51% ES = 0.78; 28.21% ES = 0.73 recovery (10 min), 36.01% ES = 0.84; 31.22% ES = 0.81), and reduction in expired CO2 fraction (7.64%, ES = 0.64; 7.75%, ES = 0.56). In conclusion, these results indicate that caffeine, when ingested by cyclists in a dose of 6 mg∙kg-1 for 4 days, does not induce tolerance to the ergogenic effects promoted by acute intake on physiological, metabolic, and performance parameters.

Chemical composition and anti-inflammatory activity of essential oil and ethanolic extract of Campomanesia phaea (O. Berg.) Landrum leaves

ETHNOPHARMACOLOGICAL RELEVANCE

Campomanesia species are used in folk medicine for anti-inflammatory, -ulcerogenic, -diabetic, -obesity, and many other purposes.

AIM OF THE STUDY

This study aimed to investigate the phytochemical profile and pharmacotherapeutic potential of the essential oil (EO) and ethanolic extract (EXT) of the leaves of Campomanesia phaea in relation to antioxidant and anti-inflammatory effects using chemical methods and in vitro bioassays in cell culture.

MATERIALS AND METHODS

Gas and liquid chromatography techniques coupled to mass spectrometry were used to identify the main secondary metabolites. The antioxidant activity was determined by the chemical methods of radical sequestration of 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-Azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), and by ferric reducing antioxidant power (FRAP); in addition to the protective effect against cellular oxidative damage caused by hydrogen peroxide (H₂O₂) in macrophage culture. The anti-inflammatory and immunomodulatory activity was evaluated for the influence on the production of nitric oxide and superoxide anion (O₂^•-), and by the quantification of proinflammatory cytokines tumor necrosis factor (TNF alpha) and interleukin 6 (IL- 6) through Enzyme Linked Immuno Sorbent Assay (ELISA) technique and inhibition of nuclear factor kappa B (NF-κB) through chemiluminescence.

RESULTS

A total of 41 compounds were identified in the essential oil (EO), being (E)-caryophyllene (14%) and caryophyllene oxide (6.9%) the major compounds. In the ethanolic extract (EXT), three flavonoids from the flavanones group were identified: alpinetin O-dideoxy-hexoside, 5,7-dimethoxyflavanone and alpinetin. The EO and EXT inhibited the production of O₂^•- (99.0% and 52.9%) at a concentration of 100 μg/mL, intracellular NO^•- (50.0% and 51.9%) and proinflammatory cytokines IL-6 (41.0% and 82.9%) and TNF-α (74.7% and 87.9%) at a concentration of 50 μg/mL, respectively. In addition, inhibition of nuclear factor kappa B (EO 36.2% and EXT 40.9%) was observed at 20 μg/mL.

CONCLUSIONS

Taken together, the results indicated that EO and EXT possess potent anti-inflammatory activities and it may hold therapeutic promise in the management of acute and chronic inflammatory conditions.

Validation of the Normocythemic Mice Bioassay for the Potency Evaluation of Recombinant Human Erythropoietin in Pharmaceutical Formulations

The normocythemic mice bioassay was validated for the potency evaluation of the recombinant human erythropoietin (rhEPO) against the European Pharmacopoeia Biological Reference Preparation for erythropoietin. The bioassays were performed in 8-week-old female BALB/c mice, which received multiple daily injections of standard or sample solutions (3 + 3), for 4 days. The blood sampling was performed 24 h after the last injection and the reticulocytes were counted by automated flow cytometry. Method validation investigated parameters such as linearity, precision, accuracy, specificity, and robustness, giving results within the acceptable range. The dose-response curve was linear in the concentration range of 164 international units (IU)/mL, and the value of the determination coefficient (r2) was 0.9708. The bioassay was applied for the potency evaluation of rhEPO pharmaceutical products containing alfa or beta forms, expressed in different cell lines, giving biological potencies within 82.79 and 119.70 of the stated potency. The precision index calculated by the weight for the independent assays was &gt;247. The results demonstrated the validity of the bioassay for the potency assessment of pharmaceutical formulations contributing to ensure the therapeutic efficacy of the biological medicine.

Intravitreal anti-VEGF treatment for choroidal neovascularization secondary to traumatic choroidal rupture

Background

So far only single cases with short follow-up have been reported on the use of intravitreal anti-VEGF for traumatic choroidal neovascularizations (CNV). This paper reports a large case series of patients with CNV secondary to choroidal rupture after ocular trauma receiving intravitreal anti-VEGF (vascular endothelial growth factor) injections.

Methods

Fifty-four patients with unilateral choroidal rupture after ocular trauma diagnosed between 2000 and 2016 were retrospectively evaluated. Eleven patients with CNV secondary to choroidal rupture were identified. Five eyes with traumatic secondary CNV were treated with anti-VEGF and were systematically analysed. The other 4 patients with inactive CNV underwent watchful observation.

Results

Four men and one woman with a mean age of 29 years (SD 12.4; range 19–45) had intravitreal anti-VEGF therapy for traumatic CNV. Another 4 patients with a mean age of 37 years (SD 6.6; range 31–46) presented with inactive CNV and did not receive specific treatment. In all 9 cases the mean interval between the ocular trauma and the diagnosis of CNV was 5.7 months (SD 4.75; range 2–12). In the treatment group per eye 4.2 injections (SD 3.2; range 1–8) were given on average. Four eyes were treated with bevacizumab and one eye with ranibizumab. Regression of CNV was noted in all eyes. In 4 eyes visual acuity (VA) improved, one eye kept stable visual acuity.

Conclusions

Here, we present the up to now largest case series of traumatic CNV membranes treated with anti-VEGF injections with a mean follow-up period of 5 years. Intravitreal anti-VEGF therapy seems to be safe and effective for secondary CNV after choroidal rupture. Compared to exudative age-related macular degeneration fewer injections are needed to control the disease.

Trial registration

Retrospective registration with local ethics committee on 21 March 2019. Trial registration number is 19-1368-104.

Simultaneous Liquid Chromatographic Determination of Ezetimibe and Simvastatin in Pharmaceutical Products

A reversed-phase liquid chromatographic (LC) method was developed and validated for the simultaneous determination of ezetimibe and simvastatin in pharmaceutical dosage forms. The LC method was carried out on a Synergi fusion C18 column (150 mm 4.6 mm id) maintained at 45C. The mobile phase consisted of phosphate buffer 0.03 M, pH 4.5acetonitrile (35 + 65, v/v) run at a flow rate of 0.6 mL/min, and detection was made using a photodiode array detector at 234 nm. The chromatographic separation was obtained within 15.0 min, and calibration graphs were linear in the concentration range of 0.5200 g/mL. Validation parameters such as specificity, linearity, precision, accuracy, and robustness were evaluated, giving results within the acceptable range for both compounds. Moreover, the proposed method was successfully applied for the routine quality control analysis of pharmaceutical products.

Validation of Liquid Chromatography and Liquid Chromatography/Tandem Mass Spectrometry Methods for the Determination of Etoricoxib in Pharmaceutical Formulations

Reversed-phase liquid chromatography (LC) and LC/tandem mass spectrometry (LC/MS/MS) methods were developed and validated for the determination of etoricoxib in pharmaceutical dosage forms. The LC method was performed by reversed-phase chromatography on a Synergi fusion C18 column (150 × 4.6 mm id) maintained at ambient temperature. The mobile phase consisted of 0.01 M phosphoric acid, pH 3.0acetonitrile (62 + 38, v/v) at a flow rate of 1.0 mL/min, and photodiode array detection at 234 nm was used. The chromatographic separation was obtained within 7.0 min, and calibration curves were linear in the concentration range of 0.02-150 μg/mL. The LC/MS/MS method was performed on a Luna C18 column (50 × 3.0 mm id). The mobile phase consisted of acetonitrilewater (95 + 5)0.1% acetic acid (90 + 10, v/v). Detection was performed by positive electrospray ionization in the multiple reaction monitoring mode, monitoring the transitions 359.3 &gt; 280.0 and 332.0 &gt; 95.0 for etoricoxib and piroxicam (internal standard), respectively. The chromatographic separation was obtained within 2.0 min, and calibration curves were linear in the concentration range of 15000 ng/mL. Validation parameters, such as specificity, linearity, precision, accuracy, and robustness, were evaluated, which gave results within the acceptable range for both methods. Moreover, the proposed methods were successfully applied for routine quality control analysis of pharmaceutical products and showed significant correlation (r = 0.9999) of the results.

Validation of the Antifactor Xa and Antifactor IIa Assays for the Potency Assessment of Nadroparin in Pharmaceutical Formulations

The low-molecular weight heparin nadroparin calcium is used clinically for the prevention and treatment of venous and arterial thrombosis. The antifactor Xa and antifactor IIa assays were validated by investigating the parameters of range, linearity (r2 0.9905 and r2 0.9914, respectively) precision, accuracy, and robustness. The 2 methods incorporated a chromogenic endpoint and detection at 405 nm, yielding good results with detection limits of 0.004 and 0.01 IU/mL and quantitation limits of 0.01 and 0.03 IU/mL, respectively, for the antifactor Xa and antifactor IIa assays. Nadroparin calcium pharmaceutical products were evaluated by the antifactor Xa assay and the antifactor IIa assay, giving potencies between 93.86 and 109.88%, with an antifactor Xa/antifactor IIa ratio between 3.2 and 3.7. The results demonstrated the validity of the assays that are useful methodologies for the routine quality control of nadroparin in pharmaceutical formulations.

S-Nitrosothiol Signaling Is involved in Regulating Hydrogen Peroxide Metabolism of Zinc-Stressed Arabidopsis

Accumulation of heavy metals such as zinc (Zn) disturbs the metabolism of reactive oxygen (e.g. hydrogen peroxide, H2O2) and nitrogen species (e.g. nitric oxide, NO; S-nitrosoglutathione, GSNO) in plant cells; however, their signal interactions are not well understood. Therefore, this study examines the interplay between H2O2 metabolism and GSNO signaling in Arabidopsis. Comparing the Zn tolerance of the wild type (WT), GSNO reductase (GSNOR) overexpressor 35S::FLAG-GSNOR1 and GSNOR-deficient gsnor1-3, we observed relative Zn tolerance of gsnor1-3, which was not accompanied by altered Zn accumulation capacity. Moreover, in gsnor1-3 plants Zn did not induce NO/S-nitrosothiol (SNO) signaling, possibly due to the enhanced activity of NADPH-dependent thioredoxin reductase. In WT and 35S::FLAG-GSNOR1, GSNOR was inactivated by Zn, and Zn-induced H2O2 is directly involved in the GSNOR activity loss. In WT seedlings, Zn resulted in a slight intensification of protein nitration detected by Western blot and protein S-nitrosation observed by resin-assisted capture of SNO proteins (RSNO-RAC). LC-MS/MS analyses indicate that Zn induces the S-nitrosation of ascorbate peroxidase 1. Our data collectively show that Zn-induced H2O2 may influence its own level, which involves GSNOR inactivation-triggered SNO signaling. These data provide new evidence for the interplay between H2O2 and SNO signaling in Arabidopsis plants affected by metal stress.

Delapril and Indapamide: Development and Validation of a Stability-Indicating Core-Shell LC Method and Its Application for Simultaneous Tablets Assay

Background: The combination of delapril (DEL) and indapamide (IND) may be regarded as an optimal drug treatment for hypertensive patients. However, there is no published study concerning the suitable stability conditions and evaluation of drugs in the raw material and commercial product. Objective: The aim of the present study was to develop an innovative, high-throughput, and stability-indicating LC method for the simultaneous analysis of DEL and IND in combined dosage form. Methods: Analyses were performed using a core-shell C18 column (100 mm × 4.6 mm id, 2.6 μm) at 45°C using isocratic elution for the mobile phase composed of triethylamine solution (0.3%, pH 5.0)-acetonitrile-methanol (58 + 35 + 7, v/v/v). The separation was obtained within 3.5 min at a flow rate of 1.0 mL/min and UV detection set at 213 nm. Results: The specificity and stability-indicating capability of the method were proven through degradation studies, which also showed that there is no interference of the formulation excipients, showing that the peak is free from any co-eluting peak. Conclusions: The method showed adequate precision, with relative standard deviation values lower than 1.85%. Excellent values of accuracy were obtained, with a mean value of 98.64% for IND and 98.65% for DEL. Experimental design was used during validation to calculate and prove the method robustness. Highlights: The proposed LC method was successfully validated according to International Conference on Harmonisation requirements and applied for the simultaneous determination of DEL and IND in tablets, presenting suitability for stability studies and contributing to improve the QC of pharmaceuticals.

MULTICOMPONENT SPECTROPHOTOMETRIC METHOD FOR SIMULTANEOUS ANALYSIS OF DELAPRIL AND INDAPAMIDE IN TABLETS

A multicomponent ultraviolet (UV) spectrophotometric method was developed and validated for simultaneous determination of delapril (DEL) and indapamide (IND) in tablets employing the partial least squares regression (PLSR) approach. The PLSR method was developed by a multilevel factorial design using 25 synthetic mixtures of drugs and a significant predict model (p < 0.05) were obtained at 225 nm for DEL (r2 = 0.9992) and 243 nm for IND (r2 = 0.9997). Validation parameters such as the specificity, linearity, precision, accuracy and robustness were evaluated in accordance with the ICH requirements, giving satisfactory results within the acceptable range. The proposed PLSR method was successfully applied for simultaneous determination of DEL and IND in fixed dose combinations and can be used as simple alternative to separation techniques.

In Vitro and In Vivo Anti-inflammatory Effects of Struthanthus vulgaris

Struthanthus vulgaris is probably the most common medicinal mistletoe plant in Brazil, and has been used in folk medicine as an anti-inflammatory agent and for cleaning skin wounds. Our proposal was to evaluate the anti-inflammatory activity of S. vulgaris ethanol leaf extract and provide further insights of how this biological action could be explained using in vitro and in vivo assays. In vitro anti-inflammatory activity was preliminarily investigated in lipopolysaccharide/interferon gamma-stimulated macrophages based on their ability to inhibit nitric oxide production and tumor necrosis factor-alpha. In vivo anti-inflammatory activity of S. vulgaris ethanol leaf extract was investigated in the mice carrageenan-induced inflammation air pouch model. The air pouches were inoculated with carrageenan and then treated with 50 and 100 mg/kg of S. vulgaris ethanol leaf extract or 1 mg/kg of dexamethasone. Effects on the immune cell infiltrates, pro- and anti-inflammatory mediators such as tumor necrosis factor-alpha, interleukin 1, interleukin 10, and nitric oxide, were evaluated. The chemical composition of S. vulgaris ethanol leaf extract was characterized by LC-MS/MS. In vitro S. vulgaris ethanol leaf extract significantly decreased the production of nitric oxide and tumor necrosis factor-alpha in macrophages and did not reveal any cytotoxicity. In vivo, S. vulgaris ethanol leaf extract significantly suppressed the influx of leukocytes, mainly neutrophils, protein exudation, nitric oxide, tumor necrosis factor-alpha, and interleukin 1 concentrations in the carrageenan-induced inflammation air pouch. In conclusion, S. vulgaris ethanol leaf extract exhibited prominent anti-inflammatory effects, thereby endorsing its usefulness as a medicinal therapy against inflammatory diseases, and suggesting that S. vulgaris ethanol leaf extract may be a source for the discovery of novel anti-inflammatory agents.

Intravitreal anti-VEGF treatment for choroidal neovascularization secondary to punctate inner choroidopathy

PURPOSE

To assess the outcome of patients with choroidal neovascularization (CNV) secondary to punctate inner choroidopathy (PIC) receiving intravitreal anti-VEGF (vascular endothelial growth factor) injections.

METHODS

Sixteen eyes of 16 patients diagnosed with CNV secondary to PIC were retrospectively assessed.

RESULTS

Eleven women and five men with a mean age of 35 years (SD 11, range 16-56 years) received intravitreal anti-VEGF for PIC-related CNV. On average, 3.5 injections (SD 2.7, range 1-9) were given per eye. Thirteen eyes were treated with bevacizumab, two eyes with ranibizumab and one eye received both substances. The mean follow-up was 15 months (SD 11, range 6-40 months). BCVA improved in eight eyes (mean Δ +2.8 lines), remained stable in four eyes and decreased in four eyes (mean Δ -4.3 lines).

CONCLUSIONS

CNV development is a frequent complication of PIC. Intravitreal anti-VEGF therapy seems to be safe and effective for PIC-related CNV.

Adjustment of the German Prospective Payment System for Psychiatric and Psychosomatic Facilities: Does PEPP Provides a Suitable Basis? Results of a Descriptive Comparative Study

Introduction

In Germany a consistent, performance-oriented, flat-rate remuneration system based on per-day payments for inpatient and day patient hospital services for psychiatric and psychosomatic facilities (PEPP) is developed. The Klinikum Chemnitz gGmbH decided in 2013 to participate in the optional PEPP introducing phase and acts as a PEPP cost accounting hospital.

Objectives

Due to a controversial discussion by the psychiatric experts, an adjustment of the hitherto only performance-based to a budget-oriented system based on PEPP is planned in 2017.

Aims

This paper discusses if the current PEPP remuneration system enables an appropriate recognition and measurement of services.

Methods

Descriptive analyses were performed by comparing inpatient and day patient treatment at a therapy oriented psychiatric unit and the emergency psychiatric unit in 2015. The evaluation primarily focused on the criteria of “staffing level and structure”, “imaging of services by German procedure classification (OPS) according to PEPP”, “PEPP remuneration”.

Results

Our findings (Table 1) show that in 2015 the PEPP remuneration system provided an appropriate recognition of unit-specific services in emergency psychiatry (e.g., 1 to 1 care, intensive care treatment), but services of board certified therapeutic staff were recognized inadequately in consequence of the definition of therapy by the OPS catalogue.

Conclusion

Further development of payment system should implicate changes in the definition of therapy according to scientific guidelines and the pay for performance concept.

Table 1

Disclosure of interest

Activity as a speaker, Janssen-Cilag GmbH.

Phytochemical Study of Tapirira guianensis Leaves Guided by Vasodilatory and Antioxidant Activities

The aim of this research was to perform a phytochemical study of the methanol leaves extract of T. guianensis (MET) guided by vasodilatory and antioxidant activities. The chemical profile of MET and the ethyl acetate fraction (EA fraction) was determined by HPLC-UV-MS and EA fraction guided fractionation by reverse-phase chromatography. The vasorelaxant effects of MET, fractions, sub-fractions and constituents were assessed on rat aorta pre-contracted with phenylephrine. Antioxidant activity was evaluated by using a DPPH assay. The results show that MET-induced vasodilation was dependent on NO/cGMP; and that the PI3K/Akt pathway seems to be the main route involved in eNOS activation. The EA fraction showed greater vasodilatory and antioxidant potency and was submitted to further fractionation. This allowed the isolation and characterization of quercetin, quercetin 3-O-(6″-O-galloyl)-β-d-galactopyranoside and 1,4,6-tri-O-galloyl-β-d-glucose. Also, galloyl-HHDP-hexoside and myricetin deoxyhexoside were identified by HPLC-UV-MS. These compounds are being described for the first time for T. guianensis. 1,4,6-tri-O-galloyl-β-d-glucose and quercetin 3-O-(6″-O-galloyl)-β-d-galactopyranoside showed no vasodilatory activity. Quercetin and myricetin glycoside seems to contribute to the MET activity, since they have been reported as vasodilatory flavonoids. MET-induced vasodilation could contribute to the hypotensive effect of T. guianensis previously reported.

Metabolic profile and safety of piperlongumine

Piperlongumine (PPL), a natural plant product, has been extensively studied in cancer treatment going up on clinical trials. Since the first report related to its use on cancer research (in 2011) around 80 papers have been published in less than 10 years, but a gap still remaining. There are no metabolism studies of PPL in human organism. For the lack of a better view, here, the CYP450 in vitro oxidation of PPL was described for the first time. In addition, the enzymatic kinetic data, the predicted in vivo parameters, the produced metabolites, the phenotyping study and possible piperlongumine-drug interactions in vivo is presented.

Malignant extrarenal rhabdoid tumour (MERT) with liver metastases as a rare cause of an esophageal tumor in a 57 years old patient

Tumors with a rhabdoid phenotype are aggressive neoplasms with a dismal prognosis. Malignant extrarenal rhabdoid tumor (MERT) of the esophagus is an extremely rare disease with so far only 6 cases reported. We report on a 57-year-old male patient with rhabdoid tumor situated in the esophagus with metastases to the liver and local lymph nodes. Assuming an undifferentiated esophageal adenocarcinoma a palliative chemotherapy with 5-FU/folinic acid, oxaliplatin, and docetaxel (FLOT) was initiated which was changed towards a combination of doxorubicin and ifosphamide as immunohistochemistry of the primary and the liver metastases revealed a rhabdoid tumor. This treatment with doxorubicin and ifosphamide resulted in a short clinical and radiological response which lasted only for 2 months. Due to the bad general condition at the time of progression no further chemotherapy was initiated. The patient died due to tumor progression 6 months after initial diagnosis which is consistent with other reports on malignant extrarenal rhabdoid tumors (median survival of metastatic disease less than 6 months). Thus, metastatic MERT represents a disease with a poor prognosis and no established standard therapy.

In vitro metabolism of the lignan (-)-grandisin, an anticancer drug candidate, by human liver microsomes

(-)-grandisin is a tetrahydrofuran lignan that displays important biological properties, such as trypanocidal, anti-inflammatory, cytotoxic, and antitumor activities, suggesting its utility as a potential drug candidate. One important step in drug development is metabolic characterization and metabolite identification. To perform a biotransformation study of (-)-grandisin and to determine its kinetic properties in humans, a high performance liquid chromatography (HPLC) method was developed and validated. After HPLC method validation, the kinetic properties of (-)-grandisin were determined. (-)-grandisin metabolism obeyed Michaelis-Menten kinetics. The maximal reaction rate (Vmax ) was 3.96 ± 0.18 µmol/mg protein/h, and the Michaelis-Menten constant (Km ) was 8.23 ± 0.99 μM. In addition, the structures of the metabolites derived from (-)-grandisin were characterized via gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS) analysis. Four metabolites, 4-O-demethylgrandisin, 3-O-demethylgrandisin, 4,4'-di-O-demethylgrandisin, and a metabolite that may correspond to either 3,4-di-O-demethylgrandisin or 3,5-di-O-demethylgrandisin, were detected. CYP2C9 isoform was the main responsible for the formation of the metabolites. These metabolites have not been previously described, demonstrating the necessity of assessing (-)-grandisin metabolism using human-derived materials.

[Outcome and complications after trabeculectomy depending on the preoperative intraocular pressure]

PURPOSE

Trabeculectomy is a frequently used surgical procedure in open-angle glaucomas. The present study analyses the outcome and complications after trabeculectomy or re-trabeculectomy depending on the preoperative intraocular pressure (IOP) < 30 mmHg and ≥ 30 mmHg.

METHODS

One hundred and eighteen patients were included in this retrospective study. Primary ocular outcomes were the postoperative IOP at discharge and postoperative complications such as choroidal detachment and flattening of the anterior chamber. The necessity of postoperative interventions such as needle revisions, viscoelastic injections or surgical revision was documented.

RESULTS

In this survey 118 patients (68 men, 50 women) were included (age [arithmetic mean] 68.3 ± 12.1 years). The postoperative follow-up period was 6-9 months. In 60 patients the preoperative IOP was < 30 mmHg, in 58 patients ≥ 30 mmHg. Postoperative complications were flattening of the anterior chamber (< 2 corneal thickness) in 11 patients (9.3 %) and temporary choroidal detachment in 20 patients (16.9 %). On the day of discharge the mean IOP was 9.8 mmHg. Hence the IOP was on average reduced by 17 mmHg (SD 11.2 mmHg). Postoperative interventions were necessary in 28 patients (23.7 %). Seventeen (14.4 %) developed tenon cysts which were treated by needle revision of the bleb. Nine patients (7.6 %) underwent a viscoelastic injection for persistent hypotony and 10 patients underwent bleb revision (8.5 %).

CONCLUSIONS

This study does not show statistically significant differences depending on preoperative IOP in temporary choroidal detachment and postoperative interventions. A postoperative flattening of the anterior chamber was found statistically significantly more often in patients with higher preoperative IOP.

High-resolution two-phase flow measurement techniques for the generation of experimental data for CFD code qualification

Computational fluid dynamics simulations for two-phase flows are important in different fields of engineering and science. Since two-phase flows are inherently complex, also CFD modeling development requires special attention. The validation of model implementation and the derivation of physics based models for momentum, heat, and mass transfer in two-phase flow require experiments with generation of high-resolution measurement data. This, however, is a great challenge, since most standard flow measurement tools used in single phase flow situations, are not suited for multiphase flows. In this article we report on advanced imaging and measuring methods for two-phase flow experiments, which have been extensively used in the recent past to conduct experiments for two-phase flows at the Helmholtz-Zentrum Dresden-Rossendorf. In particular the application of wire-mesh sensors, ultrafast X-ray tomography, gamma ray tomography and positron emission tomography will be introduced and discussed.