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Background To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small idiopathic macular hole. Methods Retrospective, multicentre cohort study including consecutive eyes with a ≤250 μm idiopathic macular hole treated with primary vitrectomy. The primary outcome was best-corrected visual acuity (BCVA) change and macular hole closure rate. Closure patterns on optical coherence tomography (OCT) and rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery were considered as secondary outcomes. Results A total of 389 and 250 eyes were included in the conventional ILM peeling group and in the inverted flap group, respectively. Hole closure rate was comparable between the two groups (98.5% in the ILM peeling group and 97.6% in the inverted flap group). Mean BCVA was comparable between the two groups at baseline ( p  = 0.331). At 12 months, mean BCVA was 0.14 ± 0.19 logMAR in the conventional ILM peeling group and 0.17 ± 0.18 logMAR in the inverted flap group ( p  = 0.08). At 12 months, 73% of eyes had a U -shape closure morphology in the conventional ILM peeling group versus 55% in the inverted flap group. At 12 months, ELM recovery rate was 96% and 86% in the conventional ILM peeling group and in the inverted flap group, respectively ( p  < 0.001); EZ recovery rate was 78% and 69%, respectively ( p  = 0.04). Conclusions The inverted flap technique provides no advantages in terms of visual outcome and closure rate in small idiopathic macular hole surgery. Additionally, this technique seems to impair postoperative restoration of external retinal layers compared with conventional peeling.

To compare the efficacy of the new lubricating product VisuEvo (VSE) vs Cationorm (CTN) in patients with dry eye disease (DED). Seventy-two patients with evaporative (n=54) and non-evaporative DED (n=18) were included in a multicenter, double-blind, 12-week cross-over study to receive VSE (6 weeks) and CTN (6 weeks) in randomized sequence. After baseline, two visits were performed during each period (intermediate and final visit, respectively at 2 and 6 weeks from the beginning of each period). Primary (tear break-up time, TBUT) and secondary endpoints (Schirmer I, Ferning, blink rate, osmometry, cytokine and lipid expression, ocular surface staining, patient satisfaction, and OSDI score) were compared. Sixty-three patients were evaluated for efficacy and 68 patients for safety. The intergroup differences for mean TBUT values were not significant at any study visit (baseline 3.2 ±1.5 sec; intermediate visits 4.5 ± 1.9 and 4.5 ± 1.8 sec in VSE and CTN groups, respectively, p = 0.10; final visits 5.4 ± 2.4 and 6.0 ± 3.1, respectively, p=0.63). Also, the assessment of secondary endpoints showed no significant difference between the two groups. The two study treatments were equally effective in evaporative and non-evaporative DED. The safety profile was excellent for both ocular treatments; transient blurred vision was observed in 11 patients only during CTN, 10 patients only during VSE, and 16 during both treatments. VSE was non-inferior to CTN in restoring tear film composition, increasing its stability and reducing ocular surface damage in evaporative and non-evaporative DED patients. NCT03833882.

Purpose: To compare the efficacy of the new lubricating product VisuEvo[R] (VSE) vs Cationorm[R] (CTN) in patients with dry eye disease (DED). Methods: Seventy-two patients with evaporative (n=54) and non-evaporative DED (n=18) were included in a multicenter, double-blind, 12-week cross-over study to receive VSE (6 weeks) and CTN (6 weeks) in randomized sequence. After baseline, two visits were performed during each period (intermediate and final visit, respectively at 2 and 6 weeks from the beginning of each period). Primary (tear break-up time, TBUT) and secondary endpoints (Schirmer I, Ferning, blink rate, osmometry, cytokine and lipid expression, ocular surface staining, patient satisfaction, and OSDI score) were compared. Results: Sixty-three patients were evaluated for efficacy and 68 patients for safety. The intergroup differences for mean TBUT values were not significant at any study visit (baseline 3.2 [+ or -]1.5 sec; intermediate visits 4.5 [+ or -] 1.9 and 4.5 [+ or -] 1.8 sec in VSE and CTN groups, respectively, p = 0.10; final visits 5.4 [+ or -] 2.4 and 6.0 [+ or -] 3.1, respectively, p=0.63). Also, the assessment of secondary endpoints showed no significant difference between the two groups. The two study treatments were equally effective in evaporative and non-evaporative DED. The safety profile was excellent for both ocular treatments; transient blurred vision was observed in 11 patients only during CTN, 10 patients only during VSE, and 16 during both treatments. Conclusion: VSE was non-inferior to CTN in restoring tear film composition, increasing its stability and reducing ocular surface damage in evaporative and non-evaporative DED patients. Study Identifier: NCT03833882. Keywords: evaporative dry eye disease, tear break-up time, Ocular Surface Disease Index questionnaire, meibomian gland disturbance, glaucoma, ocular surface

Purpose: To compare the efficacy of the new lubricating product VisuEvo[R] (VSE) vs Cationorm[R] (CTN) in patients with dry eye disease (DED). Methods: Seventy-two patients with evaporative (n=54) and non-evaporative DED (n=18) were included in a multicenter, double-blind, 12-week cross-over study to receive VSE (6 weeks) and CTN (6 weeks) in randomized sequence. After baseline, two visits were performed during each period (intermediate and final visit, respectively at 2 and 6 weeks from the beginning of each period). Primary (tear break-up time, TBUT) and secondary endpoints (Schirmer I, Ferning, blink rate, osmometry, cytokine and lipid expression, ocular surface staining, patient satisfaction, and OSDI score) were compared. Results: Sixty-three patients were evaluated for efficacy and 68 patients for safety. The intergroup differences for mean TBUT values were not significant at any study visit (baseline 3.2 [+ or -]1.5 sec; intermediate visits 4.5 [+ or -] 1.9 and 4.5 [+ or -] 1.8 sec in VSE and CTN groups, respectively, p = 0.10; final visits 5.4 [+ or -] 2.4 and 6.0 [+ or -] 3.1, respectively, p=0.63). Also, the assessment of secondary endpoints showed no significant difference between the two groups. The two study treatments were equally effective in evaporative and non-evaporative DED. The safety profile was excellent for both ocular treatments; transient blurred vision was observed in 11 patients only during CTN, 10 patients only during VSE, and 16 during both treatments. Conclusion: VSE was non-inferior to CTN in restoring tear film composition, increasing its stability and reducing ocular surface damage in evaporative and non-evaporative DED patients. Study Identifier: NCT03833882. Keywords: evaporative dry eye disease, tear break-up time, Ocular Surface Disease Index questionnaire, meibomian gland disturbance, glaucoma, ocular surface

Recent tracer-based studies using stable isotopes of hydrogen and oxygen showed that different methods for extracting water from plant tissues can return different isotopic compositions due to the presence of organic compounds and because they extract different plant water domains. One of the most used methods to extract plant water is the cryogenic vacuum distillation (CVD), which tends to extract total plant water. Conversely, the Scholander-type pressure chamber (SPC), which is commonly used by tree physiologists to measure water potential in plant tissues and determine plant water stress, is expected to extract only the more mobile plant water (i.e., xylem and inter-cellular water). However, only few studies reported the application of SPC to extract plant water for isotopic analyses, and therefore, inter-method comparisons between SPC and CVD are of great value. In this work, we analyzed the variability in the isotopic composition of plant water extracted by SPC and CVD, also considering the potential variability in the isotopic signature of the plant water extracted by CVD from various tissues (i.e., leaves, twig without bark, twig with bark, twig close to the trunk of the tree, and wood core) and from different plant species (i.e., alder, apple, chestnut, and beech). The extraction of plant water by SPC is simple, can be carried out in the field, and it does not require specific laboratory work as in the case of CVD. However, the main limitation of SPC is the very small water volume that can be extracted from the lignified twigs under water stress conditions compared to CVD. Our results indicated that plant water extracted by SPC and CVD were significantly different. The difference in the isotopic composition obtained by the two extraction methods was smaller in the beech samples compared to alder, apple, and chestnut samples. The isotopic signature of alder, apple, and chestnut plant water extracted by SPC was more enriched in δ2H and δ18O, respectively, than the samples obtained by CVD. We conclude that plant water extraction by SPC is not an alternative for CVD as SPC mostly extracts the mobile plant water, whereas CVD tends to retrieve all water stored in the sampled tissue from both living and dead cells. However, studies aiming to quantify the relative contribution of the soil water sources to transpiration should rely more on the isotopic composition of xylem water (which is theoretically sampled by SPC) than the isotopic composition of total plant water (sampled by CVD), which also contains a fraction of water that could be stored in plant tissues for a longer time.

The Maggiore Valley well field plays a fundamental role in supplying drinking water to a large territory of the Piedmont Region (northwestern Italy) and has been intensively exploited since the early twentieth century. This water resource is hosted in a deep, multilayered aquifer system. The main purpose of this study was to characterize the recharge processes of the deep aquifer through hydrochemical and isotopic assessments, as well as the water quality in the recharge and drainage areas. For this purpose, 128 physical–chemical analyses (major ions) and 50 isotopic analyses (δ18O and δ2H) were carried out on samples collected in shallow and deep aquifer complexes in two sampling campaigns in 2021. From the results, a hydrogeological conceptual model of recharge processes was developed. The chemical data confirm the presence of bicarbonate–calcium facies in most samples of the shallow and deep aquifer complexes. Clear hydrochemical differences were observed among the investigated sectors. The recharge areas were identified as (1) far zones, namely the shallow aquifer complex of the Cuneo Plain, and (2) the shallow and deep aquifer complexes with groundwater mixing in the riverside sector of Po Plain in the Turin area. The mixing of waters from the Cuneo Plain and Turin Plain was verified in the well field area. The isotopic values of the artesian well water also confirmed contributions from the Turin and Cuneo Alps. This study clarified the recharge processes, thereby defining potential pollutant pathways, and the results provide additional support for groundwater resource management and protection.

The Perrot Spring (1300 m a.s.l.), located to the right of the Chalamy valley in the Monte Avic Natural Park (Valle d’Aosta, Italy), is an important source of drinking water for the municipality of Champdepraz. This spring is located on a large slope characterised by the presence of a Quaternary cover of various origins (glacial, glaciolacustrine, and landslide) above the bedrock (essentially serpentinite referred to the Zermatt–Saas Zone, Penninic Domain). Water emerges at the contact between the landslide bodies and impermeable or semi-permeable glaciolacustrine deposits. The aim of this study is to define the processes and recharge zones of this spring. The analysis of the data revealed the presence of two contributions to the Perrot Spring input: a spring thaw contribution defined by a small increase in flow and an autumn contribution from rainwater infiltration. The low average temperature and low variation of the annual temperature (4.8–6.5 °C) suggest a sufficiently deep flow circuit. Chemical analyses showed a groundwater chemistry consistent with the regional geology: the hydrochemical facies is calcium–magnesium bicarbonate and isotopic analyses (δ2H and δ18O) of rainfall and spring water suggested a recharge altitude of about 2100 m a.s.l. In conclusion, this study makes it possible to recognize the water inputs to the spring discharge and to delineate its recharge area, which can be proposed to implement strategies to protect the resource.