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Active balancing techniques have become increasingly popular for mitigating voltage mismatches in series-connected lithium-ion (Li-ion) batteries. These techniques outperform passive balancing in enhancing battery capacity as the battery ages, leading to an increased lifetime, especially in the electric transportation sector, where residual capacitance plays a crucial role in determining battery lifespan. This study proposes a circuit configuration that utilizes a multiport active half-bridge converter for active cell balancing. The proposed method offers a high degree of flexibility owing to multiple operating modes and a relatively straightforward circuit configuration. Based on the state of charge of each cell, bidirectional power flow can be controlled between two or more arbitrary cells or between the entire battery string and a group of batteries. The proposed approach has been experimentally validated in a battery pack of seven Li-ion cells.

Only a fraction of patients with cutaneous lupus erythematosus (CLE) will eventually progress toward systemic disease (SLE).

Nickel-based alloys are used widely in aerospace components and the oil and gas industry, operating in an extremely adverse environment. These alloys are characterized as difficult-to-machine materials due to their high hardening rate, low thermal conductivity, and superior hot hardness. Since the material and its machining are very expensive, it is important to evaluate how the machining processes deteriorate the surface integrity to prolong the service life of the Inconel components as long as possible. In order to reach this goal, the influence of tool geometry, feed rate, and cutting speed on surface integrity was evaluated for the milling process of Inconel 625 cladding. Qualitative and quantitative mechanical and metallurgical analyses on the surface and subsurface were performed using 3D optical microscopy, scanning electron microscopy (SEM), instrumented indentation, X-ray diffraction for residual stress measurements, and corrosion tests. The results indicate that cutting speed has the greatest influence on specific cutting pressure. The cutting speed and feed rate were the main factors that affected the thickness of the deformed layer. The results suggest that surface and subsurface alterations after machining are driven by mechanical-thermal loadings and cause beneficial results related to corrosion resistance and compressive residual stress.

Ti–13Nb–13Zr (TNZ) parts were produced by selective laser melting under an atmosphere with a relatively high O content using a comprehensive combination of laser powers and laser beam scanning velocities. The influence of processing conditions on the density, microstructure, interstitial element contents (N and O), and hardness of as-printed TNZ parts were studied. The N and O contents in the TNZ parts increased on increasing the energy density (ED). Despite the high O content in the chamber during laser processing, it was possible to obtain TNZ parts with high density and relatively low N and O contents, depending on the EDapplied. Two different types of microstructure were observed in the TNZ parts: α′ martensite and α/α′ + β phases. Depending on its microstructure, the TNZ parts presented interstitial solid solution hardening and second phase hardening.

Accurate risk stratification of critically ill patients with coronavirus disease 2019 (COVID-19) is essential for optimizing resource allocation, delivering targeted interventions, and maximizing patient survival probability. Machine learning (ML) techniques are attracting increased interest for the development of prediction models as they excel in the analysis of complex signals in data-rich environments such as critical care.

AimsTo investigate the effect of fundus tracking perimetry on structure–function relationship in glaucoma.MethodsPerimetric data were acquired with the Humphrey Field Analyzer (HFA) and the Compass fundus perimeter (CMP, equipped with fundus tracking). We included data from 696 eyes from 360 healthy people and 711 eyes from 434 patients with glaucoma from the original study, for which the circumpapillary retinal nerve fibre layer optical coherence tomography scan (Cp-RNFL) was available. We explored the structure–function relationship using both global indices (mean deviation and average Cp-RNFL thickness loss) and anatomically defined visual field clusters comparing the R2values from mixed-effect models. We then measured the diagnostic ability of a combined Structure Function Index (SFI) using perimetric data from either perimeter. The comparisons were based on partial receiver operating characteristic curves with a minimum specificity of 75% and their areas under the curve.ResultsThe R2for the global structure–function relationship was 0.50 for the CMP and 0.48 for the HFA. When visual field clusters were included in the model, the R2was 0.29 for CMP and 0.30 for HFA. Overall, the discrimination ability of the SFI was not significantly higher than the Cp-RNFL for either the CMP (p=0.07) or the HFA (p=0.14). However, it was significantly better in eyes with perimetric damage (p<0.001), in which the CMP-SFI performed significantly better than the HFA-SFI (p=0.03).ConclusionsStructure–function relationship is similar between the two perimeters. Fundus tracking might improve discrimination ability with a combined SFI.Trial registration numberISRCTN13800424.

Glaucoma is the second leading cause of blindness in the world, affecting more than 60 million people globally. In order to reduce the progression of the disease, both medical and surgical treatments are used. Frequent side effects of both treatments include a range of modifications of the ocular surface grouped as the Ocular Surface Disease (OSD), which include Dry Eye Disease (DED). DED and other OSD negatively impact on the success of anti-glaucoma treatments and reduce the adherence to medical therapies. Tear film osmolarity (TFO) is a relatively novel test which has become a hallmark of DED. The aim of this paper was to review the association between OSD, DED and glaucoma in view of published TFO data, and to discuss future fields of research and treatments on the topic of glaucoma iatrogenic damage.

Objective.To analyze the effect of a risk-stratified disease-modifying antirheumatic drug (DMARD)–tapering algorithm based on multibiomarker disease activity (MBDA) score and anticitrullinated protein antibodies (ACPA) on direct treatment costs for patients with rheumatoid arthritis (RA) in sustained remission.Methods.The study was a posthoc retrospective analysis of direct treatment costs for 146 patients with RA in sustained remission tapering and stopping DMARD treatment, in the prospective randomized RETRO study. MBDA scores and ACPA status were determined in baseline samples of patients continuing DMARD (arm 1), tapering their dose by 50% (arm 2), or stopping after tapering (arm 3). Patients were followed over 1 year, and direct treatment costs were evaluated every 3 months. MBDA and ACPA status were used as predictors creating a risk-stratified tapering algorithm based on relapse rates.Results.RA patients with a low MBDA score (< 30 units) and negative ACPA showed the lowest relapse risk (19%), while double-positive patients showed high relapse risk (61%). In ACPA-negative and MBDA-negative (< 30 units), and ACPA or MBDA single-positive (> 30 units) groups, DMARD tapering appears feasible. Considering only patients without flare, direct costs for synthetic and biologic DMARD in the ACPA/MBDA-negative and single positive groups (n = 41) would have been €372,245.16 for full-dose treatment over 1 year. Tapering and stopping DMARD in this low-risk relapse group allowed a reduction of €219,712.03 of DMARD costs. Average reduction of DMARD costs per patient was €5358.83.Conclusion.Combining MBDA score and ACPA status at baseline may allow risk stratification for successful DMARD tapering and cost-effective use of biologic DMARD in patients in deep remission as defined by the 28-joint count Disease Activity Score using erythrocyte sedimentation rate.

Background: Compass (CenterVue, Padova, Italy) is a fundus automated perimeter which has been introduced in the clinical practice for glaucoma management in 2014. The aim of the article is to review Compass literature, comparing its performances against Humphrey Field Analyzer (Zeiss Humphrey Systems, Dublin, CA, USA).Results: Analyses on both normal and glaucoma subjects agree on the fact that Humphrey Field Analyzer and Compass are interchangeable, as the difference of their global indices is largely inferior than test -retest variability for Humphrey Field Analyzer. Compass also enables interesting opportunities for the assessment of morphology, and the integration between morphology and function on the same device.Conclusion: Visual field testing by standard automated perimetry is limited by a series of intrinsic factors related to the psychophysical nature of the examination; recent papers suggest that gaze tracking is closely related to visual field reliability. Compass, thanks to a retinal tracker and to the active dislocation of stimuli to compensate for eye movements, is able to provide visual fields unaffected by fixation instability. Also, the instrument is a true colour, confocal retinoscope and obtains high-quality 60° × 60° photos of the central retina and stereo-photos details of the optic nerve. Overlapping the image of the retina to field sensitivity may be useful in ascertaining the impact of comorbidities. In addition, the recent introduction of stereoscopic photography may be very useful for better clinical examination.

Background/aimsTo investigate the contribution of vascular volume calculated by optical coherence tomography angiography (OCTA) to the measurement of peripapillary retinal nerve fibre layer (RNFL) thickness.MethodsWe used OCTA scans to build volumetric maps of the RNFL angiograms by thresholding the decorrelation images and summing the number of white pixels along the z-axis at each location. We used these maps to calculate the contribution of the vascular tissue to the RNFL thickness.ResultsWe analysed 51 eyes from 36 subjects. The mean RNFL volume calculated on the peripapillary region was 0.607±0.045 mm3and the mean vessel volume was 0.217±0.035 mm3, with a mean vessel/total RNFL ratio of 35.627%±3.942%. When evaluated in the peripapillary circular section, the total contribution of the vascular tissue to the global RNFL thickness was 29.071%±3.945%. The superior and inferior sectors showed the highest percentage of vascular tissue within the RNFL circular profile (31.369% and 34.788% respectively).ConclusionsWe found that the vascular contribution to the RNFL thickness is 29.07±3.945%. This is much higher than what has been reported from calculations made on the structural OCT alone (13% reported by Hood et aland 11.3%±1.6% for the Cirrus OCT and 11.8%±1.4% for the Spectralis OCT reported by Patel et al). We conclude that evaluation of the vascular tissue contribution to the RNFL thickness with OCTA might be useful when performing precise quantification of the neuronal tissue.

A osteotomia em cunha de abertura da tíbia proximal é um procedimento amplamente feito para o tratamento da gonartrose medial em pacientes ativos e na presença de mau alinhamento em varo do membro inferior. O método de fixação é controverso e o uso de implantes convencionais foi substituído pelo uso de implantes com parafusos de bloqueio mais modernos. O objetivo do presente estudo clínico foi avaliar a manutenção da correção feita nos casos em que a fixação foi feita com implantes convencionais.

Purpose To compare the performance of Compass fundus automated perimetry (FAP) and Humphrey Field Analyzer (HFA) in glaucoma patients.Methods A total of 120 patients with glaucoma underwent 1 FAP and 1 HFA perimetric test over the central 24° on one eye. The chosen eye and sequence were randomized and only reliable examinations were considered for analysis. Mean deviation (MD), pattern standard deviation (PSD), visual field index (VFI), and the area of absolute scotoma were compared between perimeters. Glaucoma Staging System (GSS2) data were analyzed by means of k test.Results Mean sensitivity difference (FAP-HFA) was −1.0 ± 2.81 dB (p<0.001, 95% confidence interval [CI] −1.61, −0.60 dB), MD difference was +0.27 ± 2.84 dB (p = 0.36, 95% CI −5.30, 5.83 dB), PSD difference was +0.48 ± 1.95 dB (p = 0.0075, 95% CI −3.37, 4.33 dB), and VFI difference was +2.4% ± 8.4% (p = 0.003, 95% CI −14.0%, +18.8% dB). Weighted kappa for GSS2 was 0.87. Points with null sensitivities were 9.9 ± 10.2 with FAP and 8.2 ± 8.9 with HFA (difference: 1.7 ± 4.0 points, p = 0.013).Conclusions Mean sensitivity with FAP is 1 dB lower than HFA, a finding due to different threshold strategies. Differences of global indices for FAP and HFA are small, which makes the 2 perimeters equivalent in the clinical setting. However, FAP seems more severe in evaluating glaucomatous damage, with absolute scotoma areas larger than with HFA. We raise the hypothesis that such difference may be the result of the active compensation of eye movements available with FAP.

Tourniquet is widely used in total knee replacement surgery because it reduces intraoperative hemorrhage and provides a comfortable surgical area for the surgeon. It's possible that its use could lead to impaired postoperative functional and motor recovery, as well as local and systemic complications. Our goal was to compare the outcomes of total knee replacement without ischemia using an optimized protocol, consisting of tourniquet inflation before skin incision and deflation after cementing, with a pressure of one hundred millimeters above systolic blood pressure and without postoperative articular suction drains.). We believed that tourniquet effectively would result in no additional muscle damage and no functional or knee strength impairment compared to no tourniquet.

During machining, the workpiece material tends to undergo mechanical and thermal transformations. Machining Inconel 625 is a challenging task since this material has low thermal conductivity, rapidly work hardening, and maintains its strength even at high temperatures. This superalloy is used extensively by the aerospace and oil and gas industries due to both its corrosion and heat resistance. All these characteristics influence tool life, cutting forces, and the integrity of the machined surface, which, in turn, significantly impacts the fatigue life of the components. It is therefore important to understand the surface integrity induced during milling. Although many reports have been published about tool wear and surface integrity studies for Inconel alloys, especially on the effect of the tool condition on the surface and subsurface which address residual stress, corrosion, and deformed layers have not been investigated so far. This study highlights the importance of assessing the surface integrity of Inconel 625 clad workpieces milled with both fresh and worn tools at different cutting speeds and feed rates. The results show that the best conditions for maintaining surface integrity among the conditions tested are vc = 55 m/min and fz = 0.10 mm/tooth. The workpiece milled with a fresh tool presented better corrosion resistance, whereas the worn tool produced more compressive stress, indicating that such conditions would improve the fatigue life of the part.

Retrobulbar hemorrhage (RBH) is an uncommon complication of endoscopic sinus surgery or periorbital surgery consisting in an accumulation of blood within the orbit posteriorly to the eyeball. It must be treated within 90-100 minutes to avoid irreversible visual loss. The present paper tries to pinpoint the key steps in diagnosis and treatment of RBM.

To assess the therapeutic noninferiority of 0.005 latanoprost ophthalmic solution versus Xalatan in the treatment of patients with primary open-angle glaucoma or ocular hypertension.

The purpose of the study was to create a linear discriminant function (LDF) formula by using the new Glaucoma Probability Score (GPS) global and sectorial optic nerve head parameters measured by Heidelberg Retinal Tomograph 3 to improve the GPS diagnostic capacity to discriminate between healthy and glaucomatous eyes.

Introduction:Prostaglandins are increasingly used as first choice treatment for glaucoma because they are highly effective, lack relevant systemic side effects and require just once-daily administration. Latanoprostis an ester prodrug analog of prostaglandin F2α, which reduces intraocular pressure (IOP) by increasing uveoscleral outflow. Latanoprost 0.005% has received European and US approval as the first-line drug for reducing IOP in patients with open-angle glaucoma or ocular hypertension. Following the recent patent expiry for Xalatan®, a number of latanoprost generics have entered the glaucoma market.Areas covered:This review, achieved through PubMed and Medline research methods, describes the composition, pharmacokinetics, mode of action, efficacy, side effects and safety profile of latanoprost.Expert opinion:Latanoprost was the first prostaglandin analog introduced in glaucoma management and it dramatically changed the market of the disease thanks to its efficacy and safety. Conjunctival hyperemia, which is commonly found after latanoprost use, is associated with a minor efficacy and duration of trabeculectomy; yet, from the ophthalmologist's perspective, this side effect seems largely counterbalanced by the high efficacy and safety of this compound. It is always advisable to consider the pro-inflammatory mode of action of latanoprost because this may have negative effects in particular patients (i.e., those with uveitis and cystoid macular edema) for whom caution and close follow-up is necessary.

We have synthesized a new prodrug obtained by the 5′-ester conjugation of zidovudine (AZT), an antiviral agent substrate of active efflux transport systems (AET), with ursodeoxycholic acid (UDCA), a bile acid able to permeate into the central nervous system (CNS). We have demonstrated, by HPLC analysis, that UDCA–AZT is quickly hydrolyzed in rat plasma and whole blood (half-life <10 s). The same compound was hydrolyzed with slower rates in human plasma (half-life =7.53 ± 0.44 h) and whole blood (half-life =3.71 ± 0.16 h), allowing to control the AZT release. UDCA–AZT appeared hydrolyzed also in rat brain (half-life = 7.24 ± 0.45 min) and liver homogenates (half-life = 2.70 ± 0.14 min). In the aim to study the permeation properties of the UDCA–AZT across physiological barriers, we have used an established human retinal pigment epithelium (HRPE) cell line to obtain a polarized cell monolayer showing epithelial features. The bidirectional permeation of 30 μM AZT across this monolayer was regulated by apparent permeability coefficients (PE) higher from the apical to basolateral compartments (PE= 209 ± 4 × 10–5cm/min) than in the opposite way (PE= 133 ± 8 × 10–5cm/min), in conformity with the in vivobehavior of AZT, actively effluxed from the CNS. The influx (PE= 39.1 ± 1.2 × 10–5cm/min) and efflux (PE= 31.3 ± 3.6 × 10–5cm/min) permeability coefficients of 30 μM UDCA–AZT were instead the same, suggesting the ability of the prodrug to avoid the AET systems and, potentially, to allow its accumulation in the CNS. The relatively low PEvalues of UDCA–AZT were associated with a partial hydrolysis during its permeation across the cell monolayer.

Introduction:In the last decades, the therapy of glaucoma has largely shifted from surgery to medical treatment thanks to the introduction of strongly effective formulations, that is, prostaglandin analogs and fixed combinations. This clinical scenario may dramatically change in the future thanks to the progresses in biochemistry, genetics and drug delivery technology.Areas covered:This review covers the strategies currently used to achieve effective medical reduction of intraocular pressure in clinical practice; treatments that are currently been experimented in humans and that may be clinically available in the next few years; treatments at preclinical stages; and future goals of glaucoma treatment (gene therapy, ocular implants and neuroprotection).Expert opinion:Apart from an adequate reduction of intraocular pressure, effective glaucoma treatments should guarantee other characteristics: good tolerability, low problems of adherence and, possibly, multiple ways of action. From this viewpoint, a crucial clinical role may be played by drugs remodeling the trabecular meshwork (i.e., ROCK inhibitors, metalloproteinases). Other strategies such as the use of ocular implants for drug delivery, neuroprotection or gene therapy could renew glaucoma management in the future, but need long-term rigorous verification of safety and efficacy.

To evaluate the diagnostic assessment of optic nerve heads (ONH) by stereophotography (SP) and Heidelberg retina tomograph (HRT) in patients with retinitis pigmentosa (RP).

Purpose To compare the effects of topical antiallergic eyedrops in relieving the signs and symptoms of patients with allergic conjunctival pathology.Methods In this multicenter, single-masked, randomized study, 240 patients with signs and symptoms of allergic conjunctivitis were randomized to receive 1 of the following 8 treatments twice daily: cromolyn sodium/chlorpheniramine maleate, diclofenac, epinastine, fluorometholone, ketotifen, levocabastine, naphazoline/antazoline, and olopatadine. Clinical signs and symptoms were evaluated by a masked operator using a 10-point scale at the moment of enrollment (day 0) and at weeks 1, 2, and 4. The percentage of patients achieving at least a small (at least 50% reduction of the total scale score) or a good (at least 75%) improvement of signs and symptoms was calculated at each visit. Tolerability was also evaluated as the duration of discomfort after instillation.Results All drugs gave some improvement in symptoms in more than 85% of cases. Epinastine and olopatadine obtained at least a good relief of symptoms in 37% and 33% of cases at week 1. At the end of the study, good improvement of symptoms was obtained in at least 70% of patients by epinastine, ketotifen, fluorometholone, and olopatadine, whereas a 75% improvement for signs was obtained only by fluorometholone and ketotifen. Naphazoline/antazoline induced higher discomfort compared to the other study treatments (p<0.0001).Conclusions The efficacy of epinastine, ketotifen, and olopatadine in the treatment of allergic conjunctivitis was comparable to fluorometholone. Naphazoline/antazoline had lower tolerability than the other study treatments.

To evaluate the influence of central corneal thickness (CCT) and its 24-hour fluctuation on 24-hour intraocular pressure (IOP) fluctuation in primary open-angle glaucoma.

To evaluate the learning effect at Short-wavelength Automated Perimetry (SWAP) using the Swedish Interactive Threshold Algorithm (SITA) program over the central 24 degrees on patients with ocular hypertension experienced with standard automated perimetry.

An overview on the use of bile acid‐based compounds able to catalyze transformations, control the stereochemical course of a given reaction, recognize and bind other molecules, is presented. The recent developments in inclusion discrimination of chiral and achiral guests and enantioselective recognition achieved by bile acid are described with suitable examples. Chirality 2010. © 2009 Wiley‐Liss, Inc.

Purpose. To investigate diplopia after orbital decompression in patients with thyroid-related orbitopathy.Methods. We retrospectively analyzed medical records of 45 consecutive patients who had undergone orbital decompression surgery (DS) and a subgroup of 10/45 patients who underwent disinsertion of the inferior oblique (IO) muscle during DS. Diplopia was assessed before DS and 1 and 3 months after DS. Residual strabismus defects were treated surgically approximately 3 months after DS with follow-up visits 1 week, 3 months, and 6 months postoperatively. Patients with horizontal or vertical diplopia were evaluated using the alternate prism-and-cover test and torsional diplopia (TD) using a double Maddox rod test to quantitate their strabismus.Results. Strabismus surgery was effective in treating the horizontal and vertical diplopia (13/40 cases with residual deviations required prism glasses), but did not resolve the TD. None of the patients with IO disinsertion during DS complained of TD before strabismus surgery. However, after strabismus surgery, TD occurred in all IO patients with IO disinsertion vs 8/30 patients without IO disinsertion (p<0.001, Fisher exact test). Overall, TD was induced in 18/45 (40%) of the DS cohort.Conclusions. Patients with IO disinsertion during DS may be at increased risk of developing TD postoperatively. We recommend sparing or reattaching the IO muscle during DS when possible to reduce the risk of developing untreatable TD.

Organocatalytic asymmetric domino sulfa-Michael/aldol condensation reactions between 1,4-dithiane-2,5-diol (the dimer of mercaptoacetaldehyde) and cinnamaldehydes were efficiently promoted by (S)-diphenylprolinol TMS ether in the presence of bile acid derivatives, leading to hitherto unknown 4,5-dihydrothiophene-2-carbaldehydes in moderate to good yields and good enantioselectivities.