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Intracerebral Microdialysis in Neurosurgery for Obsessive-Compulsive Disorder: Report of 2 Preliminary Cases

Open Journal of Modern Neurosurgery 2020年第3期10卷 371-381页

作者： Sergio A. Sacchettoni Rafael Galera Juan F. Del Corral Juan P. Abud aníbal pinero Luis Teneud Napoleón Torres Rafael Rojas Pedro Rada Félix Guerrero Edgar González Mónica Bifano Dely Yazawa Luis Hernández Hospital and School of Medicine JM Vargas Universidad Central de Venezuela Caracas Venezuela Centro Medico-Docente La Trinidad Caracas Venezuela Neurology Mobile System Associates Miami FL USA Laboratory of Physiology of Behavior Universidad de Los Andes Mérida Venezuela University of Grenoble-Alpes CEA LETI Clinatec France

Neurosurgery for psychiatric disorders, notably for obsessive-compulsive disorder (OCD), was initiated in Venezuela in the decade of 1970, and consisted since that time in the classic stereotactic anterior cingulotomy. In order to know further about the physiopathology of this disorder, we performed intracerebral microdialysis in 2 patients who were operated on. The aim was to measure changes in extracellular neurotransmitters within the basal ganglia. The microdialysis probes were stereotactically placed in the right caudate nucleus and in the dorsomedial nucleus of the right thalamus. The microdialysis was done before the left cingulotomy, during the pause and after the right cingulotomy. Glutamate and gamma-aminobutyric acid (GABA) changes were similar in the caudate nucleus of both patients, whereas in the dorsomedial nucleus the changes were opposite among the 2 patients. Although this study does not bring enough data to explain such differences yet, the existence of dynamic changes in the neurochemistry of the basal ganglia during cingulotomy shows that intracerebral microdialysis can help in the understanding of the pathophysiology of OCD and eventually in the design of new surgeries with better results.

关键词： Psychiatric Neurosurgery Psychosurgery Obsessive-Compulsive Disorder Intracerebral Microdialysis

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Intense pulsed light‑based treatment for the improvement of symptoms in glaucoma patients treated with hypotensive eye drops

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Eye and Vision 2024年第2期10卷 12-21页

作者： Jose Maria Martinez‑de‑la‑Casa Carlos Oribio‑Quinto Almudena Milans‑del‑Bosch Pilar Perez‑Garcia Laura Morales‑Fernandez Javier Garcia‑Bella Jose Manuel Benitez‑del‑Castillo Julian Garcia‑Feijoo David P.pinero Ophthalmology Unit Department of Ophthalmology and ORLFaculty of MedicineHospital Clinico San-CarlosUniversidad Complutense de MadridInstituto de Investigacion Sanitaria del Hospital Clinico San-Carlos(IdISSC)28040 MadridSpain Department of Immunology Ophthalmology and ORLSchool of MedicineInstituto de Investigaciones Oftalmologicas Ramon CastroviejoUniversidad Complutense de MadridMadridSpain Department of Optics Pharmacology and AnatomyUniversity of AlicanteAlicanteSpain

Background:Ocular surface disease in glaucoma patients is a significant ocular co-morbidity that can affect 40%to 59%of these patients *** current study was aimed at evaluating the potential clinical benefit of an intense pulsed light(IPL)-based treatment in glaucomatous patients with ocular surface disease due to prolonged hypotensive eyedrop *** our knowledge,this is the first series analyzing the therapeutic effect of this treatment option in this type of ***:This non-comparative prospective case series study enrolled a total of 30 glaucoma patients ranging in age from 57 to 94 years old and treated with hypotensive eyedrops for years with dry eye *** patients received four sessions of IPL treatment using the Optima IPL system(Lumenis,Yokneam,Israel)adjusted to the official optimized Lumenis *** in symptomatology,corneal staining,conjunctival hyperemia,non-invasive break-up time(NIBUT),tear osmolarity,tear meniscus height(TMH),meiboscore and meibomian gland expressibility was analyzed after ***:Statistically significant reductions were observed after IPL treatment in the symptomatology scores measured with different questionnaires[ocular surface disease index(OSDI),standard patient evaluation of eye dryness(SPEED)and symptom assessment questionnaire in dry eye(SANDE)]as well as with the visual analogue scale(P<0.001).Mean change in OSDI was−15.0±11.3.A significant reduction was found after treatment in the corneal staining score(P<0.001).A significant reduction was found in tear film meniscus height(P=0.012),as well as in tear film osmolarity(P=0.001).A significant reduction was also found in meibomian gland expressibility(P=0.003),changing the percentage of grade 3 eyes from 44.4%before IPL to 17.2%after ***:IPL therapy combined with meibomian gland expression(MGX)seems to be an effective option to improve symptomatology in glaucomatous patients with ocular surface diseas

关键词： Glaucoma Intense pulsed light Dry eye Meibomian glands

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Characterization of the geometric properties of the sclero-conjunctival structure: a review

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International Journal of Ophthalmology(English edition) 2020年第9期13卷 1484-1492页

作者： Laurent Bataille David P pinero Research and Development Department VISSUMAlicante 03016Spain Group of Optics and Visual Perception Department of OpticsPharmacology and AnatomyUniversity of AlicanteAlicante 03690Spain

To revise the peer-reviewed literature on geometric properties of the scleral-conjunctival structure in order to define their clinical relevance and the potential relationship between their changes and myopia development or progression.A bibliographic search focused on the study of the geometry of conjunctiva and/or sclera as well as those studies evaluating the relationship between geometric changes in the scleral-conjunctival structure and myopia was carried *** studies have been performed with different diagnostic technologies,including optical coherence tomography,profilometry and Scheimpflug imaging,to detect geometric changes of the scleralconjunctival tissue in different physiological conditions of the eye,after use of contact lenses and in different ocular ***,these technologies have been shown to be a valuable clinical tool to optimize scleral contact lens *** studies should investigate new potential clinical applications of such technologies,including the evaluation of anterior scleral changes related to myopia,as well as to define standardized clinical standard operating procedures for obtaining accurate and reproducible clinical measurement of the scleral-conjunctival morphology.

关键词： conjunctiva sclera profilometry myopia scleral topography

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Sequencing of systemic treatment for hepatocellular carcinoma: Second line competitors

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World Journal of Gastroenterology 2020年第16期26卷 1888-1900页

作者： Federico pinero Marcelo Silva Massimo Iavarone Hospital Universitario Austral Facultad de Ciencias BiomédicasUniversidad AustralBuenos Aires B1629HJArgentina Latin American Liver Research Educational and Awareness Network Buenos Aires B1629HJArgentina Division of Gastroenterology and Hepatology CRC“A.M.e A.Migliavacca”Center for the Study of Liver DiseaseUniversity of MilanFondazione IRCCS Ca’Granda Maggiore HospitalMilan 20121Italy

During the last decades,further knowledge of hepatocellular carcinoma(HCC)molecular mechanisms has led to development of effective systemic treatments including tyrosine kinase inhibitors(TKIs)and *** this review,we describe first and second line systemic treatment options for advanced *** trials have evaluated new drugs for the treatment of HCC patients:In first line,lenvatinib resulted non-inferior to sorafenib and it can be used as alternative,even in the lack of evidence for sequential treatment options in second line after ***,atezolizumab plus bevacizumab have shown superiority over sorafenib in ***-regorafenib sequential administration in selected patients has opened a new paradigm of treatment in advanced HCC with a life expectancy exceeding two *** TKIs for second line treatment include cabozantinib and ramucirumab(specifically for patients with Alpha-fetoprotein values≥400 ng/mL).The combination of TKIs with immunotherapy may represent a big step forward for these patients in the near future.

关键词： Hepatocellular carcinoma Systemic Options Sequencing Advanced Future

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Characterization, passive and active treatment in strabismic amblyopia: a narrative review

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International Journal of Ophthalmology(English edition) 2020年第7期13卷 1132-1147页

作者： Myriam Milla David P.pinero Department of Optometry OFTALVIST AlicanteAlicante 03016Spain Group of Optics and Visual Perception Department of OpticsPharmacology and AnatomyUniversity of AlicanteSan Vicente del RaspeigAlicante 03690Spain

Strabismic amblyopia is characterized by a distorted spatial *** this condition,the neurofunctional disorder occurring during first years of life provoke several monocular and binocular anomalies such as crowding,deficits in the accommodative response,contrast sensitivity,and ocular motility *** inhibition of the binocular function of the brain by the misaligned amblyopic eye induces a binocular imbalance leading to interocular suppression and the reduction or lack of *** treatments such as occlusion,optical and/or pharmacological penalization,and Bangerter foils has been demonstrated to be potentially useful treatments for strabismic *** researches have proved new pharmacological options to improve and maintain visual acuity af ter occlusion treatment in strabismic ***,the active vision therapy,in the last years,is becoming a very relevant therapeutic option in combination with passive treatments,especially during and after monocular therapy,in the attempt of recovering the imbalanced binocular vision.

关键词： amblyopia strabismus occlusion vision therapy strabismic amblyopia penalization Bangerter foil

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Adjustable muscle plication:a new surgical technique for strabismic patients with high risk for anterior segment ischemia

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International Journal of Ophthalmology(English edition) 2015年第4期8卷 839-842页

作者： Carlos Laria David P.pinero Department of Ophthalmology(OFTALMAR) Vithas Medimar International Hospital Foundation for the Visual Quality(FUNCAVIS Fundación para la Calidad Visual) Department of Optics Pharmacology and AnatomyUniversity of Alicante

INTRODUCTION Anterior ciliary arteries provide 70%of the vascular supply of the anterior segment.A significant interruption of the vascular flow of these arteries increases the risk for anterior *** the frequency of this special condition is low after strabismus surgery(1:13 000)[1],its effects may involve substantial visual problems[2].We report the successful outcome of a new surgical approach for strabismus management in a case of high risk for anterior ***,we show the correction of the horizontal ocular deviation by means of an adjustable muscle

关键词： Figure a new surgical technique for strabismic patients with high risk for anterior segment ischemia high

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Profitability analysis of a femtosecond laser system for cataract surgery using a fuzzy logic approach

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International Journal of Ophthalmology(English edition) 2016年第7期9卷 1046-1050页

作者： Jose Antonio Trigueros David P pinero Mahmoud M Ismail Department of Financial Economic and Accounting Miguel Hernandez University Elche 03202 Alicante Spain Department of Optics Pharmacology and AnatomyUniversity of Alicante Crta San Vicente del RaspeigAlicante 03690 Spain Al-Azhar University Cairo 11651 Egypt

AIM：To define the financial and management conditions required to introduce a femtosecond laser system for cataract surgery in a clinic using a fuzzy logic ***：In the simulation performed in the current study,the costs associated to the acquisition and use of a commercially available femtosecond laser platform for cataract surgery（VICTUS,TECHNOLAS Perfect Vision GmbH,Bausch ＆ Lomb,Munich,Germany） during a period of 5y were considered.A sensitivity analysis was performed considering such costs and the countable amortization of the system during this 5y ***,a fuzzy logic analysis was used to obtain an estimation of the money income associated to each femtosecond laser-assisted cataract surgery（G）. RESULTS：According to the sensitivity analysis,the femtosecond laser system under evaluation can be profitable if 1400 cataract surgeries are performed per year and if each surgery can be invoiced more than $*** contrast,the fuzzy logic analysis confirmed that the patient had to pay more per surgery,between $661.8 and $667.4 per surgery,without considering the cost of the intraocular lens（IOL）.CONCLUSION：A profitability of femtosecond laser systems for cataract surgery can be obtained after a detailed financial analysis,especially in those centers with large volumes of *** cost of the surgery for patients should be adapted to the real flow of patients with the ability of paying a reasonable range of cost.

关键词： cataract surgery femtosecond laser fuzzy logic femto-cataract victus profitability analysis

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Prevalence of visual impairment and refractive errors in an urban area of Mexico

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International Journal of Ophthalmology(English edition) 2019年第10期12卷 1612-1617页

作者： Isabel Signes-Soler David P pinero Milagro Ines Murillo Silvia Tablada University of Valencia 46100 BurjassotValenciaSpain Vision Without Border 03710 CalpAlicanteSpain Department of Optics Pharmacology and AnatomyUniversity of AlicanteAlicante 03690Spain

AIM: To determine the distribution of refractive errors in a school-age population in Quintana Roo(Mexico) in the framework of an international cooperation campaign for the prevention of blindness. METHODS: A sample of 2647 school-age children(ranging from 5 to 14 years old) with a mean age of 9.1±1.9 years old were tested by trained volunteers for distance visual acuity(VA) and refractive errors. The first screening examination included uncorrected distance visual acuity(UDVA) and VA with a +2.00 D lens. Inclusion criteria for a second complete cycloplegic eye examination performed by an optometrist were UDVA <20/25(0.10 logMAR or 0.8 decimal) and/or VA with +2.00 D ≥20/***: A total of 633(23.9%) children underwent the second complete eye examination. Mean logMAR UDVA was 0.035±0.094(range 1.00 to 0.00 logMAR) for the right eyes and 0.036±0.160(range 1.00 to 0.00 logMAR) for the left eyes. Bilateral amblyopia was found in 17 children(2.7% of refracted eyes;0.64% of the total). The main reason for visual impairment(VI) in the sample analyzed was found to be refractive errors. In 12 children(1.9% of refracted eyes;0.45% of the total) the VI was bilateral and 9(1.4% of refracted eyes;0.34% of the total) achieved a corrected distance visual acuity of 20/25 or better in both eyes. Mean magnitude of sphere and refractive cylinder was +0.20±0.96 D and-0.43±0.85 D in right eyes, and +0.24±1.08 and-0.43±0.83 D in left eyes. The proportion of myopic eyes [standard equivalent(SE) ≤-0.50 D] was 4.6% of the whole sample(5290 eyes). The mean magnitude of myopia was-0.84±3.44 D for the right eyes and-0.82±5.21 D for the left eyes. The proportion of hyperopic patients(SE≥+2.00 D) was 2.4%(15/633), which corresponded to 0.60% of the whole sample(32/5290 eyes). No statistically significant correlation of age to manifest sphere or cylinder was ***: VI due to uncorrected refractive errors can be easily corrected with glasses but it is still a burden to be treated.

关键词： myopia hyperopia refractive error blindness visual impairment

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Comparative analysis of the efficacy of astigmatic correction after wavefront-guided and wavefront-optimized LASIK in low and moderate myopic eyes

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International Journal of Ophthalmology(English edition) 2017年第2期10卷 285-292页

作者： Mounir A.Khalifa Mahmoud F.Alsahn Mohamed Shafik Shaheen David P.pinero Ophthalmology Department Tanta UniversityTanta 31527Egypt Horus Vision Correction Center Alexandria 21311Egypt Alex LASIK Center Alexandria 21311Egypt Department of Ophthalmology University of AlexandriaAlexandria 21543Egypt Department of Optics Pharmacology and AnatomyUniversity of AlicanteAlicante 03690Spain

AIM： To evaluate and compare the efficacy of the astigmatic correction achieved with laser in situ keratomileusis（LASIK） in eyes with myopic astigmatism using wavefront-guided（WFG） and wavefront-optimized（WFO） ablation ***： Prospective study included 221 eyes undergoing LASIK： 99 and 122 eyes with low and moderate myopic astigmatism（low and moderate myopia groups）.Two subgroups were differentiated in each group according to the ablation profile： WFG subgroup,109 eyes（45/64,low/moderate myopia groups） treated using the Advanced Custom Vue platform（Abbott Medical Optics Inc.）,and WFO subgroup,112 eyes（54/58,low/moderate myopia groups） treated using the EX-500 platform（Alcon）.Clinical outcomes were evaluated during a 6-month follow-up,including a vector analysis of astigmatic ***： Significantly better postoperative uncorrected visual acuity and efficacy index was found in the WFG subgroups of each group（P≤0.041）.Postoperative spherical equivalent and cylinder were significantly higher in WFO subgroups（P≤0.003）.In moderate myopia group,a higher percentage of eyes with a postoperative cylinder ≤0.25 D was found in the WFG subgroup（90.6% vs 65.5%,P=0.002）.In low and moderate myopia groups,the difference vector was significantly higher in the WFO subgroup compared to WFG（P〈0.001）.In moderate myopia group,the magnitude（P=0.008） and angle of error（P〈0.001） were also significantly higher in the WFO *** induction of high order aberrations were found with WFG treatments in both low and moderate myopia groups（P≤0.006）.CONCLUSION： A more efficacious correction of myopic astigmatism providing a better visual outcome is achieved with WFG LASIK compared to WFO LASIK.

关键词： myopia wavefront-guided LASIK wavefront-optimized LASIK astigmatism

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Visual function alterations in essential tremor: A case report

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Journal of Innovative Optical Health Sciences 2015年第5期8卷 94-98页

作者： David P.pinero Begona Monllor Vicenta Moncho Vicent J.Camps Dolores de Fez Grupo de Optica y Percepcion Visual(GOPV)Department of Optics Pharmacology and Anatomy University of AlicanteSpain Department of Ophthalmology(OFTALMAR)Medimar International Hospital AlicanteSpain Foundation for the Visual Quality(Fundacion para la Calidad Visual FUNCAVIS)

Our purpose is to report alterations in contrast sensitivity function(CSF)and in the magno,parvo and koniocellular visual pathways by means of a multichannel perimeter in case of an essential tremor(ET).A complete evaluation of the visual function was performed in a 69-year old patient,including the analysis of the chromatic discrimination by the Fansworth–Munsell 100 hue test,the measurement of the CSF by the CSV-1000E test,and the detection of potential alteration patterns in the magno,parvo and koniocellular visual pathways by means of a multichannel *** acuity and intraocular pressure(IOP)were within the ranges of normality in both *** abnormalities were detected in the fundoscopic examination and in the optical coherence tomography(OCT)*** results of the color vision examination were also within the ranges of normality.A signi¯cant decrease in the achromatic CSFs for right eye(RE)and left eye(LE)was detected for all spatial *** statistical global values provided by the multichannel perimeter confirms that there were significant absolute sensitivity losses compared to the normal pattern in *** the LE,only a statistically significant decrease in sensitivity was detected for the blue-yellow(BY)*** pattern standard deviation(PSD)values obtained in our patient indicated that there were significant localized losses compared to the normality pattern in the achromatic channel of the RE and in the red-green(RG)channel of the *** color vision alterations may be present in ET that cannot be detected with conventional color vision tests,such as the FM 100 Hue.

关键词： Multichannel perimetry essential tremor color vision visual pathways contrast sensitivity

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