Anti-His Tag Antibody (Mouse IgG1)-coupled Magnetic Beads (recommended for MPCLIA)

Abstract: To present a case that underwent macular buckling with the newly designed titanium macular buckle (TMB) as a stand-alone surgery for a myopic macular hole (MH).This case presentation examines and discusses the anatomical and functional outcomes of the procedure.An 80-year-old female presented with gradual visual loss in his left eye over the past few months. She was pseudophakic and her axial length measurements were 32.09 mm in the left eye. Her best corrected visual acuity (BCVA) was counting fingers at 1 meter. Optical coherence tomography (OCT) revealed that the patient had a dome-shaped posterior pole and a full-thickness MH, with an apical diameter measuring less than 400 µm and a base diameter slightly exceeding 2000 µm. The patient underwent TMB surgery, no vitrectomy was performed. In the postoperative follow-up, BCVA improved to counting fingers at 3 meters at 1 month, with no complications related to the TMB implant or the surgical technique. Postoperative OCT showed that the macular hole had closed.TMB can be used in the management of myopic MHs in selected cases as a standalone surgery.

Abstract: Background: Retrobulbar block is a popular regional anesthetic technique in modern eye surgery due to its excellent anesthetic properties and the provision of globe akinesia. Severe complications including inadvertent subarachnoidal injection, expulsive retrobulbar hemorrhage, and intoxication with local anesthetic, are very rare. However, most reports date back several decades, mechanisms of action are not fully understood, and in recent years the procedure has changed towards facilitating the retrobulbar injection by a brief analgosedation. We therefore describe a case with inadvertent brainstem anesthesia after retrobulbar block concealed behind an analgosedation and provide cCT (cranial computed tomography) images with characteristic pathological findings. Therapy and outcome: A man in his mid-60´s presenting with retinal detachment was scheduled for surgery. After uneventful retrobulbar injection under brief analgosedation, a severe increase of blood pressure and tachycardia occurred while unconsciousness (originally induced by analgosedation) persisted. Hemodynamic alterations were treated with betablockers and antihypertensive agents, and the patient was intubated and mechanically ventilated. The diagnostic workup revealed a dural fissure with intracranial air in the cCT-scan compatible with a perforation of the dura and accidental injection of local anesthetics into the subarachnoidal space. The patient was kept intubated on ICU throughout the respiratory depression and fully recovered without neurological deficits. The vitreoretinal procedure was performed under general anesthesia 36 h after the event. Conclusion: Albeit rare, inadvertent brainstem anesthesia remains a serious adverse event of retrobulbar block. As an important aspect, analgosedation may mask the typical clinical signs making the diagnostic work-up challenging. Furthermore, for the first time we present radiographic imaging findings providing insightful evidence for a possible mechanism of action. Serious complications, such as prolonged hypoxia with potential neurological damage, can successfully prevented by ensuring the presence of a fully equipped and skilled anesthetic team throughout the regional anesthetic procedure.

Abstract: BackgroundData on the effectiveness of preventive treatments on menstrually-related migraine (MRM) is scarce. Our objective was to analyze the efficacy of anti-calcitonin gene-related peptide monoclonal antibodies (anti-CGRP mAbs) and onabotulinumtoxinA (BTX-A) in the reduction of perimenstrual headache days (PHD) and perimenstrual migraine days (PMD) compared to non-perimenstrual headache days (non-PHD) and non-perimenstrual migraine days (non-PMD) per month in women with MRM.MethodsA retrospective study was conducted including females with menstruation and headache records, treated with either anti-CGRP mAbs or BTX-A. Patients completed e-Diary one month before and three months after preventive treatment. We collected clinical data and analyzed PHD/PMD and non-PHD/non-PMD before and after treatment. Additional analyses included PHD/PMD and non-PHD/non-PMD comparisons grouped by aura, episodic/chronic migraine, treatment and contraceptive intake.ResultsWe analyzed data from 113 females with a median (range) age of 39.0 (33.0-45.0) years. When combining patients treated with anti-CGRP mAbs or BTX-A, a median (range) of 2.0 (2.0-3.0) PHD/month (corresponding to 13.6% baseline monthly headache days (MHD)) and 13.0 (9.0-17.0) non-PHD/month pre-treatment was observed. From these, 2.0 (1.0-3.0) were PMD/month, and 7.0 (4.0-11.0) were non-PMD/month. After treatment, the median PHD/month was 2.0 (1.0-3.0) (corresponding to 16.67% of MHD) (p = 0.085), and 8.0 (5.0-13.0) were non-PHD/month (p < 0.001); from these, 1.0 (0.0-3.0) were PMD/month (proportion difference, p = 0.035) and 4.0 (2.0-7.0) were non-PMD (proportion difference, p < 0.001). When analyzing grouped by treatment, only patients treated with anti-CGRP experienced a reduction in PMD. No statistically significant differences in clinical factors (aura, migraine diagnosis, contraceptive intake) between PHD/non-PHD or PMD/non-PMD, either pre- or post-treatment. A higher probability risk of headache and migraine during the perimenstrual window was observed independently of the treatment received (odds ratio = 1.637, 95% confidence interval = 1.356-1.984, p < 0.001).ConclusionsThree-month treatment with anti-CGRP mAbs or BTX-A effectively reduced non-PHD and non-PMD but had limited effect on PHD/PMD because headache probability risk was higher during the perimenstrual window after treatment.

Abstract: This systematic review aims to examine the workflows in distress screening and referral using the NCCN distress thermometer (DT) in the US, aiming to identify key elements for flexible, organization-specific approaches.A systematic review of full-text manuscripts published from 2013 to May 2024 was conducted using MEDLINE, EMBASE, and CINAHL. Studies describing distress screening and referral protocols were included, while systematic reviews, commentaries, non-US studies, non-English publications, and studies on distress score-disease burden associations were excluded. Attributes of distress screening and referral pathways were extracted.From an initial 1219 articles, 19 studies were included. Significant variability was observed in NCCN DT workflows, particularly in responder characteristics (e.g., cancer type, patient vs. caregiver). Nursing staff primarily administered screenings, varying by mode (paper vs. electronic), frequency, and location (home vs. clinic). A cut-off score of 4 or higher often triggered referrals, with some studies further stratifying distress levels for tailored follow-ups. Referral pathways included educational resources, behavioral and emotional health, social support, and rehabilitative and supportive care services. Caregiver distress screening was infrequent.This review underscores the variability in NCCN DT workflows and the need for customizable protocols. While standardization is desirable, some variation is essential to accommodate the differing availability of resources and personnel for effective distress screening and referral.Effective distress screening and referral pathways ensure survivors receive timely psychological, emotional, and social support, improving quality of life. Integrating caregiver distress screening into workflows could amplify overall support systems, fostering holistic survivorship care. A flexible yet structured approach enhances access to tailored interventions, promoting resilience in survivors and caregivers.© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.