Dr. Guilherme Rocha, Dr. Paulo Ferrara, Dr. Leonardo Torquetti, Dra. Luciene Barbosa analisam os resultados dos implantes de Anel de Ferrara de Arco longo no pós operatório de 6 meses
A multicentric nonrandomized study was conducted in which a new 320-ICRS was placed in 138 eyes of 130 patients with keratoconus. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, corneal volume, asphericity, lines of vision gain/loss, and vectorial analysis were assessed preoperatively and at the final follow-up visit after the procedure.
Purpose: To evaluate the corneal volume (CV) before and after Ferrara intrastromal corneal ring segments (ICRS) implantation and its influence in clinical outcomes in keratoconus patients.
PURPOSE: To evaluate the long-term safety and effica- cy of Ferrara intrastromal corneal ring segments (ICRS) (Ferrara Ring; AJL, Boecillo, Spain) in patients with kera- toconus.
Dr. Guilherme Rocha, Dr. Paulo Ferrara, Dr. Leonardo Torquetti, Dra. Luciene Barbosa analisam os resultados dos implantes de Anel de Ferrara de Arco longo no pós operatório de 6 meses
A multicentric nonrandomized study was conducted in which a new 320-ICRS was placed in 138 eyes of 130 patients with keratoconus. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, corneal volume, asphericity, lines of vision gain/loss, and vectorial analysis were assessed preoperatively and at the final follow-up visit after the procedure.
Purpose: To evaluate the corneal volume (CV) before and after Ferrara intrastromal corneal ring segments (ICRS) implantation and its influence in clinical outcomes in keratoconus patients.
PURPOSE: To evaluate the long-term safety and effica- cy of Ferrara intrastromal corneal ring segments (ICRS) (Ferrara Ring; AJL, Boecillo, Spain) in patients with kera- toconus.
Resultados preliminares do implante de um novo anel associado ao PRK para pre...Ferrara Ophthalmics
Dr. Sandro Coscarelli, Dr. Pablo Rodrigues, Dr. Guilherme Rocha e Dr. Leonardo Torquetti compilaram e compartilham seus resultados com o uso de Segmentos de Anel de Ferrara HM associado ao PRK para a correção da miopia de pacientes com corneas finas e contra indicados para as técnicas de Excimer Laser apenas.
Using a diamond knife, set at 90% of corneal thickness at (90 degrees meridian), at 8 mm optic zone, a radial incision was done and corneal pockets were created. A 6.0 nylon preloaded spatula was then inserted into the corneal pocket and in a counterclockwise direction rotated in 3600 to create a deep stromal tunnel
PURPOSE: To report the clinical outcomes of implantation of a new Ferrara intrastromal corneal ring segment (ICRS) with a 210-degree arc length in eyes with keratoconus.
Doktor Vedat Kaya, Canan Aslı Utine, Sezen Harmancı Karakuş, Işılay Kavadarlı ve Ömer Faruk Yılmaz tarafından hazırlanmış olan bu makaleyi ilginize sunarız.
Corneal opacities in infants and children pose unique
management challenges. Penetrating Keratoplasty (PKP) has been used in order to clear the visual axis and prevent amblyopia, but has been historically associated with high rates of graft failure and other complications
ESCRS14 - Femtosecond Laser Assisted Cataract Surgery With or Without Ophthal...CLINICA REMENTERIA
Clínica Rementería | http://www.cirugiaocular.com
ESCRS 2014 Poster: Femtosecond Laser Assisted Cataract Surgery With or Without Ophthalmic Viscosurgical Devices
Banca delle cornee e trapianto (cheratoplastica) endoteliale: presente e futuroLuca Avoni
Ospedale Maggiore Bologna - Banca Cornee dell’Emilia Romagna: Corso 110 SOI Roma, 30 Novembre 2013. Banca delle cornee e trapianto (cheratoplastica) endoteliale: presente e futuro. Documento a cura del Dottor Luca Avoni.
Utilizzo di una Scheimpflug Camera in Banca Cornee per Pachimetria pre e post...Luca Avoni
Questa Presentazione ha ricevuto l'attestazione di Best Paper in occasione del 12° Congresso Internazionale SOI - Società Oftalmologica Italiana, tenutosi a Milano dal 21 al 24 maggio 2014
La pachimetria corneale (spessore della cornea) nel trapianto endoteliale di cornea (DSAEK) è un esame molto importante sia per la Banca delle Cornee, sia per il chirurgo oculista.
In Banca Cornee è utile per poter scegliere la testina di spessore più idonea per il taglio della cornea con microcheratomo al fine di ottenere lembi endoteliali molto sottili senza perforare la cornea durante il taglio. Al chirurgo è utile per sapere le caratteristiche del lembo endoteliale pretagliato dalla Banca delle Cornee per una ottimizzazione dell'intervento e del post operatorio.
La strumentazione per effettuare la pachimetria in Banca Cornee può essere diversa: scheimpflug camera, OCT della cornea, pachimetri ad ultrasuoni. Ogni strumentazione va testata, verificata e il processo va validato.
Presso la Banca delle Cornee dell'Emilia Romagna si è effettuata una ricerca sull'utilizzo di una scheimpflug camera per ottenere le informazioni sopracitate ottenendo risultati riproducibili e validando il processo. Altre strumentazioni che si valuteranno per la pachimetria corneale saranno i pachimetri ad ultrasuoni.
Contenuto a cura del Dottor Luca Avoni
Resultados preliminares do implante de um novo anel associado ao PRK para pre...Ferrara Ophthalmics
Dr. Sandro Coscarelli, Dr. Pablo Rodrigues, Dr. Guilherme Rocha e Dr. Leonardo Torquetti compilaram e compartilham seus resultados com o uso de Segmentos de Anel de Ferrara HM associado ao PRK para a correção da miopia de pacientes com corneas finas e contra indicados para as técnicas de Excimer Laser apenas.
Using a diamond knife, set at 90% of corneal thickness at (90 degrees meridian), at 8 mm optic zone, a radial incision was done and corneal pockets were created. A 6.0 nylon preloaded spatula was then inserted into the corneal pocket and in a counterclockwise direction rotated in 3600 to create a deep stromal tunnel
PURPOSE: To report the clinical outcomes of implantation of a new Ferrara intrastromal corneal ring segment (ICRS) with a 210-degree arc length in eyes with keratoconus.
Doktor Vedat Kaya, Canan Aslı Utine, Sezen Harmancı Karakuş, Işılay Kavadarlı ve Ömer Faruk Yılmaz tarafından hazırlanmış olan bu makaleyi ilginize sunarız.
Corneal opacities in infants and children pose unique
management challenges. Penetrating Keratoplasty (PKP) has been used in order to clear the visual axis and prevent amblyopia, but has been historically associated with high rates of graft failure and other complications
ESCRS14 - Femtosecond Laser Assisted Cataract Surgery With or Without Ophthal...CLINICA REMENTERIA
Clínica Rementería | http://www.cirugiaocular.com
ESCRS 2014 Poster: Femtosecond Laser Assisted Cataract Surgery With or Without Ophthalmic Viscosurgical Devices
Banca delle cornee e trapianto (cheratoplastica) endoteliale: presente e futuroLuca Avoni
Ospedale Maggiore Bologna - Banca Cornee dell’Emilia Romagna: Corso 110 SOI Roma, 30 Novembre 2013. Banca delle cornee e trapianto (cheratoplastica) endoteliale: presente e futuro. Documento a cura del Dottor Luca Avoni.
Utilizzo di una Scheimpflug Camera in Banca Cornee per Pachimetria pre e post...Luca Avoni
Questa Presentazione ha ricevuto l'attestazione di Best Paper in occasione del 12° Congresso Internazionale SOI - Società Oftalmologica Italiana, tenutosi a Milano dal 21 al 24 maggio 2014
La pachimetria corneale (spessore della cornea) nel trapianto endoteliale di cornea (DSAEK) è un esame molto importante sia per la Banca delle Cornee, sia per il chirurgo oculista.
In Banca Cornee è utile per poter scegliere la testina di spessore più idonea per il taglio della cornea con microcheratomo al fine di ottenere lembi endoteliali molto sottili senza perforare la cornea durante il taglio. Al chirurgo è utile per sapere le caratteristiche del lembo endoteliale pretagliato dalla Banca delle Cornee per una ottimizzazione dell'intervento e del post operatorio.
La strumentazione per effettuare la pachimetria in Banca Cornee può essere diversa: scheimpflug camera, OCT della cornea, pachimetri ad ultrasuoni. Ogni strumentazione va testata, verificata e il processo va validato.
Presso la Banca delle Cornee dell'Emilia Romagna si è effettuata una ricerca sull'utilizzo di una scheimpflug camera per ottenere le informazioni sopracitate ottenendo risultati riproducibili e validando il processo. Altre strumentazioni che si valuteranno per la pachimetria corneale saranno i pachimetri ad ultrasuoni.
Contenuto a cura del Dottor Luca Avoni
DSAEK - Congresso SITRAC (Società italiana trapianto di cornea) 20 Febbraio 2014Luca Avoni
Il trapianto di cornea (cheratoplastica) endoteliale (EK) è una tecnica chirurgica in costante ascesa numerica. La letteratura internazionale ha dimostrato la validità dei lembi endoteliali pretagliati dalle Banche delle Cornee. Sempre più frequentemente i chirurghi richiedono alle Banche delle cornee lembi endoteliali pretagliati.
Durante il congresso SITRAC (società italiana trapianto di cornea) 2014 è stata presentata l'esperienza della Banca delle cornee dell'Emilia Romagna del primo anno in cui sono stati forniti i lembi endoteliali pretagliati per trapianto endoteliale DSAEK.
Correzione astigmatismo post cheratoplastica (PK, DALK)Luca Avoni
L’astigmatismo (cornea con due diverse curvature e quindi l’immagine con due diversi fuochi) è una condizione molto frequente dopo trapianto di cornea sia perforante (PK) che lamellare (DALK) e per consentire una corretta visione del paziente si deve tendere alla correzione di questo vizio refrattivo.
Le possibilità di correzione sono varie e possono essere utilizzate a seconda dell’entità dell’astigmatismo e della fase post chirurgica nella quale ci troviamo.
Si può correggere con occhiali, lenti a contatto, ridistribuendo la tensione delle suture, con incisioni chirurgiche sulla cornea, col laser ad eccimeri, con l’utilizzo di lenti intraoculari toriche.
Describes the procedure of ReLEx smile, and illustrates why it is likely to replace excimer laser LASIK over time. For more details, visit www.newvisionindia.com
Comparative Study of Visual Outcome between Femtosecond Lasik with Excimer La...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Background: Nowadays, ICRS are a step in the treatment of keratoconus. The purpose of this study was to evaluate the refractive effect and the tomographic and biomechanical parameters in keratoconus patients implanted with Ferrara ICRS, and their stability after 18 months.
Recent advances in prosthodontics / crown & bridge courses by indian dental a...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
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Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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PURPOSE: To evaluate the clinical outcomes of implantation of Ferrara intrastromal corneal ring segments (ICRS) in patients with corneal ectasia after refractive surgery.
One way to optimize Corneal Cross linking (CXL) !! DiyarAlzubaidy
Ophthalmology Lectures: Corneal crosslinking is the only way approved to stop progression of Keratoconus,,let's review the old & new methods of crosslinking
Similar to Tessuti per DSAEK: le aspettative del chirurgo (20)
Banca delle cornee 2014 - Relazione del Dottor Luca AvoniLuca Avoni
La Banca delle cornee ha il compito di analizzare, processare, conservare e distribuire i tessuti per trapianto in campo oculistico.
Relazione del Dottor Luca Avoni presentata al convegno "Le Banche dei Tessuti e delle Cellule nel Sistema Sanitario Nazionale: esperienze in Regione Emilia-Romagna" tenutosi a Cesena il 4 ottobre 2014.
Work up sulle distrofie corneali stromaliLuca Avoni
Le distrofie corneali sono un gruppo di malattie corneali accomunate dal fatto di essere geneticamente determinate e si caratterizzano per alterazioni strutturali della cornea. Le distrofie corneali a seconda della loro sede possono essere classificate in epiteliali (ad esempio Meesman e Reis-Bucklers) stromali (ad esempio maculare, granulare e lattice) ed endoteliali (ad esempio Fuchs, CHED).
La diagnosi è clinica è può essere completata con OCT cornea, confoscan, esami genetici.
La terapia è diversa a seconda della distrofia, in alcuni casi è sufficiente una PTK (cheratectomia fototerapeutica con laser ad eccimeri) in altri è necessaria una cheratoplastica lamellare (anteriore o endoteliale) in altri casi ancora una cheratoplastica (trapianto di cornea) perforante. Documento a cura del Dottor Luca Avoni.
L'intervento di cataratta ha una storia lunghissima, dagli Egizi fino ai giorni nostri, con numerose evoluzioni e scoperte che ne hanno rivoluzionato le caratteristiche.
L'intervento di cataratta può essere effettuato con diverse tecniche: estrazione intracapsulare (ICCE), si asporta il cristallino in toto, è necessario un'ampio taglio e non si ha il supporto capsulare per impiantare il nuovo cristallino artificiale (IOL) che deve essere impiantato a fissazione iridea o sclerale; estrazione extracapsulare, si asporta il cristallino in toto o frammentato lasciando un supporto capsulare per l'impianto della IOL; facoemulsificazione, attraverso l'utilizzo di ultrasuoni si frammenta e si aspira il cristallino attraverso microincisioni e si impianta poi la IOL nel sacco capsulare.
Nei Paesi industrializzati l'intervento di facoemulsificazione è il gold standard, mentre nei Paesi in via di sviluppo l'intervento di estrazione extracapsulare è il più diffuso soprattutto per valutazioni di tipo economico.
Il cheratocono è una malattia della cornea che generalmente ha un esordio in età giovanile, in alcuni casi anche infantile. Più l'esordio è precoce, più c'è il rischio di una progressione verso stadi avanzati. In età pediatrica è quindi molto importante una diagnosi precoce del cheratocono per poter effettuare un cross linking qualora vi siano le indicazioni. In questo modo si può stabilizzare il cheratocono e cercare di evitare progressioni. Documento a cura del Dottor Luca Avoni
Laser Banca delle cornee Emilia-Romagna - Congresso SITRAC (Società italiana ...Luca Avoni
Il trapianto di cornea (cheratoplastica) endoteliale è ormai il gold standard per la maggior parte delle malattie corneali con indicazione di trapianto nelle quali l'endotelio (strato più interno della cornea) non funziona correttamente.
La letteratura internazionale evidenzia gli indubbi vantaggi di tale tecnica e il crescente numero di interventi effettuati a livello mondiale.
Tra le indicazioni più frequenti di questo intervento sono la cheratopatia bollosa e la distrofia corneale endoteliale di Fuchs.
La ricerca è particolarmente attenta allo sviluppo di questa metodica di trapianto corneale per migliorare i risultati. Le direzioni sono varie, dall'UTDSAEK (ultra thin DSAEK che prevede la creazione di lembi endoteliali particolarmente sottili per poi impiantarli) alla DMEK che prevede l'impianto del solo endotelio-descemet.
Altra linea di ricerca è il trattamento della cornea con laser ad eccimeri prima del taglio col microcheratomo al fine di ottenere lembi endoteliali sottili e a facce parallele.
Presentazione del Dottor Luca Avoni in occasione del XVII Congresso Interdisciplinare Età, Lavoro, Alimentazione e Visione - Bologna 9 e 10 febbraio 2014.
I problemi di dry eye (occhio secco) sono diventati ormai una significativa realtà clinica con la quale l'oculista ogni giorno deve confrontarsi. Molti pazienti riferiscono sovente di avere la sensazione di occhio secco e chiedono allo specialista cosa possono fare. Dai dati epidemiologici presenti in letteratura risulta che oltre il 30% delle persone con età superiore ai 50 anni ha o avrà episodi sintomatologici di dry eye. Il fenomeno è talmente diffuso che ogni anno in Italia sono milioni i prodotti che vengono venduti per alleviare questi sintomi. E' importante pertanto analizzare in maniera approfondita questa sintomatologia quando riferita per un opportuno inquadramento diagnostico terapeutico.
La degenerazione maculare senile è l'invecchiamento della parte centrale della retina, la principale causa di cecità in Occidente.
Per informazioni sul documento: tinyurl.com/pnat2m5
Le occlusioni venose retiniche sono caratterizzate dall’ostruzione della circolazione di una vena retinica con formazione di emorragie retiniche e possibile formazione di aree ischemiche e/o di edema maculare. La diagnosi è basata sulla clinica sulla fluorangiografia e sull’OCT. Si deve sempre effettuare un inquadramento sistemico del paziente. La terapia oculistica si avvale dell’argon laser retinico e di farmaci intraviterali.
Le occlusioni arteriose retiniche sono caratterizzate dall’ostruzione della circolazione di una arteria retinica con ischemia retinica corrispondente all’area di mancata irrorazione sanguigna. La diagnosi è clinica, si può effettuare una fluorangiografia e un OCT. Si deve sempre effettuare un inquadramento sistemico del paziente. La terapia deve essere tempestiva.
Per informazioni sul documento: tinyurl.com/powk8rc
La terapia per il cheratocono ieri e oggi: indicazioni per il cross-linking corneale, modificazioni istologiche. Documento a cura del Dr. Luca Avoni. http://lucaavoni.com/default.aspx
Definizione, eziopatogenesi, teoria di Wilson, ipotesi di patogenesi, classificazione, segni clinici, caratteristiche biomicroscopiche del cheratocono.
Irregular Astigmatism after DSAEK in case of Congenital Hereditary Endothelial Distrophy with Intrastromal Vacuolization - L. Avoni, L. Cappuccini, M. Busin
Trattamento mediante sostituti lacrimali della sindrome da occhio secco margi...Luca Avoni
La "Sindrome da Occhio Secco" rappresenta un disturbo molto diffuso ma allo stesso tempo poco conosciuto. In Contattologia tale sindrome è spesso la causa del "drop-out" delle lenti a contatto (LaC) e studi recenti hanno affermato che i portatori di LaC riportano più frequentemente sintomi di discomfort oculare, irritazione, secchezza, sensazione di corpo estraneo e fastidio rispetto ai non portatori. Documento a cura di Pietro Gheller Optometrista Contattologo e del Dott. Luca Avoni Medico Chirurgo Oculista
Il Cheratocono è una patologia degenerativa non infiammatoria della cornea, ad eziologia incerta, che compare generalmente nell’età della pubertà. Il Cross-Linking corneale è una tecnica parachirurgica che consiste nella foto-polimerizzazione delle fibre del collagene stromale della cornea grazie all’effetto combinato di una sostanza fotosensibile (Ribloflavina o Vitamina B2) irradiata con radiazioni UV-A1 previa asportazione dell’epitelio corneale. Documento a cura del Dott. Luca Avoni, Medico Chirurgo Oculista, e Edoardo Marani, Optometrista.
La miopia: non un fatto irreversibile ma uno stile di vitaLuca Avoni
La miopia è un difetto refrattivo legato, in genere, all'allungamento del bulbo oculare. Il sintomo prevalente è la perdita esponenziale di quantità e qualità visiva da lontano: è sufficiente mezza diottria di miopia per non riuscire più a leggere quattro righe della tavola ottotipica (visus 6/10). Prevenire la miopia si può?
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
Tessuti per DSAEK: le aspettative del chirurgo
1. Dott. Luca Avoni
Ospedale Maggiore di Bologna
Banca delle Cornee dell’Emilia Romagna
SIBO , GENOVA 21 /04/2012
2. SURGEON-DISSECTED PRECUT TISSUE FOR
DESCEMET’ S STRIPPING AUTOMATED
ENDOTHELIAL KERATOPLASTY
SURGEON-PREPARED TISSUE FOR DESCEMET’ S
STRIPPING AUTOMATED ENDOTHELIAL
KERATOPLASTY
- STANDARD PROCEDURE WITH
MICROKERATOME FOR DSAEK
- “ULTRA-THIN" (UT) DSAEK
- FEMTOSECOND LASER-ASSISTED TISSUE
PREPARATION ( WITH OR WITHOUT HYP-SCL
3. Descemet's stripping automated endothelial
keratoplasty (DSAEK) tissue
preparation with femtosecond laser and
contact lens
5. The UT graft is created with two microkeratome
passes, the first one to debulk the donor tissue and the
second one to cut down the final thickness to about
100 micrometers. This is an easy-to-perform and
widely applicable procedure to obtain reproducible
results with the use of the microkeratome
6. Anterior OCT image of a donor cornea after preparation for UTDSAEK. The white arrows indicate the site of the first cut, the
yellow arrows the site of the second pass
7. FIRST CUT : remove approximately 2/3 of the anterior
stroma, using a disposable 300- or 350-micrometer
cutting head, which should be passed for at least 4
seconds.
SECOND CUT :The second cut (the refinement cut) is
made with a 90- to 200-micrometer microkeratome
head, depending on the tissue thickness, with the goal
of ultimately creating a graft that is approximately 100
micrometers or less (see guidelines in table below).
8. <150 micrometers
No second cut
Between 150 and 180 micrometers
Use 50 micrometers
Between 180 and 210 micrometers
Use 90 micrometers
Between 210 and 230 micrometers
Use 110 micrometers
Between 230 and 250 micrometers
Use 130 micrometers
With the ultra-thin procedure, the speed of visual recovery is faster than
conventional DSAEK and equivalent to DMEK—and the proportion of patients
who achieve final acuity of 20/20 is higher than conventional DSAEK and
perhaps also DMEK. In short, this procedure offers the potential to achieve the
visual results of DMEK with the ease of handling and tissue preparation of
DSAEK.
*EYEWORLD : ASCRS 2012
10. Preparation of donor tissue is performed under a
laminar flow hood in the eye bank at our institution by
the surgeon approximately 1-2 hours prior to DSAEK
surgery. The entire procedure utilizes sterile
technique and complies with Association of Operating
Room Nurses (AORN)/Eye Bank Association of
America (EBAA) regulations. The eye bank staff then
delivers the tissue to the hospital for use at the time of
the procedure.
Jay C. Bradley, MD1; David L. McCartney, MD1
Dept of Ophthalmology & Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas, USA1
11. Significant debate and study has gone into addressing
the issue of precut tissue for Descemet’s stripping
automated endothelial keratoplasty (DSAEK) surgery
and its comparison with surgeon-prepared tissue*-**
Price MO, Price FW Jr, Stoeger C, et al. Central thickness variation in precut DSAEK donor grafts. J Cataract Refract
Surg. 2008;34(9):1423-4
Kitzmann AS, Goins KM, Reed C, et al. Eye bank survey of surgeons using precut donor tissue for descemet stripping
automated endothelial keratoplasty. Cornea. 2008;27(6):632-3.
12. . Although published literature has shown eye bank
pre-cut tissue to be comparable to tissue dissected at
the time of surgery, surgeons continue to have
concerns about varying quality of tissue preparation
between different institutions. .
Possible tissue collapse on the artificial anterior
chamber, decentration of the microkeratome cut, loss
of tissue marking, lack of anterior cap adherence to
posterior lamella, anterior edge undermining, and
other tissue preparation problems continue to keep
some surgeons from moving to exclusively precut
tissue.
•Kitzmann AS, Goins KM, Reed C, et al. Eye bank survey of surgeons using precut donor tissue for
descemet stripping automated endothelial keratoplasty. Cornea. 2008;27(6):632-3.
13. In a prior surgeon survey of tissue from a single eye
bank used in 197 DSAEK surgeries, donor tissue
preparation difficulties occurred in 10% of cases and
the tissue was found to be unacceptable in 2%.
Due to these issues and the poor reimbursement for
intra-operative tissue preparation, it is necessary to
develope an efficient mechanism for surgeon-dissected
precut tissue for our DSAEK patients.
•Kitzmann AS, Goins KM, Reed C, et al. Eye bank survey of surgeons using precut donor tissue
for descemet stripping automated endothelial keratoplasty. Cornea. 2008;27(6):632-3.
14. Methods:
The procedure is performed under a laminar flow hood in the eye bank
at our institution by the surgeon approximately 1-2 hours prior to DSAEK
surgery. Preparation of donor tissue using a Moria CB microkeratome and
artificial chamber system has been previously described3. Necessary
instrumentation is assembled by an eye bank technician who also assists
during tissue preparation. The entire procedure utilizes sterile technique and
complies with Association of Operating Room Nurses (AORN)/Eye Bank
Association of America (EBAA) regulations. Proper tissue preparation is
confirmed by the surgeon. A 350 micron microkeratome head is used for all
pachymetry measurements without epithelium of 550 microns or more.
Alternatively, a 300 micron head is used. The periphery of the microkeratome
cut is marked anteriorly using a single use sterile marking pen to allow proper
centration during corneal trephination in the operating room. After the free
anterior stromal cap is replaced, the surgeon-cut tissue is placed back in
storage media, the container is resealed, and the eye bank staff then delivers
the tissue to the hospital for use at the time of the procedure.
15. The described protocol allows donor tissue preparation for
DSAEK surgery in an efficient and optimally sterile
environment.
It eliminates surgeon concern regarding the quality of
tissue preparation.
Since institution of this protocol, a total of 32 lamellar cuts
have been performed and no complications have been
encountered during tissue preparation or peri-operatively.
In institutions with an eye bank within a reasonable
proximity to the operating room, this protocol could be
easily instituted to ensure proper tissue preparation and
maximize surgical reimbursement.
16. Esterna+ spessa meno nell’ultrathin
Taglio 300
Laser eccimeri spessore uniforme
Vantaggio no variazione sferica
18. Di diversa geometria su richiesta del chirurgo
Non ancora disponibile
Device in via di sviluppo
Conservazione?
Risultati
Vantaggi: no punch e carico
19. DSAEK tissue was prepared from 11 cadaveric porcine
eyes. A femtosecond laser was used to create 400microm flaps, with or without a Hyp-SCL, after which
the eyes were imaged with anterior segment optical
coherence tomography. The ratio of the mean central
thickness (C) to the mean peripheral thickness (P) was
calculated using the flap tool.
Cornea. 2010 Jan;29(1):93-8
20. Lembi sempre meno spessi
Geometria sempre più regolare
Facilità di utilizzo
21.
22. The dsaek procedures have the unwanted effect of a
higher hyperopic shift ( approximately + 1 diopter).
Although there is no definitive evidence implicating a
specific factor, a recent study using anterior segment
optical coooherence tomography ( AS-OCT ) revealed
that there was a significant correlation between the
corneal donor lenticle C:P ratio ( the ratio of the
average Central graft thickeness to the average of the
peripheral graft thickness at 3 mm ) and the
postoperative hyperopic shift.
Cornea. 2010 Jan;29(1):93-8
23. Current DSAEK tissue preparation methods result in a
concave-shaped lenticle with a C:P ratio of less than 1.
Based on this correlation , DSAEK donor tissue in a
planar configuration with a C:P ratio of 1 would be
desirable to prevent a refractive surprise.
Placing a hyperopic soft contact lens on a eye , increase
donor central thickeness before a femtosecond laser
was applied to cut a flap
Theoretically, this wuold result in a concave-shaped
anterior corneal flap and a DSAEK donor lenticle that
was more planar with a C:P ratio closer to 1.
Cornea. 2010 Jan;29(1):93-8
25. Eleven eyes were cut (5 without, 5 with, and 1 without
and with a Hyp-SCL). In all corneas, the cut interfaces
were visualized by anterior segment optical coherence
tomography.
The C:P ratios calculated for DSAEK tissue made
without (mean 0.998, range 0.965-1.02, SD = 0.0195)
and with (mean 1.02, range 0.986-1.05, SD = 0.0250) a
Hyp-SCL did not show significance (P =0.07).
Cornea. 2010 Jan;29(1):93-8
26. Combining a femtosecond laser and a Hyp-SCL may
aid in the creation of planar donor tissue for DSAEK.
Clinically, this could reduce the amount of
postoperative hyperopic shift, although further human
corneal studies are warranted
Cornea. 2010 Jan;29(1):93-8