Systèmes de délivrance des médicaments pour le segment antérieur: bases fondamentales et applications cliniques [Drug delivery systems to target the anterior segment of the eye: fundamental bases and clinical applications].

The development of new drug delivery systems to target the anterior segment of the eye may offer many advantages: to increase the biodisponibility of the drug, to allow the penetration of drug that cannot be formulated as solutions, to obtain constant and sustained drug release, to achieve higher local concentrations without systemic effects, to target more specifically one tissue or cell type, to reduce the frequency of instillation and therefore increase the observance and comfort of the patient while reducing side effects of frequent instillation. Several approaches are developed, aiming to increase the corneal contact time by modified formulation or reservoir systems, or by increasing the tissue permeability using iontophoresis. To date, no ocular drug delivery system is ideal for all purposes. To maximize treatment efficacy, careful evaluation of the specific pathological condition, the targeted Intraocular tissue and the location of the most severe pathology must be made before selecting the method of delivery most suitable for each individual patient.

Suscetibilidade da soja a percevejos na fase anterior ao desenvolvimento das vagens

O objetivo deste trabalho foi avaliar os efeitos das populações de percevejos Euschistus heros (F.) e Piezodorus guildinii (West.) nas lavouras de soja nos meses de novembro/dezembro, antes do aparecimento das vagens nas plantas. Foram realizados experimentos em casa de vegetação e no campo, comparando-se infestações no período vegetativo e reprodutivo da cultura. As plantas de soja, mesmo sob o ataque de pesadas infestações de percevejos (até 8 por planta), no período vegetativo e no florescimento, não sofreram reduções significativas no rendimento. A qualidade das sementes foi semelhante entre os tratamentos e entre as espécies. No estádio R4, o número médio de vagens chochas foi diretamente proporcional ao aumento do número de percevejos por planta. No campo, as plantas com até quatro percevejos por metro, no final do período vegetativo-floração, tiveram rendimentos médios e qualidade de sementes semelhantes aos das plantas livres de insetos. No período R5-R6, para as duas espécies de percevejos, o número de grãos picados e inviabilizados cresceram, e os rendimentos médios decresceram com o aumento da população, tendo-se obtido, para a qualidade da soja, um dano duas vezes maior para a espécie P. guildinii em relação a E. heros. Infestações desses percevejos, na fase vegetativa-floração, não causam reduções no rendimento e na qualidade das sementes de soja.

Constitutive expression of FGF4 disrupts the development of the eye and the anterior CNS during mouse embryogenesi, but does not influence the expressionof shh in these areas.

The biological consequences of constitutive fibroblast growth factor-4 (fgf4) expression have been analysed during anterior CNS development of mouse chimeric embryos. Severe mutant embryos exhibit exencephaly, absence of eye development and anomalous differentiation of neuropithelium. These embryos also show ectopic limb buds resembling the early phases of limb development. Because our results show that anterior CNS in those chimeric embrios does not express shh ectopically, we suggest that malformations may be due to interference between the ectopic expression of fgf4 in the cephalic area and the receptors for the members of the FGF family that regulate brain and eye development, namely fgf8. If this is correct, the results indirectly suport the crucial role of fgf8 in patterning the anterior CNS.

Caracterització energètica del parc edificatori anterior al codi Tècnic de l’edificació CTE

En l'actualitat, l'eficiència energètica en l'edificació és un dels conceptes més importants, notan sols per la política energètica Espanyola, sinó també Europea amb un objectiu d'estalvidel 20% el 2020. Dins el sector de l'edificació, les normatives sobre eficiència energèticas'incorporen a partir de la transposició de les directives europees 2002/91 i 2010/31, queobliga, entre d'altres, a la certificació energètica, no només d'edificis nous, sinó també delsedificis antics que es trobin en situació de lloguer o compra/venta. L'objecte del present projecte és fer un catàleg de solucions constructives típiques, que esdonen abans de l'aprovació i entrada en vigor del CTE a partir del RD 314/2006. El catàlegconsta de variacions en l'evolvent de l'edifici, variacions en la contribució solar i variacionsen les instal•lacions de climatització. Cadascuna d'aquestes combinacions s'analitzarà ambels programaris LIDER i CALENER, de forma que s'obtindrà una estimació de les emissionsde CO2 per a cada cas, i a partir del projecte de real decret de certificació d'edificis existents(encara en tramitació a data de redacció del full de projecte d'aquest projecte), s'assignaràuna qualificació energètica. D'aquesta manera, es podrà tenir una primera aproximació de laqualificació energètica dels edificis existents, a partir de les seves característiques.Pel que fa a les especificacions, es definirà un edifici unifamiliar aïllat, s'establiran un conjuntd'evolvents, s'especificaran quins espais de l'edifici són habitables i quins no, i es definiranun conjunt d'instal•lacions.L'abast de l'estudi comprendrà els edificis situats a la zona climàtica C2 de la província deGirona. Aquesta zona inclou els edificis que es troben a una alçada del nivell del mar deentre 0 m a 342 m (dins la província de Girona)

Formation of a direct arterial blood supply to the anterior pituitary gland following complete or partial interruption of the hypophyseal portal vessels

If regions of the anterior pituitary gland received systemic blood via a direct arterial blood supply these regions would escape hypothalamic regulation and thus be a sequela in endocrine disorders. Since, in the untreated rat, all of the blood supply to the anterior pituitary gland is via the hypophyseal portal vessels, we hypothesized that partial interruption of the portal vessels could provoke the establishment of a direct arterial blood supply (arteriogenesis). We utilized the injection of polystyrene microspheres (15 or 9 micron diameter) into the left ventricle of the heart to test this hypothesis. Microspheres are trapped in the first capillary plexus they reach since they are too large to traverse the capillaries. No microspheres reached the anterior pituitary gland of control rats, a finding consistent with the fact that the anterior pituitary gland receives all of its blood supply via the hypophyseal portal blood vessels. Microspheres were observed in the primary portal capillary plexus in the infundibulum (median eminence), infundibular stalk (pituitary stalk), and infundibular process (pars nervosa), the first capillary plexus which they reached. A lesion of the medial basal hypothalamus (MBH) which destroyed the long portal vessels did not result in arteriogenesis since few, if any, microspheres were observed in the anterior pituitary gland. We confirmed, using vascular casts, that these lesions resulted in the long-term destruction of the primary portal capillaries in the infundibulum and of the long portal vessels. In MBH-lesioned animals it appears that all of the blood supply of the anterior pituitary gland is via short portal vessels arising from the infundibular stem and process.(ABSTRACT TRUNCATED AT 250 WORDS)

A new ambulatory system for comparative evaluation of the three-dimensional knee kinematics, applied to anterior cruciate ligament injuries

The aim of this study was to develop an ambulatory system for the three-dimensional (3D) knee kinematics evaluation, which can be used outside a laboratory during long-term monitoring. In order to show the efficacy of this ambulatory system, knee function was analysed using this system, after an anterior cruciate ligament (ACL) lesion, and after reconstructive surgery. The proposed system was composed of two 3D gyroscopes, fixed on the shank and on the thigh, and a portable data logger for signal recording. The measured parameters were the 3D mean range of motion (ROM) and the healthy knee was used as control. The precision of this system was first assessed using an ultrasound reference system. The repeatability was also estimated. A clinical study was then performed on five unilateral ACL-deficient men (range: 19-36 years) prior to, and a year after the surgery. The patients were evaluated with the IKDC score and the kinematics measurements were carried out on a 30 m walking trial. The precision in comparison with the reference system was 4.4 degrees , 2.7 degrees and 4.2 degrees for flexion-extension, internal-external rotation, and abduction-adduction, respectively. The repeatability of the results for the three directions was 0.8 degrees , 0.7 degrees and 1.8 degrees . The averaged ROM of the five patients' healthy knee were 70.1 degrees (standard deviation (SD) 5.8 degrees), 24.0 degrees (SD 3.0 degrees) and 12.0 degrees (SD 6.3 degrees for flexion-extension, internal-external rotation and abduction-adduction before surgery, and 76.5 degrees (SD 4.1 degrees), 21.7 degrees (SD 4.9 degrees) and 10.2 degrees (SD 4.6 degrees) 1 year following the reconstruction. The results for the pathologic knee were 64.5 degrees (SD 6.9 degrees), 20.6 degrees (SD 4.0 degrees) and 19.7 degrees (8.2 degrees) during the first evaluation, and 72.3 degrees (SD 2.4 degrees), 25.8 degrees (SD 6.4 degrees) and 12.4 degrees (SD 2.3 degrees) during the second one. The performance of the system enabled us to detect knee function modifications in the sagittal and transverse plane. Prior to the reconstruction, the ROM of the injured knee was lower in flexion-extension and internal-external rotation in comparison with the controlateral knee. One year after the surgery, four patients were classified normal (A) and one almost normal (B), according to the IKDC score, and changes in the kinematics of the five patients remained: lower flexion-extension ROM and higher internal-external rotation ROM in comparison with the controlateral knee. The 3D kinematics was changed after an ACL lesion and remained altered one year after the surgery

Management of Pharyngeal Fistulas After Anterior Cervical Spine Surgery: A Treatment Algorithm for Severe Complications.

STUDY DESIGN:: Retrospective database- query to identify all anterior spinal approaches. OBJECTIVES:: To assess all patients with pharyngo-cutaneous fistulas after anterior cervical spine surgery. SUMMARY OF BACKGROUND DATA:: Patients treated in University of Heidelberg Spine Medical Center, Spinal Cord Injury Unit and Department of Otolaryngology (Germany), between 2005 and 2011 with the diagnosis of pharyngo-cutaneous fistulas. METHODS:: We conducted a retrospective study on 5 patients between 2005 and 2011 with PCF after ACSS, their therapy management and outcome according to radiologic data and patient charts. RESULTS:: Upon presentation 4 patients were paraplegic. 2 had PCF arising from one piriform sinus, two patients from the posterior pharyngeal wall and piriform sinus combined and one patient only from the posterior pharyngeal wall. 2 had previous unsuccessful surgical repair elsewhere and 1 had prior radiation therapy. In 3 patients speech and swallowing could be completely restored, 2 patients died. Both were paraplegic. The patients needed an average of 2-3 procedures for complete functional recovery consisting of primary closure with various vascularised regional flaps and refining laser procedures supplemented with negative pressure wound therapy where needed. CONCLUSION:: Based on our experience we are able to provide a treatment algorithm that indicates that chronic as opposed to acute fistulas require a primary surgical closure combined with a vascularised flap that should be accompanied by the immediate application of a negative pressure wound therapy. We also conclude that particularly in paraplegic patients suffering this complication the risk for a fatal outcome is substantial.

Lésions du ligament croisé antérieur de l'enfant [Anterior cruciate ligament injuries in children].

An increasing number of anterior cruciate ligament injuries are now seen in children and girls seem to be equally affected. Such neglected or untreated lesions could be the cause of early degenerative changes. Recently, many authors support the trend toward early surgical management in skeletally immature patients with complex meniscal tear or recurrent knee instability after proper rehabilitation. Improvement in pediatric knowledge and surgical techniques tend to support a tendency for more surgical treatment in children. The type of management is choosing according to history and physical examination. Magnetic resonance imaging is a useful tool not only for diagnosis but also for surgical treatment planning. We usually recommend anterior cruciate ligament reconstruction in children with knee instability or with further damages to the joint.

Anterior inferior cerebellar artery aneurysms mimicking vestibular schwannomas.

BACKGROUND AND PURPOSE: Unruptured anterior inferior cerebellar artery (AICA) aneurysms are rare but potentially lethal cerebellopontine angle (CPA) lesions that may be misdiagnosed as vestibular schwannomas when they present with vestibulo-cochlear symptoms. METHODS: We report two cases of unruptured but symptomatic AICA aneurysms initially referred to us as atypical vestibular schwannomas requiring surgery. Two discriminant MR features are described. RESULTS: One patient refused treatment. The other was successfully treated by coil occlusion. CONCLUSIONS: Caution is advised before suspecting a CPA mass to be a purely extra-canalicular schwannoma, given its extreme rarity. Deafness and cerebellar ischemia may be prevented if AICA aneurysms are correctly identified preoperatively. In the absence of specific arterial imaging, two MR features may distinguish them from vestibular schwannomas: (1) the absence of internal auditory canal enlargement and (2) the "blurry dot sign," representing blood flow artefacts on pre- and postcontrast studies.

Outcome after proximal femoral fractures during primary total hip replacement by the direct anterior approach.

BACKGROUND: The literature suggests that intraoperative fractures of the greater trochanter and the metaphysis are increased with uncemented stems and the direct anterior approach. This study aims to determine the incidence and assess the functional and radiological outcome after such fractures. METHODS: 484 consecutive total hip replacements (THR) (64 ± 12 years) were analyzed. We treated trochanteric fractures conservatively without any further denuding, and secured metaphyseal fissures with cerclages. Postoperative X-rays and at the latest follow-up were compared to assess secondary fracture displacement and stem subsidence. Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores after 1 year were analyzed. For each patient sustaining a fracture, two patients without fractures were matched in terms of age, body mass index and gender. RESULTS: 13 (2.7 %, 5 male, 68 ± 9 years) patients with intraoperative fractures of the greater trochanter (n = 8) or the metaphysis (n = 5) were analyzed. Consolidation was observed in 7/8 patients sustaining a trochanteric fracture while secondary displacement of the fragment occurred in one case. Stem subsidence was observed in 2/5 cases (5 and 7 mm). Patients who sustained a fracture showed a trend towards poorer WOMAC scores at 1 year postoperatively, compared to patients without fractures. A significantly increased joint stiffness was also observed. CONCLUSION: The intraoperative fracture risk in this series of THR through a direct anterior approach was 2.7 %. Trochanteric fractures do heal without primary fixation. Metaphyseal fractures heal well if immediately stabilized with a cerclage.

Anterior uveitis and cataract after rubella vaccination: a case report of a 12-month-old girl.

Many reports associating uveitis after vaccination have been reported, including 2 cases after measles, mumps, and rubella (MMR) vaccine. We report the case of a 12-month-old girl who developed a unilateral anterior uveitis with rubeosis and cataract 3 months after an MMR vaccination at 9 months of age. Aqueous humor analysis showed the presence of more rubella-specific immunoglobulin G in the affected eye than in the unaffected one. This is the second report showing an association between MMR vaccine and anterior uveitis and the first supported by the presence of intraocular rubella antibodies.