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Simple Summary Although secondary enucleation (SE) is the treatment of choice for retinoblastoma eyes that did not respond favorably to conservative therapies, clear criteria for its indication are, however, currently missing. In this position paper on behalf of the European Retinoblastoma Group (EURbG), we discuss the available literature on SE, including its influence on metastases rate and survival, and propose guidelines to assist decision-making to interrupt eye-preserving therapies depending on the availabilities of advanced diagnostic and therapeutic modalities. Absolute indications to SE may be restricted to eyes with refractory tumor activity resisting all salvage treatments or eyes under apparent tumor control but no visual potential and irreducible complications. In contrast, eyes with an obscured optic nerve head and/or ocular complications amenable to specific surgical or medical management can be considered relative indications, provided that appropriate follow-up can be implemented and that parents are fully aware of a residual risk. Abstract Secondary enucleation (SE) puts an irreversible end to eye-preserving therapies, whenever their prolongation is expected to violate the presumed state of metastatic grace. At present, it must be acknowledged that clear criteria for SE are missing, leading to empiric and subjective indications commonly related to disease progression or relapse, disease persistence masking the optic nerve head or treatment-related complications obscuring the fundus view. This absence of evidence-based consensus regarding SE is explained by the continuously moving frontiers of the conservative management as a result of diagnostic and therapeutic advances, as well as by the lack of studies sufficiently powered to accurately stratify the risk of metastasis in conservatively treated patients. In this position paper of the European Retinoblastoma Group (EURbG), we give an overview of the progressive shift in the indications for SE over the past decades and propose guidelines to assist decision-making with respect to when SE becomes imperative or recommended, with corresponding absolute and relative SE indications. Further studies and validation of biologic markers correlated with the risk of metastasis are expected to set more precisely the frontiers of conservative management and thus consensual criteria for SE in the future.

Rapid and sensitive detection of metabolites and chemical residues in human tears is highly beneficial for understanding eye health. In this study, Schirmer paper was used for noninvasive microsampling of human tears, and then paper spray mass spectrometry (PSMS) was performed for direct analysis of human tears. Schirmer PSMS was successfully used for rapid diagnosis of dry-eye syndrome by detecting the volume and metabolites of human tears. Drugs of abuse, therapeutic drugs, and pharmacodynamics in human tears were also investigated by Schirmer PSMS. Furthermore, specific markers of environmental exposures in the air to human eyes, including volatile organic compounds, aerosol, and smoke, were unambiguously sampled and detected in human tears using Schirmer PSMS. Excellent analytical performances were achieved, including single-use, low-sample consumption (1.0 μL), rapid analysis (the whole analytical procedure completed within 3 min), high sensitivity (absolute limit of detection less than or equal to 0.5 pg, signal-to-noise ratio greater than or equal to 3), good reproducibility (relative standard deviation less than 10%, n = 3), and accurate quantitation (average deviation less than 3%, n = 3). Overall, our results showed that Schirmer PSMS is a highly effective method for direct tear analysis and is expected to be a convenient tool for human tear analysis in significant clinical applications.

Traction transformers are one of the most important equipment in the traction power supply system. Thermal aging of transformer insulation system determines its reliable life. To achieve an estimation of the insulation life of traction power transformers operated under real load condition, the effects of traction loads on the thermal aging of oil-paper insulation in traction transformers were investigated. First, the design principles for the accelerated thermal aging experiment were studied and proposed by considering magnitude (i.e., load rate) and frequency (i.e. spare time and lasting time) of the traction load. Then, an experimental system was established in the laboratory to conduct extensive accelerated thermal aging experiments, in which the traction loads were mimicked by using positive temperature coefficient (PTC) heating plates and a programmable logic controller (PLC). Finally, the experimental results were analyzed and discussed to reveal the effects of traction load on the thermal aging of oil-paper insulation in traction transformers.

Purpose To elucidate the correlation between lactoferrin concentration in the tear film and signs and symptoms of severe dry eye disease (DED) using a novel microfluidic paper-based analytical device (μPAD) and enzyme-linked immunosorbent assay (ELISA). Methods Twenty-four patients were recruited at the Keio University Hospital. Using a novel μPAD, lactoferrin concentrations were measured in 4 patients with GVHD-related DED, 3 patients with other types of DED and 2 controls (Group A). For validation by ELISA, 22 patients (7 patients from Group A) comprising 9 patients with GVHD-related DED, 6 patients with other types of DED and 7 controls were examined (Group B). The link between lactoferrin concentration and clinical data about the severity of aqueous tear deficient DED was also investigated by both μPAD and ELISA. Results The lactoferrin concentration in tear fluid of the DED patients was positively correlated between μPAD and ELISA (p = 0.006, r = 0.886). The tear fluid of the GVHD patients showed low or undetectable lactoferrin concentration. Analysis by ELISA demonstrated that lactoferrin concentrations in the tear film from the GVHD patients were significantly lower than those from the non-GVHD patients (p = 0.010576). ELISA revealed lactoferrin concentration correlated with the value of Schirmer test and tear film breakup time, whereas it was inversely correlated with OSDI, fluorescein and rose bengal scores. Conclusions The novel μPAD may pave the way for measuring lactoferrin concentration in tear fluid from DED patients. Our results suggested that lactoferrin concentration in tear fluid reflect the severity of DED.

The beneficiation of sludge from pulp and paper mills to produce high-value products such as crystalline nanocellulose will alleviate the challenges associated with conventional methods of sludge disposal, such as landfilling and incineration. In addition, the use of sludge will reduce the consumption of fresh raw materials in the synthesis of nanocellulose which is usually produced from high-purity cellulose pulps. In this study, fibres were cleaned and separated from sludge and then converted to crystalline nanocellulose using ammonium persulphate under optimised oxidative conditions. To extend potential applications of the crystalline nanocellulose produced, the crystalline nanocellulose was functionalised with zinc oxide, silver and hydroxyapatite to prepare crystalline nanocellulose-zinc oxide, crystalline nanocellulose-silver and crystalline nanocellulose-hydroxyapatite nano- and micro-composites powders using the sol–gel process. Transmission electron microscopy, field-emission scanning electron microscopy, X-ray diffraction and thermo-gravimetric analysis were used to investigate the properties of crystalline nanocellulose and functionalised crystalline nanocellulose. The transmission electron microscope and field-emission scanning electron microscope coupled with energy-dispersive X-ray spectroscopy confirmed the synthesis of crystalline nanocellulose, and inorganic nanoparticles. Functionalised samples (crystalline nanocellulose-zinc oxide, crystalline nanocellulose-silver and crystalline nanocellulose-hydroxyapatite) showed better thermal stability than pure crystalline nanocellulose. This implies that the modified inorganic crystalline nanocellulose composites could be used in applications where thermal stability is desirable. The cost of production is economically viable as the raw material cost is cheaper compared to the use of wood pulp.

High intraocular pressure (IOP) is a recognized risk factor for glaucoma and optic nerve injury, and it is one of the primary causes of vision loss globally. Anabasis articulata (AA) is a desert plant found in Iraq. The extract of AA is used to cure diabetes, fever, eczema, and kidney infections. The aim of the study is to evaluate the antioxidant effect of methanol extract of AA on intraocular pressure in the glaucoma rat model. Forty-two rats were allocated into seven groups, each with six animals:: group 1 (normal), group 2 (control), in which animals were induced to have elevated IOP by betamethasone suspension injection, groups 3,4 and 5 for evaluating the effect of 50,100 and 150 mg/kg/day of the tested extract, respectively, and the remaining two groups (group 6 and 7) for evaluating oral acetazolamide and topical timolol 0.5% respectively. Betamethasone was used for the induction. Measure the IOP every 2 days for 2 weeks. The daily dose of AA extract (50 mg/kg/day) for 6 days significantly reduces intraocular pressure (p ? 0.05), from (34.23± 0.58) to (32.83± 1.38) mmHg when compared with the control group. In group 4, IOP decreased significantly from (35.5±1.37) to (31.35±0.40) mmHg (p ? 0.05) after 1 week of treatment. In group 5, the significant (p? 0.001) IOP reduction from (35.66±0.39) to (31.88±0.74) mmHg started on day 6 and continued until the end of the experiment, reaching (24.53±0.53) mmHg (p? 0.001). The antioxidant and anti-angiogenic properties of AA make it a promising adjuvant treatment for glaucoma.

The APTA recently established a vision for physical therapists to transform society by optimizing movement to promote health and wellness, mitigate impairments, and prevent disability. An important element of this vision entails the integration of the movement system into the profession, and necessitates the development of movement system diagnoses by physical therapists. At this point in time, the profession as a whole has not agreed upon diagnostic classifications or guidelines to assist in developing movement system diagnoses that will consistently capture an individual's movement problems. We propose that, going forward, diagnostic classifications of movement system problems need to be developed, tested, and validated. The Academy of Neurologic Physical Therapy's Movement System Task Force was convened to address these issues with respect to management of movement system problems in patients with neurologic conditions. The purpose of this article is to report on the work and recommendations of the Task Force.The Task Force identified 4 essential elements necessary to develop and implement movement system diagnoses for patients with primarily neurologic involvement from existing movement system classifications. The Task Force considered the potential impact of using movement system diagnoses on clinical practice, education and, research. Recommendations were developed and provided recommendations for potential next steps to broaden this discussion and foster the development of movement system diagnostic classifications.The Task Force proposes that diagnostic classifications of movement system problems need to be developed, tested, and validated with the long-range goal to reach consensus on and adoption of a movement system diagnostic framework for clients with neurologic injury or disease states.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A198).

Identification of meat product adulteration is important to help fair-trade and to enable consumers to make informed choices. Detection of meat adulteration requires reliable analytical methods. Here, we report development of a loop-mediated isothermal amplification (LAMP) method for the detection of tissues of pig origin. We developed a kit containing lyophilized paper-buttons impregnated with the LAMP master-mix together with Lateral Flow Assay (LFA) paper strips. This paper-based LAMP-LFA kit is a ready to use device for remote settings and useful for the quick and efficient detection of tissue of pig origin. LAMP primers targeting mitochondrial COI gene and corresponding probes specific to LAMP amplicon were designed. LAMP reaction component, optimization details regarding thermal amplification protocol, hybridization conditions for probes, design of LFA paper-strips, and detection methods are provided. The paper-based LAMP-LFA platform allowed analysis of the amplified products using HNB dye-based quick visual method and gel electrophoresis-based validation to avoid personal bias. Assay limit-of-detection was 10 fg of DNA template in the reaction. Assay was validated on samples from different pigs, coded samples, binary meat admixture, diversely processed meat to mimic field situation, and supernatant from Phire Animal Tissue Direct PCR kit. The paper-based LAMP-LFA results were comparable with the pre-standardized species-specific polymerase chain reaction, a time consuming and expensive process. Lyophilized paper-based LAMP buttons in the form of a ready-to-use kit were developed to store reaction mixture. LAMP buttons were stable for up to four months when stored at 4 °C. Developed assay is capable of a rapid (3 hrs) identification of tissue of pig origin in tested samples, cost-effective, user-friendly, and requires minimal training making it a method of choice in remote point-of-care sites.

To compare the outcomes of ocular injuries of hornets and paper wasps’ stings. Retrospective case series. Patients diagnosed with ocular injuries sustained by bee stings at Miyata Eye Hospital (Miyazaki, Japan) between August 2000 and July 2016 were enrolled. Retrospective data regarding type of bee, visual acuity, and treatment were collected from medical records. Outcomes of the hornet and wasp groups were compared. Five eyes of 5 patients (3 men, 2 women; mean age 44.6±21.2 years [range 9–62 years]) were enrolled. The mean follow-up period was 50.6 ± 57.6 months (range 4 days to 121 months). The causative bee was hornet in 3 cases and wasp in 2. The anterior chamber was irrigated in 2 patients, both from the hornet group. The best-corrected visual acuity at the final visit was no light perception, light perception, and (0.02) in the hornet group, (1.5) and (1.2) in the wasp group. The hornet group exhibited significantly worse prognosis than the wasp group. Identifying the type of bee is important in establishing prognosis.

Visual and selective detection of 2,4,6-trinitrophenol (TNP) for public and environmental protection is an extremely urgent issue and challenge. Herein, a novel fluorescence polyurethane (FPU) has been successfully synthesized and exploited for selective TNP-detection in coexistence with other commonly competitive nitroaromatic analytes. Excellent recognition ability of FPU toward TNP could reach as low as 0.12 μM and the observed fluorescence responses of FPU are exceptional stable to acid, alkali, and salt. Furthermore, a portable, cost effective, and simple indicator paper depending on FPU for visual detection of TNP is developed. FPU indicator paper exhibits two unique advantages: one is the higher selectivity for TNP detection, the other is realizing the rapid and visual explosives detection. The detection mechanism is described for the synergies in the photoelectron transfer (PET), the fluorescence internal filtration effect (IFE) and the fluorescence energy transfer (FRET). This work provides a novel guidance for the design of fluorescent polymers with portable, cost effective, and visual detection of TNP.

The Xen Gel Stent lowers intraocular pressure by shunting aqueous humor to the subconjunctival space. While published studies include both open conjunctiva and closed conjunctiva approaches, most publications feature a closed conjunctiva, ab interno approach. While this approach is widely used, other approaches may be preferred for some patients. This paper provides details on surgical steps and tips for enhancing outcomes for an open conjunctiva technique for the implantation of the Xen Gel Stent, as well as reasoning as to when this approach should be used. Electronic supplementary material The online version of this article (10.1007/s12325-020-01278-1) contains supplementary material, which is available to authorized users.

Paper-based point-of-care (POC) devices have attracted tremendous attention because of low-cost, simple fabrication, and portability. LAMP-based POC platform comprises a paper substrate on which the DNA amplification reaction occurs. The quality of the paper substrate plays a critical role in performing an efficient LAMP reaction and for effective visualization of the amplification result. The major objective of the current work is to replace the frequently utilized nitrocellulose (NC) membrane by a cost-effective and high quality paper membrane viz. Whatman filter paper (WF) for rapid detection of E. coli via LAMP reaction. Isolated DNA is added on the paper membranes, which undergo LAMP reaction. The effect of initial DNA concentration and time on LAMP amplification reaction rate is analyzed on paper membranes via image analysis for the first time. Overall study inferred that WF is suitable for effective naked-eye detection and greater extent of LAMP reaction (generation of 19 968 DNA copies).

Through natural selection, many animal organs with similar functions have evolved different macroscopic morphologies and microscopic structures. Here, we comparatively investigate the structures, properties and functions of honey bee stings and paper wasp stings. Their elegant structures were systematically observed. To examine their behaviors of penetrating into different materials, we performed penetration–extraction tests and slow motion analyses of their insertion process. In comparison, the barbed stings of honey bees are relatively difficult to be withdrawn from fibrous tissues (e.g. skin), while the removal of paper wasp stings is easier due to their different structures and insertion skills. The similarities and differences of the two kinds of stings are summarized on the basis of the experiments and observations.

This paper presents a brief overview of the use of magnetic field in studying droplet adhesion to a fiber or a fibrous surface. The paper starts by discussing ways to quantify the force required to detach a droplet from a fiber for its applications in coalescence filtration, i.e., removal of dispersed droplets from a gaseous or liquid flow using a fibrous filter. It then continues to discuss droplet detachment from a fibrous surface or penetrating into a thin fibrous coating. The emphasis is put on a recently develop magnetic approach for measuring force of detachment and on its novel simplicity and non-intrusive nature in the context of existing droplet detachment methods. Our review also includes a discussion on force of detachment for multiphase droplets comprised of two immiscible liquids, i.e., compound droplets. Atomistic- and continuum-level numerical simulations pertaining to droplet detachment are also discussed throughout the paper when appropriate.

A distance-based paper analytical device (dPAD) for loop mediated isothermal amplification (LAMP) detection based on distance measurement was proposed. This approach relied on visual detection by the length of colour developed on the dPAD with reference to semi-quantitative determination of the initial amount of genomic DNA. In this communication, E. coli DNA was chosen as a template DNA for LAMP reaction. In accordance with the principle, the dPAD was immobilized by polyethylenimine (PEI), which is a strong cationic polymer, in the hydrophilic channel of the paper device. Hydroxynaphthol blue (HNB), a colourimetric indicator for monitoring the change of magnesium ion concentration in the LAMP reaction, was used to react with the immobilized PEI. The positive charges of PEI react with the negative charges of free HNB in the LAMP reaction, producing a blue colour deposit on the paper device. Consequently, the apparently visual distance appeared within 5min and length of distance correlated to the amount of DNA in the sample. The distance-based PAD for the visual detection of the LAMP reaction could quantify the initial concentration of genomic DNA as low as 4.14 × 103 copiesµL-1. This distance-based visual semi-quantitative platform is suitable for choice of LAMP detection method, particular in resource-limited settings because of the advantages of low cost, simple fabrication and operation, disposability and portable detection of the dPAD device.

Paper spray mass spectrometry (PSMS) is a powerful analytical technique for direct analysis of human body fluids. Schirmer paper is commonly used to collect human tears in clinical examination. In this work, Schirmer paper was used for noninvasive sampling and storing of healthy and disease-infected human tears, and was then performed PSMS for direct tear analysis under both positive and negative detection modes. 24 healthy tear samples, 34 tear samples of meibomain gland dysfunction, 44 tear samples of senile cataract, and 32 tear samples of allergic conjunctivitis were investigated in this work. Screening potential biomarkers of different eye diseases were carried out by combining multivariate analysis methods. 41 positive ions and 53 negative ions were proposed to be potential biomarkers in this work. The capacity of Schirmer paper for storing tear sample at different temperatures was investigated. The present study shows that direct coupling Schirmer PSMS with multivariate analysis could be a simple, rapid, and in vivo method for screening the biomarkers from human tears that involved different eye diseases.

Objective To evaluate endodontic paper point tear test (PPTT) in rabbits and compare changes in corneal touch threshold (CTT) induced by Schirmer tear test (STT) and PPTT. Normal corneal sensitivity recovery time after both tear tests was also measured. Also, mean PPTT and STT values were obtained. Methods Tear production of 20 eyes, from 10 rabbits, was evaluated using STT and the PPTT. Central corneal touch threshold was measured by a Cochet-Bonnet esthesiometer before any tear test was performed (zero time), immediately after the test (1 min), and consecutively at 6, 11, 16, and 26 min. Tests were conducted on three consecutive days: Day 1 – control condition, no tear tests performed only the CTT; Day 2 – CTT before and after PPTT; and Day 3 – CTT before and after STT. CTT values were compared using repeated measures ANOVA. Results Corneal touch threshold was significantly increased for at least 16 min after STT, indicating STT causes corneal discomfort. No difference was found between CTT following PPTT and controls, indicating PPTT caused minimal corneal discomfort. The mean (±SD) value for STT was 5.2 ± 1.0 mm/min and for PPTT was 13.8 ± 1.5 mm/min. Discussion The aqueous fraction of rabbit's tears can be successfully measured by PPTT. This report established reference values for PPTT in rabbits. Additionally, the absence of a significant difference in CTT after PPTT compared with controls shows that PPTT is well tolerated by rabbits. Considering the improved comfort (compared with STT), accuracy, and low cost, PPTT is a bona fide method of measuring aqueous tear production in rabbits.

We review the Delphi panel paper and address topics of non-consensus in the preoperative, intraoperative, and postoperative management of pediatric cataract. The Infant Aphakia Treatment Study expanded our understanding of unilateral cataract surgery in infants 6 months and younger. While primary IOL implantation is accepted for children older than 2 years, long-term data is required to determine the optimal age for primary IOL. Primary management of the posterior capsule should consider the child’s unique risks and benefits. Recent benchmarking papers confirmed higher refractive prediction error than adults and there is a need for IOL calculation formulas that cater to the pediatric eye. The impact of next-generation sequencing, bag-in-the-lens, optic capture, and femtosecond laser are yet to be determined. Pediatric cataract management is challenging and questions remain on the best approach to some surgical aspects. Future long-term randomized trials will help us move toward consensus globally.

The aim of this study is to evaluate the current practice of statistical analysis of eye data in clinical science papers published in British Journal of Ophthalmology (BJO) and to determine whether the practice of statistical analysis has improved in the past two decades. All clinical science papers (n=125) published in BJO in January–June 2017 were reviewed for their statistical analysis approaches for analysing primary ocular measure. We compared our findings to the results from a previous paper that reviewed BJO papers in 1995. Of 112 papers eligible for analysis, half of the studies analysed the data at an individual level because of the nature of observation, 16 (14%) studies analysed data from one eye only, 36 (32%) studies analysed data from both eyes at ocular level, one study (1%) analysed the overall summary of ocular finding per individual and three (3%) studies used the paired comparison. Among studies with data available from both eyes, 50 (89%) of 56 papers in 2017 did not analyse data from both eyes or ignored the intereye correlation, as compared with in 60 (90%) of 67 papers in 1995 (P=0.96). Among studies that analysed data from both eyes at an ocular level, 33 (92%) of 36 studies completely ignored the intereye correlation in 2017, as compared with in 16 (89%) of 18 studies in 1995 (P=0.40). A majority of studies did not analyse the data properly when data from both eyes were available. The practice of statistical analysis did not improve in the past two decades. Collaborative efforts should be made in the vision research community to improve the practice of statistical analysis for ocular data.