The Indacaterol: Switching Non-exacerbating Patients with Moderate COPD From Salmeterol/Fluticasone to Indacaterol (INSTEAD) study investigated the effect of switching patients at low risk of chronic obstructive pulmonary disease (COPD) exacerbations from salmeterol/fluticasone (SFC; inhaled corticosteroid (ICS) regimen) to indacaterol monotherapy (non-ICS regimen).This 26-week, double-blind, double-dummy, parallel-group, phase IV study, randomised 581 patients with moderate COPD to indacaterol 150 mg once daily or SFC 50/500 mg twice daily. Patients had been receiving SFC 50/500 mg for o3 months, with no COPD exacerbations for more than a year before the study (patients for whom ICS is not recommended). The primary objective was to demonstrate noninferiority of indacaterol to SFC, measured by trough forced expiratory volume in 1 second (FEV1) after 12 weeks (non-inferiority margin of 0.06 L).The primary objective was met, with a mean treatment difference of 9 mL (95% CI -45-26 mL). There were no significant differences between treatments in terms of breathlessness (transition dyspnoea index) or health status (Saint George's Respiratory Questionnaire) at weeks 12 or 26, or rescue medication use or COPD exacerbation rates over 26 weeks. Safety profiles of both treatments were as expected.This study demonstrated that patients with moderate COPD and no exacerbations in the previous year can be switched from SFC to indacaterol 150 mg with no efficacy loss. @ERSpublications Moderate COPD patients can switch from salmeterol/fluticasone to indacaterol with no efficacy loss

Age-related macular degeneration (AMD) is a chronic degenerative disease of the retina. Recent reports have highlighted the potential role of mucosal surface microbes in the pathogenesis of AMD. in this case-control study, the composition of the nasal and oral microbiota in newly diagnosed neovascular age-related macular degeneration cases (6 male, 7 female) was compared to controls without retinal diseases (2 male, 3 female). PCR amplification of 16S rRNA genes was performed with universal primers amplifying the V4 variable region (515F-806R). Distinct microbial community characterization was achieved using principal coordinates Analysis (pcoA) of the Bray-curtis index with comparative analysis between cases and controls performed within QIIME 2. Sequencing of all cases and controls revealed clear separation with strong beta diversity between oral and nasal microbial communities (p < 0.001). Microbial composition differed between cases and controls in both oral and nasal samples. The top three oral microbes identified as different compared to controls included Burkholderiales (7.41 log2fold change, p = 3.29E-05), Actinomyceataceae (6.22 log2fold change, p = 3.73E-06) and Gemella (5.28 log2fold change, p = 0.0002). The top three nasal microbes identified as different compared to controls included Rothia (13.6 log2fold change, p = 3.63E-18), Actinobacteria (10.29 log2fold change, p = 9.81E-10) and Propionibacteriales (8.73 log2fold change, p = 6.74E-09). These relative shifts in communities of bacteria detected in newly diagnosed neovascular AMD patients may suggest additional mechanistic links in disease pathogenesis.

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From the earliest descriptions of multiple sclerosis (MS), the venocentric characteristic of plaques was noted. Recently, numerous magnetic resonance imaging (MRI) studies have proposed this finding as a prospective biomarker for MS, which might aid in differentiating MS from other diseases with similar MRI findings. High-field MRI studies have shown that penetrating veins can be detected in most MS lesions using T2∗ weighted or susceptibility-weighted imaging. Future studies must address the feasibility of imaging such veins in a clinically practical context. The specificity of this biomarker has been studied only in a limited capacity. Results in microangiopathic lesions are conflicting, whereas asymptomatic white matter hyperintensities as well as lesions of neuromyelitis optica are less frequently venocentric compared to MS plaques. Prospective studies have shown that the presence of venocentric lesions at an early clinical presentation is highly predictive of future MS diagnosis. This is very promising, but work remains to be done to confirm or exclude lesions of common MS mimics, such as acute disseminate encephalomyelitis, as venocentric. A number of technical challenges must be addressed before the introduction of this technique as a complementary tool in current diagnostic procedures.

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BACKGROUND AND PURPOSE:SWI is an MR technique conventionally implemented with single-echo gradient-echo data. The purpose of this study was to compare single-echo SWI processing and 2 multiecho SWI processing schemes: postaverage, where an SWI image is created for each echo and then averaged to create a single volume; and frequency-based, where a SWI image is generated from an average frequency image. Linear and nonlinear mask functions were investigated for all 3 processing schemes.

Topic Prostaglandin analogues (PGAs) are first-line medical therapy for primary open angle glaucoma (POAG) and ocular hypertension (OHT). Intraocular pressure (IOP) lowering effects in full responders are known to be 25–33% for this class; however, partial responders and nonresponders do exist. In clinical trials or prospective series, discontinuation and washout of PGAs is necessary to evaluate true change in IOP from novel surgeries and medical therapies. Clinical Relevance To identify all relevant papers with pertinent data on washout of PGAs and quantify the duration and long-term effect of reported PGA washout periods in glaucoma and OHT patients. Methods A systematic review and meta-analysis was conducted to investigate the long-term effects on IOP after discontinuation of topical PGAs POAG and OHT patients. The main search was conducted in MEDLINE/PubMed, EMBASE, Cochrane Library, CINAHL, Web of Science, and BIOSIS Previews and conference proceedings. Results 1055 papers were identified, 548 were independently screened by two physicians., and 56 papers were analyzed for washout durations. The mean washout was found to be 4.56 weeks (±1.25), with the mode and median being 5 weeks. Five studies were analyzed as randomized control trials in which latanoprost was discontinued for 4 weeks prior to restarting another intraocular pressure-lowering drug. Meta-analysis revealed a 4-week discontinuation of latanoprost, on average, subjects returned to their baseline IOP. Conclusion A significant IOP-lowering effect of latanoprost was not observed beyond 4 weeks, suggesting this may be an appropriate washout period for latanoprost. We could not identify appropriate washout periods for either travoprost or bimatoprost, although a majority of articles had 4-week washout durations for the two drugs. Despite the widespread use of this class of medication, there is a paucity of literature on the effects of PGA washout in patients that are treatment naïve to other topical medications.

Early ocular findings in Cohen syndrome: case report and Canadian survey study Cohen syndrome (CS) is an extremely rare genetic disorder characterized by systemic and ocular findings, with fewer than 1000 cases estimated worldwide. 1 The condition is caused by biallelic mutations in the vacuolar protein sorting 13 homolog B (VPS13B) gene. 1 A diagnosis may be suspected in a child presenting with global developmental delay, hypotonia, microcephaly, slender hands and feet, neutropenia, and dysmorphic facial features (down-slanting palpebral fissures, hypertelorism, short philtrum, prominent upper teeth, maxillary hypoplasia, and micrognathia). 1 Other typical facial characteristics in CS include thick eyebrows, thick bushy hair, low hairline, and long and thick eyelashes. 1 Patients with CS have been described to be sociable with a cheerful disposition. 1,2 Myopia and retinochoroidal dystrophy are very common, whereas strabismus, ptosis, and lens opacities are occasionally present. 2 Owing