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Background/Objectives: The visual acuity (VA) outcomes after the first and second years of anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with diabetic macular oedema (DMO) were evaluated, and the factors associated with treatment success were investigated. Methods: Using Medisoft electronic medical records (UK), this retrospective cohort study analysed VA outcomes, changes, and determinants in DMO patients at year 1 and year 2 after initial anti-VEGF injection. Descriptive analysis examined baseline demographics and clinical characteristics, while regression models were used to assess associations between these factors and changes in VA. Results: 728 DMO patients (1035 eyes) treated with anti-VEGFs (ranibizumab, aflibercept, or bevacizumab) at the Northern Ireland Mater Macular Clinic from 2008 to 2021 were evaluated. The mean age was 64.5 (SD 12.8) years, and 59.6% were male. In the first year, the median annual injection number and interval were 6.0 (IQR 5.0–8.0) and 6.1 weeks (IQR 5.4–7.8), respectively, and in the second year, they were 3.0 (IQR 2.0–5.0) and 10.0 weeks (IQR 6.5–20.1). In the first two treatment years, 83.4% and 79.8% of eyes had improved/stable VA (ISVA) respectively. The injection number, interval, baseline VA, age, and proliferative diabetic retinopathy (PDR) significantly impacted VA outcomes. Conclusions: Our study confirms the effectiveness of anti-VEGF treatments in improving or maintaining vision for DMO patients, consistent with previous real-world clinical data. An elder age, a better baseline VA, low annual injection numbers (<5), and less frequent injection intervals (≥12 weeks) were negatively associated with ISVA success in the first two years. These findings have implications for managing patient expectations, allocating resources, and understanding DMO clinical management.

Background The anti-vascular endothelial growth factor (anti-VEGF) injection interval influences treatment burden and compliance in neovascular age-related macular degeneration (nAMD). This real-world study investigates visual acuity (VA), injection-interval extension, central macular thickness (CMT) and safety in nAMD eyes switched to the anti-VEGF agent brolucizumab and followed for up to 18 months. Methods This retrospective study included patients with nAMD who were switched from other anti-VEGF agents to brolucizumab only. Patient eyes were grouped into three nested cohorts with the overall cohort receiving ≥ 1 brolucizumab injection, the second receiving ≥ 3 brolucizumab injections with a follow-up period of ≥ 12 months and the third cohort receiving ≥ 3 brolucizumab injections with a follow-up period of ≥ 18 months. Study endpoints included changes from baseline at 12 or 18 months in VA, injection intervals, and CMT. Sub-group analyses were conducted using baseline injection interval length or baseline VA as qualifiers. Results Overall, 482 eyes received ≥ 1 brolucizumab injection; 174 eyes received ≥ 3 brolucizumab injections with ≥ 12 months of follow-up, and 95 eyes received ≥ 3 brolucizumab injections with ≥ 18 months of follow-up. VA (mean [95% confidence intervals]) remained stable relative to baseline after 12 months (− 1.1 [− 3.7, 1.6] letters; p = 0.42) and 18 months (0.0 [− 3.1, 3.1] letters; p = 0.98) of brolucizumab treatment, respectively, and pre-switch injection intervals or baseline VA had no notable effect. Following the switch to brolucizumab, injection intervals were extended from baseline to month 12 by 26.9 (19.7, 34.0) days (p < 0.0001), and eyes with pre-switch injection intervals < 8 weeks were able to have their injection intervals extended by 23.6 days longer than eyes with pre-switch injection intervals ≥ 8 weeks. At 18 months, injection intervals were extended by 36.3 (25.6, 46.9) days (p < 0.0001) compared to baseline. Following switch to brolucizumab, CMT was reduced at both 12 and 18 months (12 months: − 35.2 (− 51.7, − 18.8) µm, p < 0.0001; 18 months: − 38.9 (− 54.3, − 22.0) µm, p < 0.0001). Intraocular inflammation-related adverse events were reported in 4.6% of brolucizumab-treated eyes. Conclusions This real-world study demonstrates that injection intervals may be significantly extended with maintained vision and reduced CMT in nAMD eyes switching to brolucizumab therapy from other anti-VEGFs.

Objective: Retrospective, real-world study to evaluate visual acuity (VA), anti-vascular endothelial growth factor (anti-VEGF) injection intervals, and central macular thickness (CMT) in neovascular age-related macular degeneration (nAMD) eyes switched to brolucizumab only or to brolucizumab alternating with another anti-VEGF. Methods: The overall study population comprised eyes that were given [greater than or equal to] 1 brolucizumab injection between 1 October 2019 and 30 November 2021. The brolucizumab-only (BRO) cohort consisted of prior anti-VEGF-treated eyes treated exclusively with [greater than or equal to] 3 brolucizumab injections over [greater than or equal to] 12 or [greater than or equal to] 18 months; the alternating brolucizumab (ALT) cohort comprised prior anti-VEGF-treated eyes treated with [greater than or equal to] 2 brolucizumab injections and [greater than or equal to] 1 other anti-VEGF over [greater than or equal to] 12 or [greater than or equal to] 18 months. Results: A total of 482 eyes received[greater than or equal to] >1 brolucizumab injection during the study period. Mean VA changes from baseline were -1.1 [+ or -] 15.1 letters (BRO cohort; n = 174) and 1.3 [+ or -] 13.0 letters (ALT cohort; n = 47) at Month 12, and 0.0 [+ or -] 13.5 letters (BRO cohort; n = 95) and -7.3 [+ or -] 17.2 letters (ALT cohort; n = 29) at Month 18. Mean changes in injection intervals were +26.9 [+ or -] 48.1 days (BRO cohort) and +11.1 [+ or -] 17.3 days (ALT cohort) at Month 12 and +36.3 [+ or -] 52.3 days (BRO cohort) and +14.0 [+ or -] 19.9 days (ALT cohort) at Month 18. Mean changes in CMT were -35.2 [+ or -] 108.1 pm (BRO cohort) and -31.5 [+ or -] 91.2 [ILLUSTRATION OMITTED] m (ALT cohort) at Month 12 and -38.9 [+ or -] 75.0 [micro]m (BRO cohort) and -9.0 [+ or -] 59.9 [micro]m (ALT cohort) at Month 18. Intraocular inflammation-related adverse events were recorded in 22/482 (4.6%) eyes. Conclusion: Treatment with either brolucizumab alone or brolucizumab alternating with another anti-VEGF can preserve vision, reduce CMT, and extend anti-VEGF injection intervals in patients with nAMD. Keywords: alternating anti-VEGF treatments, brolucizumab, neovascular age-related macular degeneration, wet age-related macular degeneration, 12-month outcomes, 18-month outcomes

•Eptifibatide mediates potent antithrombotic effects when used in primary PCI.•Standard eptifibatide infusion for several hours increases bleeding complications.•A novel, short eptifibatide regimen retains ischemic protection during primary PCI.•Bleeding complications are greatly reduced by the abbreviated eptifibatide regimen.•Avoiding prolonged eptifibatide treatment may improve clinical outcomes. The glycoprotein IIb/IIIa inhibitor eptifibatide, administered as bolus followed by infusion, is an adjunctive antithrombotic treatment during primary percutaneous coronary intervention (PCI) in selected patients with ST-segment elevation myocardial infarction (STEMI). Whether both bolus and infusion are necessary to improve outcomes is unknown. We hypothesized that primary PCI with eptifibatide bolus only is non-inferior to the conventional treatment (bolus and infusion) with regard to infarct size, while reducing bleeding complications. We analyzed 720 consecutive STEMI patients receiving eptifibatide bolus only or conventional treatment in an observational case-control study utilizing propensity score matching of clinical and intervention-specific confounders. Infarct size was estimated based on myocardial bound creatine kinase, creatine kinase (CK), and CK area under the curve values, with a prespecified non-inferiority margin of 20%. Major bleeding was defined as type 2, 3, or 5 on the Bleeding Academic Research Consortium classification. Eptifibatide bolus only was administered to 147 patients (20%), which were matched 1:1 to patients receiving conventional treatment. Based on peak myocardial bound creatine kinase, CK and CK area under the curve values, infarct size was −8.4% (95% CI [−31.2%, 14.4%]), −11.6% (95% CI [−33.5%, 10.3%]), and −13.9% (95% CI [−34.1%, 6.2%]) after eptifibatide bolus, respectively, reaching prespecified noninferiority compared with conventional treatment. Bolus treatment significantly reduced major bleeding complications (OR 0.48, 95% CI [0.30, 0.79]). In conclusion, eptifibatide given as abbreviated bolus only to selected STEMI patients who underwent primary PCI was noninferior regarding infarct size and resulted in less bleeding complications compared with conventional bolus and infusion treatment.

Biogasification (or anaerobic digestion) is a biochemical process that converts organic matter to biogas under anaerobic conditions. Biogas, a mixture of methane (50- 70%) and carbon dioxide, can be used as Renewable Natural Gas (RNG) which is chemically identical to fossil natural gas after scrubbing carbon dioxide. Biogas is mainly produced as a byproduct from organic waste treatment. However, biogas generated from waste alone does not meet growing energy demands. Terrestrial biomass such as sugarbeet is cultivated once a year usually in excess of quantities regulated for sugar production. This potential availability and high amount of sugar in sugarbeet projects it as an ideal feedstock for anaerobic digestion. However, sugarbeets are not available in sufficient quantity to meet energy requirements hence aquatic biomasses such as microalgae are also looked upon as a potential biomass resource for biogas production. Algae have higher growth rates and can be grown in saline or brackish water obviating the need for precious fresh water resources. This dissertation deals with the biogasification of sugar beets and the saline microalgae, Nannochloropsis oculata. Studies were done to explore options for economical long term storage of sugarbeet for biogas production. Biomethane potential of beets stored under ambient temperature air tight storage conditions was compared to that of frozen and freshly harvested sugarbeets. It was then verified that size reduction of sugarbeets did not considerably increase rate and yield of methane production. A two-reactor pilot scale system (200/600 liter) was designed to efficiently biogasify whole sugarbeets without any size reduction. This approach overcame issues related to biomass compaction and rapid acidification. Nannochloropsis oculata can be grown easily in brackish or seawater, has satisfactory growth rates, can tolerate a wide range of pH and temperature and is rich in carbohydrates. However, this feedstock was shown to be resistant to biogasification. Pretreatment techniques such as ultrasonication, thermal hydrolysis and enzyme saccharification including novel technique of photocatalysis by titanium dioxide were assessed for biomethane potential of N.oculata. This novel technique was assessed better than costly radiation pretreatment technology such as ultrasonication and was equally good as best pretreatment technologies for microalgae such as thermal.

This chapter contains sections titled: Introduction Materials and Methods Results and Discussion Conclusions