BackgroundIndependence from all optical aids, and freedom from unwanted symptoms, following cataract and lens surgery remains the ultimate goal of both patient and surgeon. The development of trifocal IOL technology provides an ever-increasing range of options. The purpose of our study is to understand the predictability, safety and efficacy of a new trifocal intraocular lens (IOL) following cataract or refractive lens exchange (RLE) surgery.MethodsThis was a retrospective consecutive case series of patients undergoing cataract extraction or RLE followed by implantation of the Alcon IQ Panoptix IOL. Pre and postoperative refractive and visual parameters were recorded and evaluated. As the cohort followed a normal distribution, standard parametric tests were used. Paired t-test was used to compare the difference between target and postoperative refractive errors. The incidence of intraoperative and postoperative complications was also reported.ResultsThe IOL was implanted in 66 eyes of 33 patients. Mean postoperative spherical equivalent (SE) refraction was -0.08 ± 0.25 dioptres (D). This was not significantly different from the target refraction (p = 0.841). Sixty-five percent of patients were within ± 0.25 D of the target SE refraction with 100% within ± 0.50 D of intended correction. Mean postoperative uncorrected distance visual acuity (UDVA) was 0.01 ± 0.10 LogMAR. All patients achieved an unaided distance acuity of 20/40 or better postoperatively. Binocularly, 100% saw 0.20 LogMAR or better at near without correction and 88.9% achieved this level for uncorrected intermediate visual acuity. No intraoperative complications were noted. Five patients complained of moderate haloes in the early postoperative period.ConclusionThe AcrySof IQ Panoptix IOL provides functional uncorrected visual acuity at distance, intermediate and near positions. Our results remain equivalent with existing trifocal IOL outcomes and provide surgeons with a further IOL alternative for the patient motivated to obtain true spectacle independence. Surgeons should consider individual reading and working requirements when counselling patients preoperatively to optimise postoperative patient satisfaction.Electronic supplementary materialThe online version of this article (doi:10.1186/s40662-017-0076-8) contains supplementary material, which is available to authorized users.

Non-technical skills of medical emergency teams are known to often be suboptimal; however, average ratings of 89% were achieved in this real-world study. TEAM™ is a valid, reliable and easy to use tool, for both training and clinical settings, with benefits for team performance when used as an assessment and/or debriefing tool.

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Immune checkpoint inhibitors have recently emerged as an exciting new treatment paradigm across a broad spectrum of malignancies. This new class of agents also challenges oncologists with a unique set of immunebased toxicities. Early recognition and precise management of these toxicities can result in better outcomes, with minimization of toxicity and harm to the patient. This article provides a comprehensive review of immune-based toxicities caused by immune checkpoint inhibitors, including recommendations for their investigation and guidelines for specific management.

Exercise therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer (Review)

Abstract. Methane emissions associated with the production, transport, and use of oil and natural gas increase the climatic impacts of energy use; however, little is known about how emissions vary temporally and with commodity prices. We present airborne and ground-based data, supported by satellite observations, to measure weekly to monthly changes in total methane emissions in the United States’ Permian Basin during a period of volatile oil prices associated with the COVID-19 pandemic. As oil prices declined from ~$ 60 to $ 20 per barrel, emissions changed concurrently from 3.4 % to 1.5 % of gas production; as prices partially recovered, emissions increased back to near initial values. Concurrently, total oil and natural gas production only declined by a maximum of ~10 % from the peak values seen in the months prior to the crash. Activity data indicate that a rapid decline in well development and subsequent effects on associated gas flaring and midstream infrastructure throughput are the likely drivers of temporary emission reductions. Our results, along with past satellite observations, suggest that under more typical price conditions, the Permian Basin is in a state of overcapacity in which rapidly growing natural gas production exceeds midstream capacity and leads to high methane emissions.

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