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Fedele Passidomo,1 Giuseppe Addabbo,1 Francesco Pignatelli,1 Alfredo Niro,1 Rosa Buonamassa2 1Eye Clinic, “SS. Annunziata” Hospital, ASL Taranto, Taranto, Italy; 2Eye Clinic, P.O. “Madonna delle Grazie”, Matera, ItalyCorrespondence: Fedele Passidomo, Eye Clinic, “SS. Annunziata” Hospital, ASL Taranto, Via Francesco Bruno, 1, Taranto, 74121, Italy, Tel +393288569125, Email dotpaoli@yahoo.itPurpose: To report a case of Calcific Band Keratopathy (CBK) treated successfully with transepithelial Phototherapeutic keratectomy (PTK) combined with customized Photorefractive Keratectomy (PRK).Methods: One case report.Results: A 63-year-old man presented to our clinic with decreased visual acuity and ocular discomfort in both eyes. Clinical examination revealed a horizontal gray-whitish band across the central cornea in both eyes, supporting the diagnosis of CBK. Initially, an EDTA chelating procedure was attempted, but it had no effect on the deeper calcium deposits and on the irregular corneal morphology. In both eyes, a topography-guided trans-epithelial PRK with PTK was performed. Following PRK surface ablation, PTK was used to smooth the ablated area using 1% hydroxymethylcellulose as masking agent. The procedure was completed applying 0.02% Mitomycin C. At the 1-month follow-up, both eyes corneal opacities were resolved, and the LE visual acuity had improved to 20/63 and the RE to 20/20, which was maintained at the 3-, 6-, and 12-months follow-up. Furthermore, there was an improvement in spherical equivalent and corneal morphological irregularity index.Conclusion: CBK may be successfully treated using a combined topography-guided trans-epithelial PRK and PTK.Keywords: calcific band keratopathy, corneal degenerations, phototherapeutic keratectomy, topography-guided photorefractive keratectomy

Francesco Pignatelli,1 Fedele Passidomo,1 Rosa Buonamassa,2 Alfredo Niro,1 Giuseppe Addabbo1 1Eye Clinic, “SS. Annunziata” Hospital, ASL Taranto, Taranto, Italy; 2Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, ItalyCorrespondence: Fedele Passidomo, Eye Clinic, “SS. Annunziata” Hospital, ASL Taranto, Via Francesco Bruno, 1, Taranto, 74121, Italy, Tel +39 3288569125, Email dotpaoli@yahoo.itPurpose: To report morphologic and functional changes after topography-guided trans-epithelial photorefractive keratectomy (PRK) combined with phototherapeutic keratectomy (PTK) for recalcitrant recurrent corneal erosions in Lattice Corneal Dystrophy (LCD).Methods: One case report.Results: A 78-year-old man presented us with decreased visual acuity [20/100 in right eye (RE), and 20/400 in left eye (LE)], and redness with foreign body sensation in both eyes. Clinical examination revealed epithelial erosions, and linear stromal opacities involving the center of the cornea in both eyes, supporting the diagnosis of LCD. Several medical approaches including autologous serum, amniotic membrane extract, and nerve growth factor eye drops allowed a temporary improvement in symptoms. A single-step topography-guided trans-epithelial PRK combined with PTK (CIPTA® 2 software, iVis Technologies) was performed in both eyes. After surface ablation using PRK, PTK was performed using masking agents (1% hydroxy-methylcellulose) to smooth the ablated surface. Subsequently, 0.02% Mitomycin C was applied over the ablated surface. At the 3-month follow-up, a resolution of corneal erosions, and stromal opacities were observed in both eyes, with a visual improvement to 20/25 in the RE and 20/50 in the LE. Furthermore, spherical equivalent, keratometric astigmatism, and corneal morphological irregularity index improved.Conclusion: Recalcitrant corneal erosions and stromal opacities in LCD may be successfully treated using combined topography-guided trans-epithelial PRK and PTK.Keywords: corneal dystrophy, recurrent corneal erosions, phototherapeutic keratectomy, topography-guided photorefractive keratectomy

Samuele Gigliola,1 Giancarlo Sborgia,1 Alfredo Niro,2 Carmela Palmisano,1 Pasquale Puzo,1 Gianluigi Giuliani,1 Luigi Sborgia,1 Valentina Pastore,1 Alessandra Sborgia,2 Giovanni Alessio1 1Eye Clinic, Depatment of Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy; 2Eye Clinic, Hospital “S. G. MOSCATI”, ASL TA, Taranto, ItalyCorrespondence: Alfredo NiroEye Clinic, Hospital “S. G. MOSCATI,” ASL TA, Via per Martina Franca, Statte, Taranto, 74010, ItalyEmail alfred.nir@tiscali.itIntroduction: We described a one-handed rotational phacoemulsification technique to decrease phaco time and power, and surgical stress on the cornea in eyes with different types of cataract.Methods: In this technique a single sutureless corneal incision was made without any side-port incision. After hydrodissection and hydrodelamination were performed, a phaco tip was positioned in contact with the nucleus beside the capsulorhexis edge. By using a peristaltic pump, phacoemulsification was started with high levels of vacuum to keep the probe tip on the edge of the lens and to ensure the rotation of the nucleus, and with low ultrasound energy. The torsional mode used required less occlusion time and volume of fluid. The inclination of the tip was modified to 45-degree, directing it toward the lens center. So the nucleus was aspirated from the periphery toward the center by a rotational movement.Results: The eye in the technical video had a NC4-NO4 cataract. The preoperative vision in this eye was 20/100 with no improvement with refraction. On postoperative day 1, visual acuity had improved to 20/20. We recorded low intraoperative parameters including ultrasound time (21.4 sec), phacoemulsification power (73%), balanced salt solution used (31 mL) and cumulative dissipated energy (7.27) at the conclusion of the case. After 1 month, Central Corneal Thickness changed from 504 μm to 516 μm, and Endothelial Cell Loss was 1.15%.Conclusion: This technique uses a single clear corneal incision, high vacuum and low ultrasound power to reduce the exposition to excessive surgical maneuvers, fluid turbulence and ultrasound energy.Keywords: cataract surgery, single corneal incision, one-handed phacoemulsification, phaco-rolling

Understanding forest water limitation during droughts within a warming climate is essential for accurate predictions of forest-climate interactions. In hyperdiverse ecosystems like the Amazon forest, the mechanisms shaping hysteresis patterns in transpiration relative to environmental factors are not well understood. From this perspective, we investigated these dynamics by conducting in situ leaf-level measurements throughout and after the 2015 El Niño-Southern Oscillation (ENSO) drought. Our findings indicate a substantial increase in the hysteresis area (Harea) among transpiration (E), vapor pressure deficit (VPD), and stomatal conductance (gs) at canopy level during the ENSO peak, attributed to both temporal lag and differences in magnitude between gs and VPD peaks. Specifically, the canopy species Pouteria anomala exhibited an increased Harea, due to earlier maximum gs rates leading to a greater temporal lag with VPD compared to the post-drought period. Additionally, leaf water potential (ΨL) and canopy temperature (Tcanopy) showed larger Harea during the ENSO peak compared to post-drought conditions across all studied species, suggesting that stomatal closure, particularly during the afternoon, acts to minimize water loss and may explain the counterclockwise hysteresis observed between ΨL and Tcanopy. The pronounced Harea during the drought points to a potential imbalance between water supply and demand, underlining the role of stomatal behavior of isohydric species in response to drought.

This work aims at investigating the effect of NO2 absorption on aerosol-optical-depth (AOD) measurements and Ångström exponent (AE) retrievals of sun photometers by the synergistic use of accurate NO2 characterization for optical-depth estimation from co-located ground-based measurements. The analysis was performed for ∼ 7 years (2017–2023) at several sites worldwide for the AOD measurements and AE retrievals by Aerosol Robotic Network (AERONET) sun photometers which use OMI (Ozone Monitoring Instrument) climatology for NO2 representation. The differences in AOD and AE retrievals by NO2 absorption are accounted for using high-frequency columnar NO2 measurements by a co-located Pandora spectroradiometer belonging to the Pandonia Global Network (PGN). NO2 absorption affects the AOD measurements in UV-Vis (visible) range, and we found that the AOD bias is the most affected at 380 nm by NO2 differences, followed by 440, 340, and 500 nm, respectively. AERONET AOD was found to be overestimated in half of the cases, while also underestimated in other cases as an impact of the NO2 difference from “real” (PGN NO2) values. Overestimations or underestimations are relatively low. About one-third of these stations showed a mean difference in NO2 and AOD (at 380 and 440 nm) above 0.5 × 10−4 mol m−2 and 0.002, respectively, which can be considered a systematic contribution to the uncertainties in the AOD measurements that are reported to be of the order of 0.01. However, under extreme NO2 loading scenarios (i.e. 10 % highest differences) at highly urbanized/industrialized locations, even higher AOD differences were observed that were at the limit of or higher than the reported 0.01 uncertainty in the AOD measurement. PGN NO2-based sensitivity analysis of AOD difference suggested that for PGN NO2 varying between 2 × 10−4 and 8 × 10−4 mol m−2, the median AOD differences were found to rise above 0.01 (even above 0.02) with the increase in NO2 threshold (i.e. the lower limit from 2 × 10−4 to 8 × 10−4 mol m−2). The AOD-derivative product, AE, was also affected by the NO2 correction (discrepancies between the AERONET OMI climatological representation of NO2 values and the real PGN NO2 measurements) on the spectral AOD. Normalized frequency distribution of AE (at 440–870 and 340–440 nm wavelength pair) was found to be narrower for a broader AOD distribution for some stations, and vice versa for other stations, and a higher relative error at the shorter wavelength (among the wavelength pairs used for AE estimation) led to a shift in the peak of the AE difference distribution towards a higher positive value, while a higher relative error at a lower wavelength shifted the AE difference distribution to a negative value for the AOD overestimation case, and vice versa for the AOD underestimation case. For rural locations, the mean NO2 differences were found to be mostly below 0.50 × 10−4 mol m−2, with the corresponding AOD differences being below 0.002, and in extreme NO2 loading scenarios, it went above this value and reached above 1.00 × 10−4 mol m−2 for some stations, leading to higher AOD differences but below 0.005. Finally, AOD and AE trends were calculated based on the original AERONET AOD (based on AERONET OMI climatological NO2), and its comparison with the mean differences in the AERONET and PGN NO2-corrected AOD was indicative of how NO2 correction could potentially affect realistic AOD trends.

As one of the world's largest archipelagic nations, Indonesia faces a major challenge in distributing its wealth, including basic infrastructure such as electricity and internet, to some of its most remote islands. Due to its remote location, most people in this area live in poverty and have poor-quality education. To help solve this problem, an offline digital library was created based on a Raspberry Pi 'minicomputer.' With the ability to store more than 2,500 educational movies and e-books for offline viewing, the device has proven to be reliable even in areas with unpredictable power., INTRODUCTION Indonesia is an archipelago consisting of thousands of islands. Unfortunately, many of these islands and regions still live in poverty. Despite recent economic growth and development in Indonesia, poverty [...]

Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease soon to become the second leading cause of cancer deaths in the US. Beside surgery, current therapies have narrow clinical benefits with systemic toxicities. FOLFIRINOX is the current standard of care, one component of which is 5- Fluorouracil (5-FU), which causes serious gastrointestinal and hematopoietic toxicities and is vulnerable to resistance mechanisms. Recently, we have developed polymeric fluoropyrimidines (F10, CF10) which unlike 5-FU, are, in principle, completely converted to the thymidylate synthase inhibitory metabolite FdUMP, without generating appreciable levels of ribonucleotides that cause systemic toxicities while displaying much stronger anti-cancer activity. Here, we confirm the potency of CF10 and investigate enhancement of its efficacy through combination with inhibitors in vitro targeting replication stress, a hallmark of PDAC cells. CF10 is 308-times more potent as a single agent than 5-FU and was effective in the nM range in primary patient derived models. Further, we find that activity of CF10, but not 5-FU, is enhanced through combination with inhibitors of ATR and Wee1 that regulate the S and G2 DNA damage checkpoints and can be reversed by addition of dNTPs indicative of CF10 acting, at least in part, through inducing replication stress. Our results indicate CF10 has the potential to supersede the established benefit of 5-FU in PDAC treatment and indicate novel combination approaches that should be validated in vivo and may be beneficial in established regimens that include 5-FU.

Background: This study determined pooled estimates of short- and long-term complications of early versus delayed implantation of penile prosthesis in patients with ischemic priapism. Methods: We searched Pubmed, ProQuest, Scopus, EBSCOHost, and other sources from January 1, 2013, to March 2023. All study designs were included except animal studies, review articles, and consensus documents. Of the 214 articles, four studies were included in the systematic review, and further meta-analysis included three studies (PROSPERO CRD42023411005). Results: The short-term complication rate was lower with early implantation than with later implantation (β= -2.08; 95% Confidence Interval [CI] = -3.54, -0.6; p = < 0.05). A similar value was also found in the pooled analysis for long-term outcomes, defined as overall satisfaction rate, which is better with early implantation than later (β = 2.18; 95% CI = 1.35, 3.02; p= < 0.05). Conclusions: The results of the pooled analysis confirmed that short-term complications were significantly lower with early implantation than with delayed implantation. Overall satisfaction rates were higher in early implantation than in delayed implantation of penile prostheses.

As one of the world's largest archipelagic nations, Indonesia faces a major challenge in distributing its wealth, including basic infrastructure such as electricity and internet, to some of its most remote islands. Due to its remote location, most people in this area live in poverty and have poor-quality education. To help solve this problem, an offline digital library was created based on a Raspberry Pi "minicomputer." With the ability to store more than 2,500 educational movies and e-books for offline viewing, the device has proven to be reliable even in areas with unpredictable power. [ABSTRACT FROM AUTHOR]

Background and Aims: We aimed to characterize the epidemiologic and comorbidities profiles of patients with chronic Hepatitis D (CHD) followed in clinical practice in Italy and explored their interferon (IFN) eligibility. Methods: This was a cross-sectional study of the PITER cohort consisting of consecutive HBsAg-positive patients from 59 centers over the period 2019-2023. Multivariable analysis was performed by logistic regression model. Results: Of 5492 HBsAg-positive enrolled patients, 4152 (75.6%) were screened for HDV, 422 (10.2%) were anti-HDV positive. Compared with HBsAg mono-infected, anti-HDV positive patients were more often younger, non-Italians, with a history of drug use, had elevated alanine transaminase (ALT), cirrhosis, or hepatocellular carcinoma (HCC). Compared with Italians, anti-HDV positive non-Italians were younger (42.2% age ≤ 40 years vs. 2.1%; P < 0.001), more often females (males 43.0% vs. 68.6%; P < 0.001) with less frequent cirrhosis and HCC. HDV-RNA was detected in 63.2% of anti-HDV-positive patients, who were more likely to have elevated ALT, cirrhosis, and HCC. Extrahepatic comorbidities were present in 47.4% of anti-HDV positive patients and could affect the eligibility of IFN-containing therapies in at least 53.0% of patients in care. Conclusions: CHD affects young, foreign-born patients and older Italians, of whom two-thirds had cirrhosis or HCC. Comorbidities were frequent in both Italians and non-Italians and impacted eligibility for IFN.

RESUMEN La insuficiencia mitral funcional auricular (IMFA) ha sido recientemente el foco de atención de muchos artículos y revisiones originales. El envejecimiento de la población, el aumento de la prevalencia de insuficiencia cardiaca con fracción de eyección preservada y fibrilación auricular así como el desarrollo de las técnicas transcatéter para la reparación de la válvula mitral han resaltado la IMFA, un fenotipo de insuficiencia mitral que presenta desafíos diagnósticos específicos y para el cual actualmente las guías no tienen recomendaciones sólidas para su tratamiento. Existe una importante acumulación de datos que sugieren que el pronóstico de los pacientes con IMFA grave es malo si no se tratan. Sin embargo, las nuevas terapias para la insuficiencia cardiaca y las técnicas mínimamente invasivas pueden tener un impacto positivo en el prognóstico de esos pacientes.

ABSTRACT Atrial functional mitral regurgitation (AFMR) has recently been the focus of numerous original articles and reviews. This entity has been highlighted by population aging, the increasing prevalence of heart failure with preserved ejection fraction and atrial fibrillation, and the advent of the transcatheter techniques for mitral valve repair. AFMR is phenotype of mitral regurgitation that presents specific diagnostic challenges and current guidelines do not provide strong recommendations for its management. Cumulative data show that the outcomes of patients with severe AFMR are poor if left untreated. However, new heart failure therapies and minimally invasive techniques may have a positive impact on the outcomes of these patients.

RESUMO O estudo das relações entre o solo e a floresta tem se mostrado importante para a compreensão, conservação e manejo destes recursos. Além disso, se constitui em instrumento valioso para o planejamento do território. A região ao norte de Manaus faz parte de um sub-domínio ecológico, onde as características edáficas e vegetacionais mostram diferenças ao longo de platôs, vertentes intermediárias e fundos de vales. Com o objetivo de avaliar o padrão destas mudanças, foram feitas descrições morfológicas de oito perfis de solo, em duas toposequências. Ao lado de cada perfil, foi feito também o estudo de um transecto, para a caracterização do tipo florestal presente, com o registro do nome vulgar e coleta de material botânico para posterior identificação. No sentido do platô para as posições mais baixas do relevo, se observa uma diferenciação da morfologia do solo com um aumento gradual no percentual de areia. As características edáficas mostram-se cada vez mais limitantes para o crescimento vegetal. No platô os solos apresentam uma textura argilosa ao longo de todo o perfil, tomando-se franco argilo arenoso a argilo arenoso nas vertentes, até chegar ao nível mais baixo da paisagem, onde os perfis se apresentam arenosos. Os resultados mostram também uma diferenciação progressiva no tipo de vegetação. A área basal decresce no sentido do platô para as áreas mais baixas. As florestas presentes em ambientes hídromórficos apresentam também uma relação estreita entre o tipo vegetacional e as características morfológicas do solo. São propostos oito tipos de paisagens florestais, que deverão subsidiar o planejamento, as intervenções e o manejo dos recursos naturais presentes na região.

Background and Aims: Hypoalbuminemia, as defined by serum albumin (SA) levels ≤35 g/L, is associated to venous and arterial thrombosis in general population and in patients at risk of cardiovascular disease. It is unknown if SA ≤35 g/L is also associated to portal vein thrombosis (PVT) in cirrhosis. Methods: Cirrhotic patients enrolled in the Portal vein thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry (PRO-LIVER) study (n = 753), were followed-up for 2 years to assess the risk of PVT, that was diagnosed by Doppler ultrasonography. Child-Pugh classes, Model for End-Stage Liver Disease score, presence of hepatocellular carcinoma and laboratory variables including SA, D-dimer, and high-sensitivity C-reactive protein (hs-CRP) were measured at baseline. Results: SA ≤35 g/L was detected in 52% of patients. A logistic multivariate regression analysis showed that higher Child-Pugh class, hepatocellular carcinoma and thrombocytopenia were significantly associated to SA ≤35 g/L. In a subgroup of patients where data regarding hs-CRP and D-dimer were available, SA ≤35 g/L was inversely associated with hs-CRP and D-dimer. During the follow-up, a total of 61 patients experienced PVT. A Kaplan Meier survival analysis showed SA ≤35 g/L was associated to increased risk of PVT compared to SA >35 g/L (P = .005). A multivariate Cox proportional hazards regression analysis showed that male sex, lower platelet count, and SA ≤35 g/L remained associated to PVT after adjusting for confounding factors. Conclusion: Cirrhotic patients with SA ≤35 g/L are at higher risk of experiencing PVT compared to those with SA >35 g/L and could be considered as potential candidates to anticoagulant prophylaxis for PVT prevention.

Key message: Annual stem CO2 efflux increases with stem wood production rates and are inhibited by daily moisture stress. Abstract: Tropical forests cycle a large amount of CO2 between the land and atmosphere, with a substantial portion of the return flux due tree respiratory processes. However, in situ estimates of woody tissue respiratory fluxes and carbon use efficiencies (CUEW) and their dependencies on physiological processes including stem wood production (Pw) and transpiration in tropical forests remain scarce. Here, we synthesize monthly Pw and daytime stem CO2 efflux (ES) measurements over 1 year from 80 trees with variable biomass accumulation rates in the central Amazon. On average, carbon flux to woody tissues, expressed in the same stem area normalized units as ES, averaged 0.90 ± 1.2 µmol m−2 s−1 for Pw, and 0.55 ± 0.33 µmol m−2 s−1 for daytime ES. A positive linear correlation was found between stem growth rates and stem CO2 efflux, with respiratory carbon loss equivalent to 15 ± 3% of stem carbon accrual. CUEW of stems was non-linearly correlated with growth and was as high as 77–87% for a fast-growing tree. Diurnal measurements of stem CO2 efflux for three individuals showed a daytime reduction of ES by 15–50% during periods of high sap flow and transpiration. The results demonstrate that high daytime ES fluxes are associated with high CUEW during fast tree growth, reaching higher values than previously observed in the Amazon Basin (e.g., maximum CUEW up to 77–87%, versus 30–56%). The observations are consistent with the emerging view that diurnal dynamics of stem water status influences growth processes and associated respiratory metabolism.

Transpiration is often considered to be light- but not water-limited in humid tropical rainforests due to abundant soil water, even during the dry seasons. The record-breaking 2015-16 El Niño drought provided a unique opportunity to examine whether transpiration is constrained by water under severe lack of rainfall. We measured sap velocity, soil water content, and meteorological variables in an old-growth upland forest in the Central Amazon throughout the 2015-16 drought. We found a rapid decline in sap velocity (-38 ± 21%, mean ± SD.) and in its temporal variability (-88%) during the drought compared to the wet season. Such changes were accompanied by a marked decline in soil moisture and an increase in temperature and vapor pressure deficit. Sap velocity was largely limited by net radiation during the wet and normal dry seasons; however, it shifted to be primarily limited by soil moisture during the drought. The threshold in which sap velocity became dominated by soil moisture was at 0.33 m3 m-3 (around -150 kPa in soil matric potential), below which sap velocity dropped steeply. Our study provides evidence for a soil water threshold on transpiration in a moist tropical forest, suggesting a shift from light limitation to water limitation under future climate characterized by increased temperature and an increased frequency, intensity, duration and extent of extreme drought events.

We report the annulation of heterocyclic building blocks to access π-extended polycyclic aromatic hydrocarbons (PAHs). The method involves the trapping of short-lived hetarynes with catalytically-generated biaryl palladium intermediates and allows for the concise appendage of three or more fused aromatic rings about a central heterocyclic building block. Our studies focus on annulating the indole and carbazole heterocycles through the use of indolyne and carbazolyne chemistry, respectively, the latter of which required the synthesis of a new carbazolyne precursor. Notably, these represent rare examples of transition metal-catalyzed reactions of N-containing hetarynes. We demonstrate the utility of our methodology in the synthesis of heterocyclic π-extended PAHs, which were then applied as ligands in two-coordinate metal complexes. As a result of these studies, we identified a new thermally-activated delayed fluorescence (TADF) emitter that displays up to 81% photoluminescence efficiency, along with insight into structure-property relationships. These studies underscore the utility of heterocyclic strained intermediates in the synthesis and study of organic materials.