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Subretinal injection is a delicate and complex microsurgery. The main surgical difficulties come from the surgeon's hand tremor, dexterous motion, and insufficient visual feedback. In order to begin addressing these challenges, this article presents a robot system for subretinal insertion integrated with intraoperative optical coherence tomography (OCT). The surgical workflow using this system consists of two main parts. The first part is the manual robot control, which aims the target before approaching the retinal surface, while considering the remote center of motion (RCM) constraint. When the injection area has been located precisely, needle is inserted into retina. To ensure surgical safety, needle insertion depth is estimated using OCT images on a continuous basis. A soft RCM control method is designed and integrated for the controller of our hybrid parallel–serial surgical robot. Safety and accuracy performance evaluation with a 15-ms control loop shows that the worst-case RCM deviation error is within 1 mm. Experimental results demonstrated that the proposed system has the ability to improve surgical outcomes by surgeons overcoming their physical limitations in order to enable a better dexterous motion, and furthermore enhancing their visual feedback for a better intraocular perception.

Durch die vollstandige Integration der SD-OCT (Spectral-Domain-optische Koharenztomographie) in das Operationsmikroskop bietet die intraoperative optische Koharenztomographie (iOCT) die Moglichkeit einer gezielten hochauflosenden Bildgebung in Echtzeit. Der Operateur erhalt neben dem En-Face-Bild eine Live-Darstellung aller Netzhautschichten, des Glaskorpers sowie der Instrument-Gewebe-Interaktion, die fur intraoperative Entscheidungen genutzt werden kann. Im Vergleich zur herkommlichen Operationsmikroskopie ermoglicht die iOCT eine weitaus hohere Prazision vitreoretinalchirurgischer Masnahmen und ist essenzielle Voraussetzung zur Umsetzung Echtzeit-kontrollierter Operationstechniken im Mikrometerbereich.

Retinal surgery is known to be a complicated and challenging task for an ophthalmologist even for retina specialists. Image guided robot-assisted intervention is among the novel and promising solutions that may enhance human capabilities during microsurgery. In this letter, a novel method is proposed for 3D navigation of a microsurgical instrument based on the projection of a spotlight during robot-assisted retinal surgery. To test the feasibility and effectiveness of the proposed method, a vessel tracking task in a phantom with a Remote Center of Motion (RCM) constraint is performed by the Steady-Hand Eye Robot (SHER). The results are compared to manual tracking, cooperative control tracking with the SHER and spotlight-based automatic tracking with SHER. The reported results are that the spotlight-based automatic tracking with SHER can reach an average tracking error of 0.013 mm and keeping distance error of 0.1 mm from the desired range demonstrating a significant improvement compared to manual or cooperative control methods alone.

The emergence of robotics could enable ophthalmic microsurgical procedures that were previously not feasible due to the precision limits of manual delivery, for example, targeted subretinal injection. Determining the distance between the needle tip, the internal limiting membrane (ILM), and the retinal pigment epithelium (RPE) both precisely and reproducibly is required for safe and successful robotic retinal interventions. Recent advances in intraoperative optical coherence tomography (iOCT) have opened the path for 4D image-guided surgery by providing near video-rate imaging with micron-level resolution to visualize retinal structures, surgical instruments, and tool-tissue interactions. In this work, we present a novel pipeline to precisely estimate the distance between the injection needle and the surface boundaries of two retinal layers, the ILM and the RPE, from iOCT volumes. To achieve high computational efficiency, we reduce the analysis to the relevant area around the needle tip. We employ a convolutional neural network (CNN) to segment the tool surface, as well as the retinal layer boundaries from selected iOCT B-scans within this tip area. This results in the generation and processing of 3D surface point clouds for the tool, ILM and RPE from the B-scan segmentation maps, which in turn allows the estimation of the minimum distance between the resulting tool and layer point clouds. The proposed method is evaluated on iOCT volumes from ex-vivo porcine eyes and achieves an average error of 9.24 µm and 8.61 µm measuring the distance from the needle tip to the ILM and the RPE, respectively. The results demonstrate that this approach is robust to the high levels of noise present in iOCT B-scans and is suitable for the interventional use case by providing distance feedback at an average update rate of 15.66 Hz.

Machine learning and especially deep learning techniques are dominating medical image and data analysis. This article reviews machine learning approaches proposed for diagnosing ophthalmic diseases during the last four years. Three diseases are addressed in this survey, namely diabetic retinopathy, age-related macular degeneration, and glaucoma. The review covers over 60 publications and 25 public datasets and challenges related to the detection, grading, and lesion segmentation of the three considered diseases. Each section provides a summary of the public datasets and challenges related to each pathology and the current methods that have been applied to the problem. Furthermore, the recent machine learning approaches used for retinal vessels segmentation, and methods of retinal layers and fluid segmentation are reviewed. Two main imaging modalities are considered in this survey, namely color fundus imaging, and optical coherence tomography. Machine learning approaches that use eye measurements and visual field data for glaucoma detection are also included in the survey. Finally, the authors provide their views, expectations and the limitations of the future of these techniques in the clinical practice.

Clear Corneal Incision, a challenging step in cataract surgery, and important to the overall quality of the surgery. New surgeons usually spend one full year trying to perfect their incision, but even after such rigorous training deficient incisions can still occur. This paper proposes an autonomous robotic system for this self-sealing incision. A conventional ophthalmic microscope system with a monocular camera is utilized to capture the surgical scene, ascertain the robot’s position, and estimate depth information. Kinematics with a remote centre of motion (RCM) is designed for a multi-axes robot to perform the incision route. The experimental results on ex-vivo porcine eyes show the autonomous Clear Corneal Incision has a stricter three-plane structure than a surgeon-made incision, which is closer to the ideal incision.

Echinops persicus is a species of Echinops that can be found in Europe and western Asia especially in Iran. In this paper, the phytochemical properties of Echinops persicus were thoroughly investigated and studied. In this way, total amounts of flavonoid, tannins, phenols, carotenoids, saponins, alkaloids, and anthocyanin were measured by various analytical methods. The major phenolic and flavonoid content was found in the root acetone and flower ethanolic extract of the plant. Also, major saponins and carotenoid contents was found in root and leaf of the plant. These measurements were also performed for root, leaf, and flower of the plant in various solvent extracts. The results indicated that Echinops persicus is a rich source of secondary metabolites. Also, the plant extract demonstrated a considerable antiradical activity, which evaluated qualitatively as well as quantitatively. The largest capacity to neutralize DPPH radicals was found for root water extract of Echinops persicus plant. Finally, the possibility of the plant extract was evaluated for the green preparation of carbon quantum dots (CQDs). As-prepared CQDs were characterized by TEM, HRTEM, UV–Vis, XRD, and EDX analyses.

Ophthalmic microsurgery is known to be a challenging operation, which requires very precise and dexterous manipulation. Image guided robot-assisted surgery (RAS) is a promising solution that brings significant improvements in outcomes and reduces the physical limitations of human surgeons. However, this technology must be further developed before it can be routinely used in clinics. One of the problems is the lack of proper calibration between the robotic manipulator and appropriate imaging device. In this work, we developed a flexible framework for hand-eye calibration of an ophthalmic robot with a microscope-integrated Optical Coherence Tomography (MIOCT) without any markers. The proposed method consists of three main steps: a) we estimate the OCT calibration parameters; b) with micro-scale displacements controlled by the robot, we detect and segment the needle tip in 3D-OCT volume; c) we find the transformation between the coordinate system of the OCT camera and the coordinate system of the robot. We verified the capability of our framework in ex-vivo pig eye experiments and compared the results with a reference method (marker-based). In all experiments, our method showed a small difference from the marker based method, with a mean calibration error of 9.2 $\mu$m and 7.0 $\mu$m, respectively. Additionally, the noise test shows the robustness of the proposed method., Comment: *The first two authors contributed equally to this paper. Accepted by IEEE Robotics and Automation Letters (RA-L), 2018

Die Verschlussrate von grosen Makulaforamen nach Vitrektomie und konventionellem „Internal-limiting-membrane“(ILM)-Peeling betragt unter 90 %. Ziel dieser Studie war es, die Visusergebnisse und den anatomischen Erfolg mittels hochauflosenden OCTs („optical coherence tomography“) nach transkonjunktivaler nahtloser 23-Gauge-Pars-plana-Vitrektomie sowie iOCT („intraoperative OCT“) und Brilliant Peel(BP)-assistiertem ILM-Peeling mit invertierter ILM-Flap-Technik bei Patienten mit grosem Makulaforamen (MF) zu erfassen. In einer retrospektiven Studie bei 25 Augen von 25 konsekutiven Patienten mit grosem Makulaforamen wurde eine standardisierte 23-G-Pars-plana-Vitrektomie mit BP- und iOCT-assistiertem ILM-Peeling und invertierter ILM-Flap-Technik sowie Gastamponade durchgefuhrt. Bei allen Patienten wurde praoperativ der bestkorrigierte Visus bestimmt, und mittels hochauflosenden Spectral-domain-OCTs (SD-OCT, Spectralis, Heidelberg Engineering) wurden der maximale Durchmesser, die Basis und die Hohe des Makulaforamens sowie intraretinale Veranderungen erfasst. Postoperativ wurden der bestkorrigierte Visus nach 1, 3 und 6 Monaten und die Verschlussrate bestimmt. Daneben wurde die mikrostrukturelle Integritat der Netzhautausenschichten („external limiting membrane“ [ELM], ellipsoide Zone und Photorezeptorausensegment [OS]) im SD-OCT erfasst und mit dem Visusergebnis nach Makulaforamenchirurgie korreliert. Das iOCT ermoglichte bei allen Operationen mit invertierter Flap-Technik eine gute Visualisierung sowie eine kontrollierte Positionierung des ILM-Flaps. Der mittlere Ausgangsvisus betrug 0,2 (0,7 logMAR). Er verbesserte sich nach 1, 3 und 6 Monaten signifikant auf 0,4 (0,4 logMAR), 0,5 (0,3 logMAR) und 0,63 (0,2 logMAR). Die Verschlussrate der Makulaforamina betrug 100 %. Die mikrostrukturelle Integritat der auseren Netzhautschichten wurde semiquantitativ bestimmt und zeigte eine positive Korrelation zum bestkorrigierten Visus. Die Vitrektomie mit Brilliant Peel(BP)- und iOCT-assistiertem ILM-Peeling mit invertierter ILM-Flap-Technik bei Patienten mit grosem Makulaforamen ist eine sehr kontrollierte und sichere Operationsmethode, die zu guten funktionellen und anatomischen Ergebnissen fuhrt. Die Morphologie des MF, der ILM-Flap und die Lage des invertierten ILM-Flaps unter Luft lassen sich mittels iOCT sehr gut darstellen. Die mikrostrukturelle Integritat der Netzhautausenschichten lasst sich mittels SD-OCT gut beurteilen. Sie ist ein wichtiger pradiktiver Parameter fur die Visusentwicklung nach Makulaforamenchirurgie.

Intraoperative optical coherence tomography (iOCT) is an increasingly available imaging technique for ophthalmic microsurgery that provides high-resolution cross-sectional information of the surgical scene. We propose to build on its desirable qualities and present a method for tracking the orientation and location of a surgical needle. Thereby, we enable the direct analysis of instrument–tissue interaction directly in OCT space without complex multimodal calibration that would be required with traditional instrument tracking methods. The intersection of the needle with the iOCT scan is detected by a peculiar multistep ellipse fitting that takes advantage of the directionality of the modality. The geometric modeling allows us to use the ellipse parameters and provide them into a latency-aware estimator to infer the 5DOF pose during needle movement. Experiments on phantom data and ex vivo porcine eyes indicate that the algorithm retains angular precision especially during lateral needle movement and provides a more robust and consistent estimation than baseline methods. Using solely cross-sectional iOCT information, we are able to successfully and robustly estimate a 5DOF pose of the instrument in less than 5.4 ms on a CPU.

Zusammenfassung Hintergrund Die hochauflösende optische Kohärenztomografie (OCT) ermöglicht eine kontrastreiche Bildgebung von Mikrostrukturen, die mit konventioneller Bildgebung nicht so detailliert darstellbar waren. Wir berichten über unsere Erfahrungen beim Einsatz der intraoperativen OCT (iOCT) in der vitreoretinalen Chirurgie. Methoden 110 Patienten mit vitreoretinalen Erkrankungen (Makulaforamen, epiretinale Membranen, vitreomakulärem Traktionssyndrom, Ablatio und Glaskörperblutung) wurden unter Visualisierung mit dem im Mikroskop integrierten iOCT-Gerät operiert. Ergebnisse Das iOCT liefert durch die Integration von Mikroskop und SD-OCT eine sofortige Visualisierung der „Region of Interest“ (ROI). Der Operateur erhält neben dem Mikroskopbild die intraoperative Darstellung aller Netzhautschichten, des Glaskörpers sowie der Instrument-Gewebe-Interaktion in Echtzeit und kann diese intraoperativ sofort verfügbare Information für die chirurgische Strategie nutzen. Schlussfolgerung Bisher ist das iOCT nur als Standmikroskop erhältlich, es besitzt keine Messfunktion, keine Tracking-Funktion, und die Metallinstrumente verdecken den Scan. Künftig könnten transparente Instrumente, Tracking-Funktionen, ein Autofokus sowie eine noch bessere Auflösung eine optimierte, lückenlose, hochauflösende intraoperative OCT-Diagnostik in Echtzeit erlauben.

Introduction:Coronary artery disease (CAD) is a leading cause of death worldwide. The association of socioeconomic status with CAD is supported by numerous epidemiological studies. Whether such factors also impact the number of diseased coronary vessels and its severity is not well established.Materials and Methods:We conducted a prospective multicentre, multi-ethnic, cross sectional observational study of consecutive patients undergoing coronary angiography (CAG) at 5 hospitals in the Kingdom of Saudi Arabia and the United Arab Emirates. Baseline demographics, socioeconomic, and clinical variables were collected for all patients. Significant CAD was defined as ≥70% luminal stenosis in a major epicardial vessel. Left main disease (LMD) was defined as ≥50% stenosis in the left main coronary artery. Multi-vessel disease (MVD) was defined as having >1 significant CAD.Results:Of 1,068 patients (age 59 ± 13, female 28%, diabetes 56%, hypertension 60%, history of CAD 43%), 792 (74%) were from urban and remainder (26%) from rural communities. Patients from rural centres were older (61 ± 12vs58 ± 13), and more likely to have a history of diabetes (63vs54%), hypertension (74vs55%), dyslipidaemia (78vs59%), CAD (50vs41%) and percutaneous coronary intervention (PCI) (27vs21%). The two groups differed significantly in terms of income level, employment status and indication for angiography. After adjusting for baseline differences, patients living in a rural area were more likely to have significant CAD (adjusted OR 2.40 [1.47, 3.97]), MVD (adjusted OR 1.76 [1.18, 2.63]) and LMD (adjusted OR 1.71 [1.04, 2.82]). Higher income was also associated with a higher risk for significant CAD (adjusted OR 6.97 [2.30, 21.09]) and MVD (adjusted OR 2.49 [1.11, 5.56]), while unemployment was associated with a higher risk of significant CAD (adjusted OR 2.21, [1.27, 3.85]).Conclusion:Communal and socioeconomic factors are associated with higher odds of significant CAD and MVD in the group of patients referred for CAG. The underpinnings of these associations (e.g.pathophysiologic factors, access to care, and system-wide determinants of quality) require further study.

Cancer stem cells are responsible for the failure of a large number of cancer treatments and the re-emergence of cancer in patients. Parthenolide is a potent anticancer sesquiterpene lactone that is also able to kill cancer stem cells. The main problem with this compound is its poor solubility in water. To solve this problem, medicinal chemists have tried to prepare amino-derivatives of parthenolide, however, most amino-derivatives have less potency than that of parthenolide. In this paper, we proposed a new approach to synthesize parthenolide derivatives with better solubility and higher potency. We prepared novel parthenolide derivatives through the aza-Michael addition of nitrogen-containing anticancer drug molecules (cytarabine and melphalan) to the α-methylene-γ-lactone group of parthenolide. Different types of catalysts were used to catalyze the aza-Michael addition. Among all the used catalysts, 1,8-diazabicyclo [5.4.0] undec-7-ene (DBU) was found to have the highest catalytic activity. In addition, we examined the effects of parthenolide-anticancer drug hybrids on the growth and proliferation of three cancer cell lines (MCF-7, LNcaP, Hep G2) and CHO. The parthenolide prodrugs showed potent cytotoxic property with IC50 values ranging from 0.2 to 5.2μM, higher than those of parthenolide and anticancer drugs (cytarabine and melphalan).

Intraoperative Optical Coherence Tomography (iOCT) has advanced in recent years to provide real-time high resolution volumetric imaging for ophthalmic surgery. It enables real-time 3D feedback during precise surgical maneuvers. Intraoperative 4D OCT generally exhibits lower signal-to-noise ratio compared to diagnostic OCT and visualization is complicated by instrument shadows occluding retinal tissue. Additional constraints of processing data rates upwards of 6GB/s create unique challenges for advanced visualization of 4D OCT. Prior approaches for real-time 4D iOCT rendering have been limited to applying simple denoising filters and colorization to improve visualization. We present a novel real-time rendering pipeline that provides enhanced intraoperative visualization and is specifically designed for the high data rates of 4D iOCT. We decompose the volume into a static part consisting of the retinal tissue and a dynamic part including the instrument. Aligning the static parts over time allows temporal compounding of these structures for improved image quality. We employ a translational motion model and use axial projection images to reduce the dimensionality of the alignment. A model-based instrument segmentation on the projections discriminates static from dynamic parts and is used to exclude instruments from the compounding. Our real-time rendering method combines the compounded static information with the latest iOCT data to provide a visualization which compensates instrument shadows and improves instrument visibility. We evaluate the individual parts of our pipeline on pre-recorded OCT volumes and demonstrate the effectiveness of our method on a recorded volume sequence with a moving retinal forceps.

Hintergrund: In zahlreichen Studien konnte ein präoperativ großes Makulaforamen (MF) (>400µm) als negativer prognostischer Faktor in Bezug auf postoperativen Visus und Verschlussrate identifiziert werden. Zum Vergleich des postoperativen Verlaufs bei kleinem, bzw. mittelgroßem,[zum vollständigen Text gelangen Sie über die oben angegebene URL], 32. Jahrestagung der Retinologischen Gesellschaft

Subretinal injection is known to be a complicated task for ophthalmologists to perform, the main sources of difficulties are the fine anatomy of the retina, insufficient visual feedback, and high surgical precision. Image guided robot-assisted surgery is one of the promising solutions that bring significant surgical enhancement in treatment outcome and reduces the physical limitations of human surgeons. In this paper, we demonstrate a robust framework for needle detection and localization in subretinal injection using microscope-integrated Optical Coherence Tomography (MI-OCT) based on deep learning. The proposed method consists of two main steps: a) the preprocessing of OCT volumetric images; b) needle localization in the processed images. The first step is to coarsely localize the needle position based on the needle information above the retinal surface and crop the original image into a small region of interest (ROI). Afterward, the cropped small image is fed into a well trained network for detection and localization of the needle segment. The entire framework is extensively validated in ex-vivo pig eye experiments with robotic subretinal injection. The results show that the proposed method can localize the needle accurately with a confidence of 99.2%.

Subretinal injection is a delicate and complex microsurgery, which requires surgeons to inject the therapeutic substance in a pre-operatively defined and intra-operatively updated subretinal target area. Due to the lack of subretinal visual feedback, it is hard to sense the insertion depth during the procedure, thus affecting the results of surgical outcome and hindering the widespread use of this treatment. This paper presents a novel approach to estimate the 3D position of the needle under the retina using the information from microscope-integrated Intraoperative Optical Coherence Tomography (iOCT). We evaluated our approach on both tissue phantom and ex-vivo porcine eyes. Evaluation results show that the average error in distance measurement is $4.7 \mu \text{m}$ (maximum of $16.5 \mu \text{m})$ . We furthermore, verified the feasibility of the proposed method to track the insertion depth of needle in robot-assisted subretinal injection.

Space applications have evolved to play a significant role in disaster relief by providing services including remote sensing imagery for mitigation and disaster damage assessments; satellite communication to provide access to medical services; positioning, navigation, and timing services; and data sharing. Common issues identified in past disaster response and relief efforts include lack of communication, delayed ordering of actions (eg, evacuations), and low levels of preparedness by authorities during and after disasters. We briefly summarize the Space for Health (S4H) Team Project, which was prepared during the Space Studies Program 2014 within the International Space University. The S4H Project aimed to improve the way space assets and experiences are used in support of public health during disaster relief efforts. We recommend an integrated solution based on nano-satellites or a balloon communication system, mobile self-contained relief units, portable medical scanning devices, and micro-unmanned vehicles that could revolutionize disaster relief and disrupt different markets. The recommended new system of coordination and communication using space assets to support public health during disaster relief efforts is feasible. Nevertheless, further actions should be taken by governments and organizations in collaboration with the private sector to design, test, and implement this system. (Disaster Med Public Health Preparedness. 2015;9:319-328)

Quinolines, an important class of potentially bioactive compounds, have been synthesized by treatment of o-aminoaryl ketones and carbonyl compound utilizing niobium (V) chloride (NbCl5) as an available and inexpensive catalyst. The quinoline derivatives were prepared in glycerol, an excellent solvent in terms of environmental impact, with high yields (76–98%) and short reaction times (20–90 min). Not only diketones but also ketones afforded the desired products in good to excellent yields. The reaction time of 2-amino-5-chlorobenzophenone and dicarbonyl compounds was longer than that of 2-aminobenzophenone. The reaction of cyclic diketones took place faster than open chain analogues. These reactions also proceeded with acetophenone derivatives. In these cases the reaction times are longer.

AIM: To evaluate and compare structural optical coherence tomography (OCT)-based parameters, such as Bruch’s membrane opening-minimum rim width (BMO-MRW), and retinal nerve fiber layer (RNFL) thickness in glaucoma patients with visual field (VF) defects, and to correlate both to mean deviation (MD) values of obtained standard achromatic perimetry (SAP) examinations. METHODS: Patients with glaucoma and glaucomatous VF defects were enrolled in this prospective study and compared to age-matched healthy individuals. All study participants underwent a full ophthalmic examination and VF testing with SAP. Peripapillary RNFL thickness and BMO-MRW were acquired with SD-OCT. Correlation analyses between obtained global functional and global as well as sectorial structural parameters were calculated. RESULTS: A consecutive series of 30 glaucomatous right eyes of 30 patients were included and compared to 36 healthy right eyes of 36 individuals in the control group. Global MD of values correlated significantly with global RNFL (Pearson corr. coeff: 0.632, P=0.001) and global BMO-MRW (Pearson corr. coeff: 0.746, P4 diopters) within the glaucoma group (n=6) revealed a tendency for higher correlations between MD and BMO-MRW than MD and RNFL measurements. CONCLUSION: In a clinical setting, RNFL thickness and BMO-MRW correlate similarly with global VF sensitivity in glaucoma patients with BMO-MRW showing higher correlations in myopic glaucoma patients.

STUDY DESIGN A cross-sectional study. PURPOSE To describe the correlation between lumbar lordosis angle and functional status of patients with chronic mechanical low back pain (CMLBP). OVERVIEW OF LITERATURE There are different and conflicting opinions regarding the relationship between the degree of lumbar lordosis and functional status of patients with low back pain. Nonetheless, the severity of lordosis is still one of the routine physical exams considered in rehabilitation clinics. METHODS The degree of lumbar lordosis of 150 patients with CMLBP was measured by means of Cobb's method using sagittal standing spinal radiographs. Subjects with probable secondary causes of low back pain (trauma, congenital anomaly, spinal infection, rheumatologic problems and history of spinal surgery) were excluded. Besides recording demographic data, their score of functional disability was estimated using Oswestry Disability Questionnaire, one of the most useful and reliable questionnaires. Comparison between these data was made regarding different age and gender groups. RESULTS In this study, 119 subjects were female and 31 male, with an age range of 19-85 years. The average degree of lumbar lordosis was 44.69±11.43 and that of Oswestry disability index (ODI) 30.52%. Although we found a significant direct relationship between age and degree of lumbar lordosis (Pearson's correlation coefficient, p=0.016, r=0.197), while insignificant correlation was seen between the degree of lumbar lordosis and ODI (p=0.129). CONCLUSIONS There was no significant correlation between the degree of lumbar lordosis and the score of functional disability with regards to different age groups and gender.

There is lack of well-designed trials evaluating structural benefits of non-pharmacologic therapies in knee osteoarthritis (OA). In this parallel-group randomized controlled trial, we aim to compare the possible advantages of lateral wedge insole and acupuncture in patients with medial knee OA.Patients with grade two or three of medial knee OA were randomly allocated to group one who received an in shoe lateral wedge and group two who underwent acupuncture. We assessed patients' pain, function and knee joint cartilage thickness before and after intervention. Paired t-test and independent samples t-test were used for in group and between group analyses. (2.)Twenty patients in each group were recruited in the study. Pain significantly decreased after therapy in both groups one and two (paired t test, P0.001, 95% CI: 1.62-3.25 and 1.58-3.20 respectively). Function improved in each group (paired t test, P=0.001, 95% CI of 0.94-2.38 in group one and 0.97-2.43 in group two). A non-clinically statistically significant difference regarding the femoral and tibial cartilage thickness was obtained in both groups one (P=0.005, CI: -0.43-0.82 and P=0.037, CI: -0.44-0.80 respectively) and two (P=0.025, CI: -0.45-0.79 and P=0.035, CI: -0.29-0.96 respectively). Between groups analysis showed no significant difference regarding abovementioned measures.Both lateral wedge insole and acupuncture can be effective in the treatment of medial knee osteoarthritis without any superiority of one over the other. Iranian Registry of Clinical Trials: IRCT201201108235N1. URL: http://irct.ir/searchen.php.

AIM To assess the association of inter-ethnic vs intra-ethnic marriage with severity of coronary artery disease (CAD) in men undergoing angiography. METHODS We conducted a prospective multicenter, multi-ethnic, cross sectional observational study at five hospitals in Saudi Arabia and the United Arab Emirates, in which we used logistic regression analysis with and without adjustment for baseline differences. RESULTS Data were collected for 1068 enrolled patients undergoing coronary angiography for clinical indications during the period of April 1st, 2013 to March 30th, 2014. Ethnicities of spouses were available only for male patients. Of those enrolled, 687 were married men and constituted the cohort for the present analysis. Intra-ethnic marriages were reported in 70% and inter-ethnic marriages in 30%. After adjusting for baseline differences, inter-ethnic marriage was associated with lower odds of having significant CAD [adjusted odds ratio 0.52 (95%CI: 0.33, 0.81)] or multi-vessel disease (MVD) [adjusted odds ratio 0.57 (95%CI: 0.37, 0.86)]. The adjusted association with left main disease showed a similar trend, but was not statistically significant [adjusted odds ratio 0.74 (95%CI: 0.41, 1.32)]. The association between inter-ethnic marriage and the presence of significant CAD and MVD was not modified by number of concurrent wives (P interaction > 0.05 for both). CONCLUSION Among married men undergoing coronary angiography, inter-ethnic, as compared to intra-ethnic, marriage is associated with lower odds of significant CAD and MVD.

Ophthalmic surgery is a typical microsurgery, where the surgical progress imposes huge challenges on delicate operations to surgeons. The fixation plays an important role in restriction the head movement and also providing a friendly interaction with both patients and surgeons. A fixation specific for ophthalmic robotic set-ups is developed in this paper for a hybrid parallel-serial robot. Evaluations for the benefits of the fixation device are performed with an optical tracking system. The experimental result shows that the designed fixation can restrict an average of absolute movements below 10 mm.

Ferric hydrogensulfate was found to be an efficient catalyst for the three-component synthesis of indeno[1,2-b]quinoline-7-one derivatives through one-pot condensation of 1-naphthylamine or 1-antharacylamine, aromatic aldehydes, and 1,3-indandione. The catalyst could be recovered conveniently and reused at least four times without any loss of activity. The efficient method has the advantages of inexpensiveness of the catalyst, short reaction times, simplicity, easy workup, and good to excellent yields.

In interventional radiology or surgery, C-arm systems are typical imaging modalities. Apart from 2D X-ray images, C-arm systems are able to perform 2D/3D overlays. For this application, a previously recorded 3D volume is projected on a 2D X-ray image for providing additional information to the clinician. The required accuracy for this application is 1.5[Formula: see text]mm. Such a spatial accuracy is only achievable with C-arms, if a calibration is performed.State-of-the-art approaches interpolate between values of lookup tables of a sampled Cartesian volume. However, due to the non-linear system behavior in Cartesian space, a trade-off between the calibration effort and the calibrated volume is necessary. This leads to the calibration of the most relevant subvolume and high calibration times.We discuss a new model-based calibration approach for C-arm systems which potentially leads to a smaller calibration effort and simultaneously to an increased calibrated volume.In this work, we demonstrate that it is possible to calibrate a robotic C-arm system using X-ray images and that a static model of the system is required to achieve the desired accuracy for 2D/3D overlays, if re-orientations of the system are performed.

Ninety-six 26-wk-old white leghorn layers (w-36 variety) were fed commercial diets containing 0, 4, 7 and 10% safflower seed (SS) and the diets were iso-caloric and iso-nitrogenous. Hens randomly assigned to 4 treatment diets, with 3 replicates and 8 layers in each replicate. The experiment was conducted over a period of 12 wk in order to study the effects of feeding safflower seed on hen performance (egg production, egg weight, egg mass, feed intake, feed conversion ratio (FCR) and weight gain) and egg quality parameters (Hough unit score, yolk color index, yolk index, egg shape, shell weight, shell thickness and density). The yolk of eggs extracted and cholesterol content were determined in each period. Blood samples were collected in non-heparinsed tubes from six hens in each treatment by puncturing the bronchial vein in end of experiment and serum was collected after 8-10 hrs as per standard procedures and was stored for subsequent analysis. Hen performance and egg quality parameters were not significantly (p>0.05) different among treatments except in specific gravity and body weights. The lowest specific gravity observed in 10% SS (1.0806) and the highest gain weight was in 4% SS (140g) treatment. However the lowest Hough unit and shell thickness observed in 10% SS but the different among treatments were not statistically significant. The mean yolk cholesterol content, blood cholesterol and antibody titter against ND and IBD were not significantly (p

Background: Scorzonera Paradoxa (Asteraceae family) is an herbaceous plant traditionally used as a vegetable in the east of Iran. Objectives: The amount of total phenolic compounds, flavonoids and tannins in five different extracts and composition of fatty acids in the root and leaves of Scorzonera Paradoxa (S. Paradoxa) were investigated. Besides, antioxidant activity of tissues was determined. Materials and Methods: Fatty acid compositions were extracted with n-hexane and analyzed by gas chromatograph with a flame ionization detector (GC-FID). Total phenolic compounds, tannin and flavonoids content in the extracts were measured spectrophotometrically and free radical scavenging activity was evaluated by 2, 2-dipheny l-1-picrylhydrazyl (DPPH) assay. Results: The amount of total phenolic compounds was higher in leaves than roots. Besides, root extract showed lower DPPH scavenging activity compared with leaves. In addition, leaves were found to be rich in oleic and arachidonic acids, while roots were rich in linoleic and stearic acids. Conclusions: Further investigations are needed about favorable composition of unsaturated fatty acids and flavonoid content of leaves of S. Paradoxa. In addition, due to high phenolic content of the leaves, S. Paradoxa is a promising source of natural antioxidants and may play good antidiabetic activity.

Globally, we rely on the use of space assets to support public health. Tele-medicine in remote areas, pandemic monitoring, and remote sensing and satellite communication for disaster relief are just some examples of how space has helped improve public health services. The Space4Health (S4H) team, consisting of 30 individuals from 14 nations with diverse professional backgrounds, convened in Montreal in July 2014 with the task of studying the use of space assets and activities in support of public health goals as part of the requirements for the International Space University's Space Studies Program [1]. After reviewing the different interactions between public health and space, the S4H team chose to focus on the means in which space resources can be used to support public health during and immediately after a natural disaster. To provide a novel view on the topic, this paper focuses on new concepts and innovations that have the potential to disrupt the market and their possible use in facilitating the operation and coordination of disaster relief efforts.

Along with crown-rump length (CRL), the size (diameter) of embryonic structures such as gestational sac (GS) and yolk sac (YS) may have prognostic value for embryonic development. We proposed that first-trimester volume calculations of these structures using transvaginal three-dimensional ultrasound technique may have value as predictors of adverse reproductive outcome. Forty-nine consecutive patients (treated for infertility) with singleton pregnancies were included in this prospective study. Seventy-three examinations were performed in case of pregnancies with normal, and 12 with abnormal outcome. GS and YS volumes were plotted against gestational age (GA) (25-65 days post ovulation) to create nomograms for normal outcome and the same procedure was carried out with CRL measurements as well. Measurements of abnormal pregnancies were compared with these nomograms. Specificity, sensitivity, positive and negative predictive values were also calculated. Regression analysis revealed a power correlation between GS volumes and GA, logarithmic relationship was observed when YS volumes were plotted against GA. CRL showed logarithmic correlation with GA as well. Both GS volumetry and CRL measurements proved to have statistically significant predictive value for adverse outcome (p

Objective: To determine whether baseline serum FSH and/or E 2 concentrations can predict the risk for fetal chromosomal abnormalities. Design: Case control study. Setting: Reproductive technology program at a university hospital. Patient(s): Patients who underwent dilation and curettage (D + C), and whose products of conception were karyotyped. Intervention(s): Patients underwent natural conception or controlled ovarian hyperstimulation followed by intrauterine insemination, in vitro fertilization and embryo transfer, gamete intrafallopian transfer, or zygote intrafallopian transfer. Main Outcome Measure(s): Baseline serum FSH and E 2 concentrations and fetal karyotype. Result(s): Genetic evaluation of 78 D + C specimens revealed 34 normal and 44 abnormal fetal karyotypes. A significantly greater proportion of women with abnormal fetal karyotype had elevated baseline serum FSH (≥15 mIU/mL [RIA] or 10 mIU/mL [Immulite]) and/or E 2 (≥50 pg/mL [Immulite]) compared with women of normal fetal karyotype. Among karyotypically abnormal abortuses, autosomal trisomy was the most common abnormality noted (79.5%), followed by mosaicism (6.8%), triploidy (6.8%), monosomy XO (4.5%), and balanced translocation (2.3%). Conclusion(s): Baseline serum FSH and/or E 2 concentrations may be valuable as predictors of fetal aneuploidy.

Dear Editor, We are extremely grateful for the opportunity to discuss the details that have been raised by Kothari et al. Although Kothari et al. have conducted an intelligent review, we would like to address a few points raised in their research. Firstly, they have suggested using magnetic resonance imaging to examine disc conditions and exclude patients with advanced disc degeneration. They also believed that we should have excluded patients with paraspinal muscle spasm and hamstring tightness from our study which was not done but we do not think so. Our response to this comment is somewhat hidden in the definition of mechanical low back pain which is the pain that does not receive a specific diagnosis. The majority of patients with mechanical low back pain have a multifactorial cause for their problems, which includes deconditioning; poor muscle recruitment; emotional stress; and changes associated with aging and injury such as disc degeneration, arthritis, and ligamentous hypertrophy. This type of lower back pain can be given many names; a few of the common names for this condition are simple backache, nonspecific lower back pain, lumbar strain, and spinal degeneration [1]. Hence, conditions that Kothari et al. listed as part of the exclusion criteria are some instances of probable causes for mechanical lower back pain. Secondly, in the article, Kothari et al. correctly pointed to the need to present values of the Oswestry Disability Index (ODI). The mean value of ODI was 30.51±13.75 (31.64±14.41 in females and 26.19±9.96 in males) and there was no significant correlation between the Oswestry Disability Questionnaire (ODQ) score and the degree of lumbar lordosis (Pearson's correlation coefficient; r=0.125, p=0.129). The mean value of lumbar lordosis (LL) in our sample was 44.69±11.43 degrees but 23 subjects had LL of more than 56.12 degrees and 20 subjects had LL that was less than 33.26 degrees. The mean ODI in patients in the outlier group (either LL greater than 56.12 degrees or less than 33.26 degrees) was 29.12±12.2 and the mean ODI in patients whose LL was within the average range was 31.02±14.29. The difference between these two groups was not statistically significant (independent samples test; p=0.45). Also, using oneway analysis of variance there was no significant statistical difference between any groups of patients who were out of range regarding the degree of lumbar lordosis (LL greater than 56.12 degrees or LL less than 33.26 degrees) and patients with an average range (p=0.38). Thirdly, we agree that our study has a skewed male to female ratio (F:M=119:31) which we should have mentioned as one of study limitations. However, we don't think that the ages of subjects will create an issue because osteoporosis mainly causes fractures in the upper spine and not the low back (except sacral insufficiency fractures). In addition, in the acute phase, patients usually experience pain in the upper back. Chronic spinal pain due to deformity caused by vertebral wedging and compression, as well as secondary ligamentous strain is often difficult to distinguish from disc deterioration. Chronic spinal pain can also be categorized as mechanical low back pain [2]. Fourthly, we agree with Kothari et al. that pelvic incidence and sacral slope are two of the other main sagittal spinopelvic parameters, which can potentially contribute to developing low back pain [3]. We have already noted this entry and mentioned that future studies should focus more on disability as the main consequence of low back pain when investigating the role of different spinopelvic parameters in chronic mechanical low back pain [4]. Thus, we recommend performing randomized trials to investigate whether there is a relationship between the various spinopelvic alignment parameters and the level of functional disability in patients suffering from chronic mechanical low back pain.

Objective : To review the genetics of aging specifically as it pertains to human fertility, as well as the recent advancements in the diagnosis of genetic diseases prior to embryo implantation. Methods : A review of our own experience as well as the scientific literature with regards to the decline in female fertility with age, the success of IVF in women of older reproductive age, and the role of preimplantation genetic diagnosis (PGD) in the evaluation of the patient at risk for fetal genetic anomalies. Results : The decline in female fertility occurs primarily as a result of a decline in oocyte quality as well as quantity. The frequency of chromosomal anomalies in recognized abortuses increases in parallel with the age-specific rise in the incidence of spontaneous abortions. PGD is an accurate diagnostic tool for exclusion of genetically deficient embryos prior to initiation of pregnancy. Conclusion : Reproductive failure in women of older age appears to be directly related to ovarian age. Recent techniques such as cytoplasmic or germinal vesicle transfer are designed to replace the senescent cellular machinery believed to be responsible for genetic errors that occur during early cell division. PGD can accurately identify embryos with genetic deficiencies prior to implantation.

Purpose: We aimed to investigate the utility of sympathetic skin response (SSR) test for evaluating vasculogenic erectile dysfunction (ED) which is the most common type of impotence. Materials and Methods: Men in the age group of 28 to 60 years and suffering from vasculogenic ED, as confirmed by a papaverin test and color Doppler sonography, at least for 6 months referred from our university urology department were included. We used the International Index of Erectile Function (IIEF-5) for grading severity of dysfunction and recorded the SSR of every patient from the median, tibial, and dorsal nerves of the penis. One-way analysis of variance (ANOVA), independent t-test and Pearson’s correlation coefficient were used for comparing quantitative variables, and Fisher"s Exact test was used for comparing qualitative variables. The Mann-Whitney U Test and the Kruskal-Wallis test were performed for analysis of data that were not normally distributed. A p value of less than 0.05 was considered significant. Results: Forty-two patients were recruited for the study. We found a strong statistical relationship between the IIEF score and the pathologic SSR registered from every mentioned nerve. Patients with abnormal SSR had more severe ED according to IIEF score (p＜0.001). In addition, the IIEF score had a significantcorrelation with diabetes mellitus and cardiovascular disease (t-test; p ＜0.05). Conclusions: Our results confirmed the presence of autonomic dysfunction in patients with vasculogenic impotence via an SSR test. We suggest evaluating the efficacy of the SSR test in patients with vascular impotence for treatment response monitoring in future studies.