Central Serous Chorioretinopathy – an Overview

Central serous chorioretinopathy (CSCR) is characterised by retinal serous detachment usually localised in the macular region. CSCR predominantly affects men between 30 and 50 years of age. Traditional classification differentiates between acute (duration shorter than 4 to 6 months) and chronic disease (duration longer than 4 to 6 months). The pathogenesis is multifactorial and current thinking assumes the presence of localised choroidal hyperpermeability with subsequent secondary changes in the retinal pigment epithelium (RPE). The symptoms of acute CSCR include central blurred vision, often with deterioration in visual acuity. Optical coherence tomography (OCT) reveals subretinal fluid (SRF) and/or single retinal pigment epithelial detachments. Fluorescein angiography (FA) usually shows a leaking point with absent or only minor RPE changes in the acute phase and indocyanine green angiography (ICG) highlights circumscribed areas of thickened and hyperpermeable choroid. Acute cases may show spontaneous resolution of SRF, but may also recur and/or become chronic. After the initial diagnosis, spontaneous remission is seen in about 70 to 80% of cases, with a recurrence rate of about 50%. Due to the favourable spontaneous course, it is recommended to wait for 4 to 6 months after the first symptoms manifest. Steroid therapy is considered as a major risk factor. Chronic cases are characterised by slow deterioration in visual acuity with reduced contrast and colour perception. There are extensive RPE changes, with secondary degenerative changes of the photoreceptors. The disease can by complicated by choroidal neovascularisation (CNV), especially in elderly patients. The literature lists a number of treatments: The leakage point (visible in the FA) can be treated by focal laser therapy, either micropulse laser or, if sufficiently distant from the fovea, by argon laser coagulation. Randomised trials in chronic CSCR demonstrated good outcomes with photodynamic therapy. With observation periods ranging from 3 to 6 months, several case series reports found improvement after systemic administration of mineralocorticoid receptor antagonists, carbonic anhydrase inhibitors or non-steroidal anti-inflammatory drugs. In the presence of secondary CNV, anti-VEGF treatment should be initiated. It is unclear whether the combination with PDT might be useful.

Utilization of Smartphones’ Depth Mapping Cameras for the App-based Grading of Facial Movement Disorders: Design and Development (Preprint)

BACKGROUND For the classification of facial palsy, various efforts have been made for the description and evaluation of clinician-graded and software-based scoring systems. They serve the purpose of scientific and clinical assessment of the spontaneous course of the disease or monitoring therapeutic interventions. Nevertheless, none of them could achieve universal acceptance in everyday clinical practice. Hence, a quick and precise tool for assessing the functional status of the facial nerve would be desirable. In this context, the possibilities that depth mapping cameras of recent smartphones offer have sparked our interest. OBJECTIVE This study describes the utilization of a smartphone’s depth mapping camera via a specially developed app prototype for a quick, objective and reproducible quantification of facial asymmetries. METHODS After conceptual and user interface design a native app prototype for iOS was programmed, that accesses and processes the data of the TrueDepth-camera. Using a special algorithm, the app returns a new index for the grading of unilateral facial palsy ranging from 0% to 100%, called Digital Facial Index. The algorithm was adapted to the well-established Stennert’s index by weighting the individual facial regions based on functional and cosmetic aspects. Test measurements were performed in order to proof the reliability of the system. RESULTS The app prototype turned out to be stable and met all of the criteria previously defined. The newly defined index expresses the results of the measurement as an easily understandable numerical value for each half of the face. Test measurements were reproducible and revealed no statistically significant intertest variability. CONCLUSIONS The use of a smartphone’s depth mapping camera has considerable potential for the app-based grading of facial movement disorders. The app and its algorithm, which is based on theoretical considerations, should be checked in a prospective clinical study and correlated with common facial scores.

SORPTION OF NICKEL (II) IONS BY CHELATING RESIN WITH IMINODIACETATE FUNCTIONALITY

The regularities of sorption of nickel (II) ions from a monocomponent system on macroporous weakly acidic cationite Lewatit MonoPlus TP 207 were studied. Sorption isotherms were obtained. It is shown that the extraction process can be fairly reliably described by Langmuir and Freundlich equations. The static exchange capacity (SEC) of the resin was determined. The SEC dependencies at temperatures of 305 and 328 K during the sorption process were revealed. Integral kinetic curves were obtained. It is defined that the equilibrium concentration of nickel (II) ions is reached about 13 times faster with temperature increase from 305 to 328 K. The experimental data were processed using equations that take into account the influence of external, internal diffusion, "sorbent-sorbate" and "sorbate-sorbate" chemical interactions. It was found that the main limiting stage of sorption of nickel (II) ions is the internal diffusion. The values of external and internal diffusion rate constants at the indicated temperatures were determined. The kinetic curves were processed by pseudo first and pseudo second order models, which satisfactorily describe the experimental data. According to transition-state theory the thermodynamic characteristics of the activation process (activation energy, entropy, enthalpy, and Gibbs free energy) were calculated. Relatively low activation energy indicates the decisive contribution of diffusion in the process of sorption of nickel (II) ions. Positive entropy is the evidence of nickel hydration shells destruction during the sorption process. Positive enthalpy proves an endothermic nature of interaction of nickel (II) ions and ionogenic groups. Negative Gibbs free energy witnesses to spontaneous course of the reaction in the forward direction. For known values of stability constants the contents of nickel ionic forms and SEC’s were calculated in terms of pH value. Nickel extraction from solution increases with the appearance of singly-charged NiOH+ ions in the pH range from 8 to 9.

Systematic Review of Hearing Preservation in Observed Vestibular Schwannoma

Objective This is a systematic review of the literature on the spontaneous course of hearing in patients observed with a vestibular schwannoma. Included studies are appraised using the Grading of Recommendations Assessment, Development and Evaluation system. Design PubMed, Embase, Medline, Cochrane library, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched for literature on hearing in patients observed with a vestibular schwannoma. Participants Of 217 evaluated papers, 15 were included, representing a total of 2,142 patients. Main Outcome Measures Hearing according to the AAO-HNS (American Academy of Otorhinolaryngology- Head and Neck Surgery) classification system. Weighted average of the proportion of patients preserving good hearing (>70% discrimination score and pure tone audiometry [PTA] < 30dB) and serviceable hearing (>50% discrimination score and PTA < 50dB) was determined. Results Fifty percent of patients presenting with good hearing at diagnosis had preserved this after a mean of 5 years of observation, whereas serviceable hearing was preserved in 54%. Patients with normal discrimination at diagnosis preserve their hearing very well. Very few studies exist on long-term hearing preservation. Conclusions After 5 years of observation, around half of patients will have preserved good or serviceable hearing. Patients with normal discrimination at diagnosis are more likely to preserve good hearing.

Material Performance of Nickel Ions Adsorption by Larix Sibirica Needles

Adsorption of ions of nickel on alternative sorption material - needles of Siberian larch (Larix sibirica) is investigated at temperatures of 20, 30 and 40 0C. The maximum sorption capacities of needles of Larix sibirica in relation to ions of nickel (II) at temperatures of 20 are determined °C, 30° C, 40° C which made 0,80 mmol/g (47,2 mg/g), 0,87 mmol/g (51,3 mg/g) and 0,92 mmol/g (54,3 mg/g) respectively. Isotherms of adsorption are received and shortchanged with use of models of Langmuir, Friendlich, Temkin and Dubinin-Radushkevich. It is defined that process of adsorption of ions of Ni2+ at a temperature of 20the ° C is best of all described by Friendlich's model (R2 = 0,983), and at temperatures of 30° C and 40° C - the Langmuir model (R2 = 0,995 and 0,996 respectively). By the carried-out calculations it is defined that process of adsorption of ions of Ni2+ needles of Larix sibirica treat processes of physical adsorption as values of energy of adsorption have size less than 8 kJ/mol, and values of energy of Gibbs demonstrate spontaneous course of physical adsorption. Processing of kinetic dependences of processes of adsorption of ions of nickel (II) Larix sibirica needles at three temperatures within diffusive model defined the limiting stages of processes - the mixed diffusion.

COLON AND RECTAL CANCER ARE DIFFERENT TUMOR ENTITIES ACCORDING TO EPIDEMIOLOGY, CARCINOGENESIS, MOLECULAR- AND TUMOR BIOLOGY, PRIMARY AND SECONDARY PREVENTION: PRECLINICAL EVIDENCE

Introduction.Colon and rectal cancer (CC, RC) are different entities from a clinical and tumor biological point of view. Up to now, both, CC and RC, are synonymously called “Colorectal Cancer” (CRC). With our experience in basic and clinical research and routine work in this field we now have come to the opinion, that the term “CRC” should definitely be questioned, and if justified, be abandoned.Materials/Methods.We analyzed the actual available data from the literature and our own results from the Ulm based study group FOGT to proof or reject our hypothesis.Results.The following evident differences were recognized: Anatomically, the risk to develop RC is 4× higher than for CC. Molecular changes in carcinogenesis in CC are different from RC. Physical activity helps to prevent CC, not RC. Pathologically there are differences between RC and CC. In addition, there are also major clinical differences between CC and RC, such as in surgical topography and– procedures, multimodal treatment (MMT) approaches (RC in MMT is less sensitive to chemotherapy than CC), and prognostic factors for the spontaneous course and for success of MMT (e.g. TS or DPD ). Discussion. CC ´sand RC´s definitely are different in parameters of causal and formal carcinogenesis, effectivity of primary prevention by physical activity, conventional and molecular pathology.According to our findings we can demand from the preclinical point of view that CC and RC are two different tumor entities in terms of various representative biological characteristics.CC and RC are also differing substantially in many clinical features, as outlined in a separate paper from our group.Conclusion.“CRC” should no longer be used in basic and clinical research and other fields of cancer classification as a single disease entity. CC is not the same as RC. CC might even be divided into right and left CC.

Pitfalls in Suspected Acute Aortic Syndrome: Impact of Appropriate and If Required Repeated Imaging

The incidence of acute aortic syndrome is low, but the spontaneous course is often life-threatening. Adequate ECG-gated imaging is fundamental within the diagnostic workup. We here report a case of a 53-year-old man presenting with atypical chest pain, slight increase of D dimers at admission, and extended diameter of the ascending aorta accompanied by mild aortic regurgitation. Interpretation of an initial contrast-enhanced computed tomography was false negative due to inadequate gating and motion artifacts, thereby judging a tiny contrast signal in the left anterior quadrant of the ascending aorta as a pseudointimal flap. By hazard, cardiac magnetic resonance imaging demonstrated an ulcer-like lesion superior to the aortic root, leading to aortic surgery at the last moment. As sensitivity of imaging is not 100%, this example underlines that second imaging studies might be necessary if the first imaging is negative, but the clinical suspicion still remains high.