Temeljni argument ovog rada izgrađen je na osnovi važnosti ublažavanja korištenja zapadnih kategorija morala kako ih se može naći u konceptu sebstva i personalizma pri apostrofiranju moralnih i ...praktičnih problema u nekim dijelovima Afrike; specifično u etničkim nigerijskim skupinama Igboa i Yorube. Sažeto, personalizam kao etička teorija promiče vrijednost i dostojanstvo ljudskog bića, što je čini atraktivnom teorijom morala koja se lako primjenjuje na općem planu problema morala. Međutim, s tim dolaze neke opasnosti jer je znanje o nekim moralnim problemima drugačije pojmljeno od različitih društava i kultura. Primjerice, afrička koncepcija ljudske osobe, kako je predstavljena u moralnom sistemu Yoruba i Igbo naroda, nema oštro kategoričko razlikovanje između transcendentnog, duhovnog i materijalnog, kako je to slučaj u koncepcijama Zapada koje naglašavaju materijalnu, funkcionalnu i tjelesnu dimenziju. Predstoji vidjeti da rasprava ovog tipa ima instrumentalnu važnost u pribavljanju vrijednosti i potrebnog okvira za ispitivanje bezbroj problema s kojima se susreće afrički kontinent.
The Diabetic Retinopathy Clinical Research Network (DRCR Network), sponsored by the National Eye Institute, reported the results of a comparative effectiveness randomized clinical trial (RCT) ...evaluating the 3 anti-vascular endothelial growth factor (anti-VEGF) agents aflibercept (2.0 mg), bevacizumab (1.25 mg), and ranibizumab (0.3 mg) for treatment of diabetic macular edema (DME) involving the center of the retina and associated with visual acuity loss. The many important findings of the RCT prompted the American Society of Retina Specialists to convene a group of experts to provide their perspective regarding clinically relevant findings of the study.
To describe specific outcomes of the RCT judged worthy of highlighting, to discuss how these and other clinically relevant results should be considered by specialists treating DME, and to identify unanswered questions that merit consideration before treatment.
The DRCR Network-authored publication on primary outcomes of the comparative effectiveness RCT at 89 sites in the United States. The study period of the RCT was August 22, 2012, to August 28, 2013.
On average, all 3 anti-VEGF agents led to improved visual acuity in eyes with DME involving the center of the retina and with visual acuity impairment, including mean (SD) improvements by +13.3 (11.1) letters with aflibercept vs +9.7 (10.1) letters with bevacizumab (P < .001) and +11.2 (9.4) letters with ranibizumab (P = .03). Worse visual acuity when initiating therapy was associated with greater visual acuity benefit of aflibercept (+18.9 11.5) over bevacizumab (+11.8 12.0) or ranibizumab (14.2 10.6) 1 year later (P < .001 for interaction with visual acuity as a continuous variable, and P = .002 for interaction with visual acuity as a categorical variable). It is unknown whether different visual acuity outcomes associated with the use of the 3 anti-VEGF agents would be noted with other treatment regimens or with adequately repackaged bevacizumab, as well as in patients with criteria that excluded them from the RCT, such as persistent DME despite recent anti-VEGF treatment.
On average, all 3 anti-VEGF agents led to improved visual acuity in eyes with DME involving the center of the retina and visual acuity impairment. Worse visual acuity when initiating therapy was associated with greater visual acuity benefit of aflibercept over bevacizumab or ranibizumab 1 year later. Care needs to be taken when attempting to extrapolate outcomes of this RCT to differing treatment regimens. With access to adequately repackaged bevacizumab, many specialists might initiate therapy with bevacizumab when visual acuity is good (ie, 20/32 to 20/40 as measured in the DRCR Network), recognizing that the cost-effectiveness of bevacizumab outweighs that of aflibercept or ranibizumab.
This study investigated the correlation between in vivo serial T_2 -weighted magnetic resonance (MR) imaging and changes in superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities, ...and water, sodium ion (Na^+ ), and potassium ion (K^+ ) contents measured in vitro using rat brain following right middle cerebral artery occlusion in conjunction with bilateral common carotid artery (CCA) occlusion. One hour later the left CCA was released. Serial MR images showed edema developed from the outer cortex towards the center. The T_2 signal intensity of the injured right cortex increased with time compared to that of the contralateral cortex. Increased Na^+ and water and decreased K^+ contents occurred in the injured cortex, indicating that serial T_2 -weighted MR imaging reflects the changes in water content and Na^+ and K^+ concentrations determined by biochemical techniques. GSH-Px activity was little changed. Total SOD in the injured cortex decreased 1 hour after ischemia and remained low throughout the experiment. In contrast, SOD activity in the noninfarcted left cortex also decreased after 1 hour but returned to normal after 2 hours of ischemia. Our results suggest that oxygen free radicals are important in developing ischemic brain edema and cerebral infarction.
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