Search

Background: Loeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder characterized by a classic triad of hypertelorism, bifid uvula and/or cleft palate, and generalized arterial tortuosity. There are limited data on the prevalence and rupture risk of intracranial aneurysms (IAs) in the setting of LDS, with no established guidelines., Objective: To analyze the prevalence and rupture risk of IA in LDS., Methods: Electronic medical records of patients with a confirmed diagnosis of LDS and available cerebrovascular imaging were reviewed. Patients were divided into 2 groups based on the presence of IA. Unmatched and propensity-matched analyses were used to identify potential risk factors for aneurysm formation., Results: Records of 1111 patients were screened yielding a total of 60 patients with a diagnosis of LDS. Eighteen (30%) patients had IA, 4 (22.2%) of whom had multiple aneurysms for a total of 24 IAs. Twenty-three (95.8%) aneurysms were located in the anterior circulation; none of them were ruptured. On unmatched analysis, age ( P = .015), smoking history ( P = .034), hypertension ( P = .035), and number of extracranial aneurysms ( P < .001) were significantly higher in patients with IA. After matching for age, sex, race, stroke history, family history, and extracranial aneurysms, smoking history ( P = .009) remained significant., Conclusion: Patients with LDS have an increased risk of IAs, especially with a history of smoking. The prevalence rate of IAs in our series was 30%. Screening imaging should be considered at diagnosis, and patients should be encouraged to abstain from smoking. Further studies are needed to elucidate the risk of IA rupture and treatment considerations in this unique population., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)

Background: The ability to accurately predict pain generators for chronic neck and back pain remains elusive., Objective: We evaluated whether injections targeted at foci with uptake on single-photon emission computerized tomography-computed tomography (SPECT-CT) were associated with improved outcomes in patients with chronic neck and back pain., Methods: A retrospective review was completed on patients undergoing SPECT-CT for chronic neck and back pain between 2016 and 2020 at a tertiary academic center. Patients' records were reviewed for demographic, clinical, imaging, and outcomes data. Only those patients who had facet injections after SPECT-CT were included in this evaluation. Patients undergoing injections targeted at foci of abnormal radiotracer uptake were compared with patients without uptake concerning immediate positive response, visual analog scale, and the need for additional injection or surgery at the target level., Results: A total of 2849 patients were evaluated with a SPECT-CT for chronic neck and back pain. Of those, 340 (11.9%) patients received facet joint injections after SPECT-CT. A propensity score regression analysis adjusted for age, gender, body mass index, hypertension, multiple target injections, and injection location showed uptake targeted injections not being associated with an improved immediate positive response (odds ratio: 0.64; 95% confidence interval: 0.34-1.21; P = 0.172). In patients with a failed facet injection preceding SPECT-CT, adding SPECT-CT to guide facet injections was associated with a decrease in visual analog scale pain scores 2 weeks after injection (P = 0.018), particularly when changes were made to the facets being targeted (P = 0.010)., Conclusion: This study suggests that there is benefit with SPECT-CT specially to guide facet injections after failed prior facet injections., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Higher cyclic variability in combustion adversely influences emissions, efficiency, and driveability of internal combustion engines. In this paper, we used wavelet transform techniques to investigate the dynamical characteristics of a combustion process in numerous combustion parameters of a 4-cylinder turbocharged common rail direct injection (CRDI) diesel engine fuelled with Argemone mexicana biodiesel (AGB)/diesel blended fuel. In addition, statistical analysis is described to validate the results of the wavelet spectrum methods for cyclic variation in the diesel engine. The results show that the cyclic variations in IMEP and Pmax are sensitive to the engine load and fuel properties. The coefficient of variation of both combustion parameters decreases as engine load increases for all tested fuels. Moreover, adding Argemone mexicana biodiesel (AGB) into diesel fuel up to 20% (AB20) reduces cyclic variations in combustion parameters at all tested engine loads. Furthermore, the global wavelet spectrum and wavelet power spectrum are utilized to identify the dominant oscillatory combustion modes. The cycle-to-cycle fluctuations in combustion parameters (i.e., IMEP and Pmax) exhibit multi-scale dynamics for all experimental conditions. Compared to long and intermediate oscillations in diesel fuel, AB10 and AB20 fuel showed short and intermittent period fluctuations. The findings of this experimental work will be helpful to optimize engine control strategies for AGB/diesel blended fueled multi-cylinder CRDI diesel engines.

The authors illustrate the use of through-and-through brachio/radio-femoral access technique in two patients who presented with subclavian steal syndrome. This is an additional tool in the armamentarium of the endovascular specialist to improve management of complex cases with subclavian steal syndrome. This technique provides several advantages to improve efficiency and precision of the procedure while reserving the open surgical bypass option if needed., Competing Interests: The authors declare no conflict of interest related to this article., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Rapid and robust sensing of nerve agent (NA) threats is necessary for real-time field detection to facilitate timely countermeasures. Unlike conventional phosphotriesterases employed for biocatalytic NA detection, this work describes the use of a new, green, thermally stable, and biocompatible zirconium metal-organic framework (Zr-MOF) catalyst, MIP-202(Zr). The biomimetic Zr-MOF-based catalytic NA recognition layer was coupled with a solid-contact fluoride ion-selective electrode (F-ISE) transducer, for potentiometric detection of diisopropylfluorophosphate (DFP), a F-containing G-type NA simulant. Catalytic DFP degradation by MIP-202(Zr) was evaluated and compared to the established UiO-66-NH 2 catalyst. The efficient catalytic DFP degradation with MIP-202(Zr) at near-neutral pH was validated by 31 P NMR and FT-IR spectroscopy and potentiometric F-ISE and pH-ISE measurements. Activation of MIP-202(Zr) using Soxhlet extraction improved the DFP conversion rate and afforded a 2.64-fold improvement in total percent conversion over UiO-66-NH 2 . The exceptional thermal and storage stability of the MIP-202/F-ISE sensor paves the way toward remote/wearable field detection of G-type NAs in real-world environments. Overall, the green, sustainable, highly scalable, and biocompatible nature of MIP-202(Zr) suggests the unexploited scope of such MOF catalysts for on-body sensing applications toward rapid on-site detection and detoxification of NA threats.

Objective: We sought to identify risk factors for intracranial aneurysms (IAs) in Marfan syndrome (MFS) patients and to describe their characteristics., Methods: Patients with confirmed MFS and vessel-dedicated brain imaging from January 1, 1980-December 1, 2020 were categorized according to the presence (IA) or absence (NIA) of IAs. Unmatched logistic regression analysis and propensity score matching were used for comparison., Results: We included 159 patients, of whom 18 (11.3%) patients had radiographic diagnosis of IAs. Three patients (16.7%) had multiple lesions for a total of 24 IAs. One patient (5.5%) had de novo IA formation. Four patients (22.2%) underwent treatment: Two (11.1%) had open surgical clipping for ruptured aneurysms, and two (11.1%) patients had endovascular embolization for growth. In the unmatched analysis, current tobacco smoker status (odds ratio [OR]: 4.20; confidence interval [CI]: 1.11-15.6; P = 0.027) and history of coronary artery disease (CAD) (OR: 5.79; CI 1.76-20.2; P = 0.004) increased the odds for IA. Propensity score matching yielded 18 IA and 18 NIA patients matched for age, gender, race, prior stroke, and family history of aneurysms. History of CAD (IA = 11 [61.1%] vs. NIA = 4 (22.2%), P = 0.043) and current smoker status (IA = 6 [33.3%] vs. NIA = 0 (0%), P < 0.01) were significantly higher in the IA cohort. Body mass index (P = 0.622), diabetes (P = 0.180), hypertension (P = 0.732), prior stroke (P = 1.00), family history (P = 0.732), alcohol (P = 0.314), recreational drugs (P = 1.00), and other aneurysms (P = 0.585) were not statistically significant., Conclusions: Prevalence of IAs in our series of MFS patients was 11.3%, and de novo formation was 5.5%. MFS patients with a history of CAD and current smoker status had an increased risk of IA. Neurovascular radiographic screening should be considered in all patients with MFS, particularly in patients who smoke or have a history of heart disease., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Public health activities under district health offices (DHOs) play a major role in Malaysia's fight against COVID-19. This article aims to describe and illustrate the public health activity pathway in combating the COVID-19 pandemic, and a team of public health workers who are familiar with DHO work settings was created in April 2020 for that purpose. Review of documents and the Ministry of Health's updates was carried out, followed by a series of discussions with stakeholders. Based on the steps in the outbreak investigation tasks, the flow of activities from January to May 2020 was listed in line with the phases of the country's National Movement Control Order 2020. Results show that the activities can be classified into three different sections-namely, the main action areas, category of cases, and level of care. The main process flow of activities comprised the case management and support activities. Case management flow was split into tasks for patients under investigation and persons under surveillance, while the support services existed throughout the phases. The pathways illustrate that the progression of the pandemic translated directly to changes in the pattern of activities, with additional subgroups of activities in accordance with all imposed guidelines.

Rising global concerns posed by chemical and biological threat agents highlight the critical need to develop reliable strategies for the real-time detection of such threats. While wearable sensing technology is well suited to fulfill this task, the use of on-body devices for rapid and selective field identification of chemical agents is relatively a new area. This work describes a flexible printed textile-based solid-contact potentiometric sensor for the selective detection of fluoride anions liberated by the biocatalytic hydrolysis of fluorine-containing G-type nerve agents (such as sarin or soman). The newly developed solid-contact textile fluoride sensor relies on a fluoride-selective bis(fluorodioctylstannyl)methane ionophore to provide attractive analytical performance with near-Nernstian sensitivity and effective discrimination against common anions, along with excellent reversibility and repeatability for dynamically changing fluoride concentrations. By using stress-enduring printed inks and serpentine structures along with stretchable textile substrates, the resulting textile-based fluoride sensor exhibits robust mechanical resiliency under severe mechanical strains. Such realization of an effective textile-based fluoride-selective electrode allowed biosensing of the nerve-agent simulant diisopropyl fluorophosphate (DFP), in connection to immobilized organophosphorus acid anhydrolylase (OPAA) or organophosphorus hydrolase (OPH) enzymes. A user-friendly portable electronic module transmits data from the new textile-based potentiometric biosensor wirelessly to a nearby smartphone for alerting the wearer instantaneously about potential chemical threats. While expanding the scope of wearable solid-contact anion sensors, such a textile-based potentiometric fluoride electrode transducer offers particular promise for effective discrimination of G-type neurotoxins from organophosphate (OP) pesticides, toward specific field detection of these agents in diverse defense settings., (Copyright © 2021. Published by Elsevier B.V.)

Background and Aims: Dexmedetomidine and ketamine are commonly used pre-medicants to propofol. Previous literature shows a delay in recovery with their use without any clarity on discharge. This study was planned to find out whether adding these premedicants to Bispectral index (BIS) guided propofol anaesthesia led to delayed discharge in minor gynaecological surgeries., Methods: Totally, 120 adult females belonging to American Society of Anesthesiologists (ASA) physical status I and II undergoing minor gynaecological surgeries under general anaesthesia were randomly allocated to receive 1 μg/kg dexmedetomidine (Group D), 0.5 mg/kg ketamine (Group K) and normal saline (Group P) as premedication. Propofol 1% was used for induction and maintenance of anaesthesia keeping BIS between 55 and 70. After the procedure, patients were assessed primarily for discharge readiness using Modified Post Anaesthesia Discharge Scoring System (MPADSS).The secondary outcomes were Modified Aldrete Score (MAS), total dose of propofol used and haemodynamics., Results: The percentage of patients ready for discharge were 22.5%, 30% and 15%at 1 hour in group D, K and P, respectively (p = 0.275). Median MAS was 5, 4 and 6 respectively for group D, K and P immediately post-surgery (p = 0.000). The mean dose of propofol used was 69.75 ± 12.56 mg in group D and 135.25 ± 9.2 mg in group P (p = 0.001). There were significant haemodynamic variations in group D (16.4% fall in heart rate at 5 minutes and 24.18% fall in mean arterial pressure at 15 minutes)., Conclusion: Premedication with dexmedetomidine and ketamine in propofol anaesthesia does not delay discharge. However, stable haemodynamics and good analgesia with ketamine make it a better option., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Journal of Anaesthesia.)

Purpose: We describe a rare case of exogenous endophthalmitis due to Neisseria meningitidis, of which only two have previously been published., Methods: Retrospective audit of patient's medical notes., Patients: An 82-year-old man from The Royal Victoria Eye and Ear Hospital, a tertiary ophthalmic service in Melbourne, Australia., Results: Found to have exogenous endophthalmitis from a leaking, filtering bleb., Conclusion: This seems to be the first case in which a conjunctival swab was diagnostic. These cases demonstrate that it is reasonable to consider meningococcal endophthalmitis in systemically well patients with leaky filtering blebs. Of note for occupational health and safety, prophylaxis is not required for staff contacts treating these patients.

Importance: Diabetic retinopathy (DR) may progress following cataract surgery due to surgery-induced inflammation. The effect of intravitreal bevacizumab (BVB) and triamcinolone acetonide (TCA), which have differing anti-inflammatory properties, on DR progression following cataract surgery has not been reported., Background: To report the progression of DR in diabetic patients undergoing cataract extraction treated with intravitreal BVB or TCA during the surgery., Design: Post hoc analysis of 6-month data from a prospective, randomized, double-masked clinical trial., Participants: Diabetic patients with clinically significant cataract and fovea involving diabetic macular oedema (DME), or a recent history of DME., Methods: Participants were randomly allocated 1:1 to receive intravitreal BVB 1.25 mg or TCA 4 mg during and post-cataract surgery as needed. The rate of DR progression between groups was compared., Main Outcome Measures: DR progression., Results: There were 61 eyes included. Patients receiving BVB were older than those receiving TCA (70.2 vs 64.3 years; P < .05). Three participants (10.7%) in the BVB and three (9.09%) in the TCA group had a one-step progression, while none in BVB and only one (3%) in the TCA group demonstrated two-step DR progression. In the majority of these patients, DR progression was from mild to moderate non-proliferative diabetic retinopathy., Conclusion and Relevance: In this study, BVB and TCA groups had a similar, and lower rate of DR progression compared to previous studies where no adjunctive treatment was administered, suggesting that patients with DME may benefit from either intraoperative intravitreous BVB or TCA injection to reduce the risk of DR progression following cataract surgery., (© 2020 Royal Australian and New Zealand College of Ophthalmologists.)

Aim: To investigate the association between intravitreal ranibizumab therapy and serum cytokine concentrations in patients with diabetic macular edema (DME)., Methods: Twenty-five patients with center-involved DME were recruited prospectively. Serum samples were collected from the patients before and 4 weeks after two ranibizumab injections. The levels of 32 cytokines at these two time points were assessed using a multiplex array assay., Results: Following two ranibizumab injections, there was a statistically significant decrease in the median [interquartile range] levels of Interleukin 1-1beta (IL-1β) from 5.56 [3.6, 8.75] to 2.33 [1.51, 2.89], Interleukin 13 (IL-13) from 4.30 [1.84, 18.55] to 0.38 [0.38, 0.78], granulocyte-colony stimulating factor (G-CSF) from 64.65 [42.9, 108] to 37.8 [27.3, 46.37], Interferon gamma (IFN-γ) from 241 [103.33, 753.4] to 94.4626 [42.04, 118.58], Interferon gamma-induced protein 10 (IP-10) from 234.68 [144.16, 285.98] to 158.73 [94.71, 198.64], Macrophage Inflammatory Protein-1 alpha (MIP-1α) from 3.65 [2.62, 11.02] to 1.41 [0.94, 1.88], and Tumor necrosis factor- alpha (TNF-α) from 131.09 [100.68,28 240.27] to 45.19 [24.04, 68.55]. There was a statistically significant increase in the levels of Interleukin 9 (IL-9) from 0.76 [0.76, 7.03] to 19.67 [5.36 27.76], Macrophage Inflammatory Protein-1 beta (MIP-1β) from 0.28 [0.28, 30 0.28] to 6.79 [I3.74, 14.16], Vascular endothelial growth factor (VEGF) from 2.55 [2.55, 2.55] to 25.24 [14.51, 41.73], and soluble vascular endothelial growth factor -1 (sVEGFR-1) from 333.92 [204.99, 440.43] to 500.12 [38.7, 786.91]. A Bonferroni-corrected p value of 0.00156 was considered statistically significant., Conclusions: In patients with DME, intravitreal ranibizumab therapy appears to influence the serum levels of a range of cytokines. After two injections, intravitreal ranibizumab therapy appears to be associated with a significant decrease in inflammatory mediators and a rise in VEGF and sVEGFR1., (Copyright © 2020 Molecular Vision.)

Introduction Our purpose is to highlight the articulating surfaces between the hamate and fourth and fifth metacarpal (MC) bases of the hand using three- dimensional (3D) laser scanning. This joint surface is used for osteochondral grafting of small joints such as the proximal interphalangeal joint using the hamate articular surface. It is an important joint for hand function and can develop osteoarthritis.  Methods NextEngine (NextEngine, Santa Monica, CA) 3D laser scanner (accurate to ±100 µm) was used to capture the articular surfaces of the hamate with the fourth and fifth MC bases of 10 embalmed cadaver right hands. Articular surfaces were defined and modeled using Amira (Visage Imaging, Andover, MA) and MatLab7 (MathWorks, Natick, MA). Articular surfaces were evaluated in terms of size, shape, the radius of curvature (ROC) by three points and sphere-fit (SF) and inter-facet angles. Results In the fourth carpometacarpal (CMC) joint, the hamate articular surface with the 4th MC was single, concave, and well approximated by SF ROC (mean: 11.18 mm). The fourth MC base was convex; SF ROC mean was 9.94 mm. Six of the 10 articulations flattened from volar to dorsal. In the fifth CMC joint, we noted a bicondylar construct. The two hamate surfaces were concave while MC bases were convex. The joint surface was best approximated with two overlapping spheres. Ulnar sphere averaged 30.21% of the surface of the hamate and 29% of the MC base. Ulnar hamate SF ROC mean was 11.63 mm, and ulnar fifth MC SF ROC mean was 8.07 mm. Radial SF hamate mean was 7.92 mm, and the radial fifth MC SF mean was 7.47 mm. The mean of the angle of divergence between the condylar spheres represented on the hamate surface was 21.4°, while that of the fifth MC base angle of divergence was 10.99°. The mean of the angle formed between the fourth and fifth CMC joints at the hamate was 31.69°. A single articular facet between the fourth and fifth MC bases was concave on fourth and convex on the fifth MC base. Conclusions and clinical relevance Laser scanning of cadaver fourth and fifth CMC joints clarified the normal anatomy of the osteochondral joint surface. The topography of the joints was well-approximated by SF with curved surfaces in both the anteroposterior and radial-ulnar planes with the fifth CMC having two unique surfaces for articulation. We noted the distinct radial and ulnar articulating surfaces of the fifth CMC joint, which would permit flexion and limited supination., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, McRae et al.)

Aim: To report the 6-month results of a clinical trial that compared intravitreous bevacizumab (BVB) 1.25 mg versus triamcinolone acetonide (TA) 4 mg when administered as an adjunct during cataract surgery to patients with diabetic macular oedema (DMO)., Methods: Prospective, double-masked, single-centre (Royal Victorian Eye and Ear Hospital, Melbourne) clinical trial. Patients with visually significant cataract and centre-involving DMO (either current or prior) were randomised (1: 1) to receive either intravitreous BVB 1.25 mg or TA 4 mg at the time of cataract surgery and if required at review. Main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline to the 6-month time point of this 12-month study., Results: 61 eyes of 58 patients were enrolled. At baseline, both groups were similar in terms of BCVA and CMT (p>0.2). At 6 months, there was no significant difference in vision between the groups, with mean letter gain of +21.4 (95% CI +14.5 to +28.4) in the TA group and +17.3 (95% CI +12.1 to +22.6) in the BVB group (p=0.35). The TA group had a significant sustained anatomical improvement at 6 months, with a reduction in CMT (-51.4 µm; 95% CI -98.2 to -4.7) compared with thickening in the BVB group (+15.6 µm; 95% CI -26.4 to +57.7, p=0.04)., Conclusions: When given as an adjunct to cataract surgery, both TA and BVB improved visual outcomes at 6 months postoperatively. However, only TA resulted in sustained improvement in CMT, with the majority not requiring any further treatment postoperatively., Competing Interests: Competing interests: A/Prof Lim has received consultancy fees from Abbvie, Allergan and Bayer, and her institution has received research funding from Bayer that does not pertain to this study., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To evaluate the secondary and exploratory outcomes of the Laser Intervention in Early Stages of Age-Related Macular Degeneration (LEAD) study, a 36-month trial of a subthreshold nanosecond laser (SNL) treatment for slowing the progression to late age-related macular degeneration (AMD) in its early stages., Design: Multicenter, randomized, sham-controlled trial., Participants: Two-hundred ninety-two patients with bilateral large drusen., Methods: Participants were randomly assigned to receive SNL or sham treatment to the study eye at 6-month intervals., Main Outcome Measures: The secondary outcome measure of the LEAD study was the time to development of late AMD, defined by multimodal imaging in the non-study eye. The exploratory outcome measures were the rate of change in best-corrected visual acuity (BCVA), low-luminance visual acuity, microperimetric mean sensitivity, drusen volume in the study and non-study eyes, and participant-reported outcomes based on the Night Vision Questionnaire and Impact of Vision Impairment questionnaire., Results: Progression to late AMD in the non-study eye was not significantly delayed with SNL treatment (hazard ratio, 0.83; 95% confidence interval, 0.40-1.71; P = 0.611). There was no evidence of effect modification based on the coexistence of reticular pseudodrusen; interaction P = 0.065). There was no significant difference between study groups in the rate of change of low-luminance visual acuity, microperimetric mean sensitivity, and drusen volume in the study or non-study eyes, and Night Vision Questionnaire and Impact of Vision Impairment questionnaire scores (all P ≥ 0.167). The rate of BCVA decline was slightly higher for participants in the SNL group compared with the sham treatment group in the study eye (-0.54 and 0.23 letters/year, respectively; P < 0.001) but not the non-study eye (-0.48 and -0.56 letters/year, respectively; P = 0.628)., Conclusions: Subthreshold nanosecond laser treatment of one eye did not have an effect on delaying progression to late AMD in the fellow eye and did not, in general, have an impact on the exploratory structural, functional, and participant-reported outcomes., (Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: The CANON [ CA VATAK in NON -muscle-invasive bladder cancer (NMIBC)] study evaluated a novel ICAM-1-targeted immunotherapeutic-coxsackievirus A21 as a novel oncolytic agent against bladder cancer., Patients and Methods: Fifteen patients enrolled in this "window of opportunity" phase I study, exposing primary bladder cancers to CAVATAK prior to surgery. The first 9 patients received intravesical administration of monotherapy CAVATAK; in the second stage, 6 patients received CAVATAK with a subtherapeutic dose of mitomycin C, known to enhance expression of ICAM-1 on bladder cancer cells. The primary endpoint was to determine patient safety and maximum tolerated dose (MTD). Secondary endpoints were evidence of viral replication, induction of inflammatory cytokines, antitumor activity, and viral-induced changes in resected tissue., Results: Clinical activity of CAVATAK was demonstrated by induction of tumor inflammation and hemorrhage following either single or multiple administrations of CAVATAK in multiple patients, and a complete resolution of tumor in 1 patient. Whether used alone or in combination with mitomycin C, CAVATAK caused marked inflammatory changes within NMIBC tissue biopsies by upregulating IFN-inducible genes, including both immune checkpoint inhibitory genes (PD-L1 and LAG3) and Th1-associated chemokines, as well as the induction of the innate activator RIG-I, compared with bladder cancer tissue from untreated patients. No significant toxicities were reported in any patient, from either virus or combination therapy., Conclusions: The acceptable safety profile of CAVATAK, proof of viral targeting, replication, and tumor cell death together with the virus-mediated increases in "immunological heat" within the tumor microenvironment all indicate that CAVATAK may be potentially considered as a novel therapeutic for NMIBC., (©2019 American Association for Cancer Research.)

Importance: Driving is a highly visual task and a primary mode of transportation for many people around the world., Background: There appears to be little uniformity of vision standards across the world for driving. We reviewed the basic screening visual requirements for obtaining standard private and commercial driving licences for a total of 70 jurisdictions, and reviewed the evidence behind these standards., Design: Systematic review of basic screening vision standards worldwide for driving and literature review., Samples: Published online documentation on visual acuity and field requirements for driving., Methods: Journal articles, government reports and websites obtained via a Google search were used to review the regulations for driving. This was limited by the comprehensiveness of resources, and countries were excluded if the requirements were unclear or unattainable. A literature review was performed using Medline with keywords vision, driving and visual field., Main Outcome Measures: Visual parameters used for driving assessment., Results: The results suggest significant variations across the world. The visual acuity requirements for a private licence range from a minimum of 6/9 to 6/60. The minimum binocular horizontal field requirement ranges from 110° to 150°. In general, standards for a commercial licence are stricter compared to a private licence. A literature review could not support the current driving standards as evidence-based., Conclusions and Relevance: The disunity of driving vision requirements worldwide likely reflects the inconclusive evidence base. Accounting for individual differences and the ability to predict individual risk is important in the context of determining driving licensure., (© 2019 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose of Review: To review the current evidence supporting the use of endovascular thrombectomy (EVT) for the treatment of acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO)., Recent Findings: Recent advances in AIS management by EVT have led to significant reduction in morbidity and mortality in selected patients with LVO within the anterior circulation. Until recently, use of EVT was strictly based on time criteria, within 4.5 to 12 h of symptom onset with many patients presenting with "wake-up" stroke who were not considered for EVT. The positive results of the DAWN and DEFUSE-3 trials have shown benefit in extending the therapeutic window for EVT to 24 and 16 h, respectively, after last known normal (LKN) time in the setting of large ischemic penumbra. These trials represent a paradigm shift in contemporary treatment of AIS, changing from a purely time-based decision to treat to an individualized decision based on clinical and radiographic findings of salvageable tissue. Overall, acute stroke management has evolved considerably over the years from intravenous thrombolysis to include EVT, with paralleled improvements in patient selection and thrombectomy devices. Since the results of the DAWN and DEFUSE-3, EVT is now considered the standard of care in select patients with anterior circulation LVO up to 24 h from LKN time. Despite these developments, post-stroke disability remains pervasive and further studies are warranted in establishing the role of EVT in posterior circulation and distal vessel occlusions, with need for development of new and effective techniques for revascularization of small vessels.

Manure impacts labile pools of soil organic carbon (SOC) and nitrogen (N) which can influence soil microbial composition (MCC) and enzyme activities, and hence soil health. The present study was conducted to investigate the impacts of long-term dairy manure and inorganic fertilizers (INF) on soil carbon (C) as well as nitrogen (N) fractions, enzyme activities, and microbial community structure in different time horizons at planting (P), one month after planting (1MAP), and after harvesting (H) under corn (Zea mays L.)-soybean (Glycine max L.) rotation. Study treatments included three manure application rates (low, phosphorus-based recommended rate; medium, nitrogen-based recommended rate; and high, the double rate of medium nitrogen based recommended rate), two INF rates (medium only nitrogen additions; and high nitrogen, phosphorus, potassium, zinc, and sulfur additions) and a control (no application of manure and/or inorganic fertilizer). In comparison to the INF, the dairy manure not only significantly increased chemical fractions of C and N but also impacted the enzyme activities. Average urease activity after manure was applied was shown to be 26.8% higher than it was with INF applied at planting. The β-Glucosidase activity was 6 and 14% higher with manure than it was with INF at 1MAP and harvesting, respectively. The cold-water extractable nitrogen (CWEN) was enhanced with high manure rate at all timings of sampling compared to the high fertilizer rate (53%), and CK (90%). Principal component analysis indicated that MCC under manure differed from those under the INF treatments. The total bacteria/total fungi ratio at planting was increased with the INF compared to the manure addition. Pearson's correlation analysis showed that CWEC, CWEN, and enzyme activities especially β-Glucosidase activity were the key determinants of MCC. Data from this study showed that, compared to inorganic fertilizers, manure can be beneficial in enhancing soil health indicators.

The role of the microbiome in healthy and disease states of the human body is progressively being found to extend beyond the gastrointestinal tract and into other organ systems such as the skin. Researching the microbiome thus has become paramount to understanding additional physiological and pathophysiological mechanisms that may be at play between microbes and their hosts. Cell cultures have traditionally been used to study the microbiome, but in our current day and age, advanced metagenomic techniques - such as 16S rRNA amplicon sequencing and whole metagenomic shotgun sequencing - are better able to classify the microorganisms making up the microbiome. Utilizing metagenomics alone, however, does not allow for the study of the more complex effects of the microbiome, such as changes in gene expression and metabolic byproducts. Thus, incorporation of other modalities such as metatranscriptomics, metaproteomics, and metabolomics are needed to further elucidate the extensive intricacies of the skin microbiome.

Purpose: There is an urgent need for a more effective intervention to slow or prevent progression of age-related macular degeneration (AMD) from its early stages to vision-threatening late complications. Subthreshold nanosecond laser (SNL) treatment has shown promise in preclinical studies and a pilot study in intermediate AMD (iAMD) as a potential treatment. We aimed to evaluate the safety of SNL treatment in iAMD and its efficacy for slowing progression to late AMD., Design: The Laser Intervention in Early Stages of Age-Related Macular Degeneration (LEAD) study is a 36-month, multicenter, randomized, sham-controlled trial., Participants: Two hundred ninety-two participants with bilateral large drusen and without OCT signs of atrophy., Methods: Participants were assigned randomly to receive Retinal Rejuvenation Therapy (2RT ® ; Ellex Pty Ltd, Adelaide, Australia) SNL or sham treatment to the study eye at 6-monthly intervals., Main Outcome Measures: The primary efficacy outcome was the time to development of late AMD defined by multimodal imaging (MMI). Safety was assessed by adverse events., Results: Overall, progression to late AMD was not slowed significantly with SNL treatment compared with sham treatment (adjusted hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.33-1.14; P = 0.122). However, a post hoc analysis showed evidence of effect modification based on the coexistence of reticular pseudodrusen (RPD; adjusted interaction P = 0.002), where progression was slowed for the 222 participants (76.0%) without coexistent RPD at baseline (adjusted HR, 0.23; 95% CI, 0.09-0.59; P = 0.002), whereas an increased progression rate (adjusted HR, 2.56; 95% CI, 0.80-8.18; P = 0.112) was observed for the 70 participants (24.0%) with RPD with SNL treatment. Differences between the groups in serious adverse events were not significant., Conclusions: In participants with iAMD without MMI-detected signs of late AMD, no significant difference in the overall progression rate to late AMD between those receiving SNL and sham treatment were observed. However, SNL treatment may have a role in slowing progression for those without coexistent RPD and may be inappropriate in those with RPD, warranting caution when considering treatment in clinical phenotypes with RPD. Our findings provide compelling evidence for further trials of the 2RT ® laser, but they should not be extrapolated to other short-pulse lasers., (Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Despite advancements in healthcare facilities for diagnosis and treatment, cancer remains the leading cause of death worldwide. As prevention is always better than cure, efficient strategies are needed in order to deal with the menace of cancer. The use of phytochemicals as adjuvant chemotherapeutic agents in heterogeneous human carcinomas like breast, colon, lung, ovary, and prostate cancers has shown an upward trend during the last decade or so. Flavonoids are well-known products of plant derivatives that are reportedly documented to be therapeutically active phytochemicals against many diseases encompassing malignancies, inflammatory disorders (cardiovascular disease, neurodegenerative disorder), and oxidative stress. The current review focuses on two key flavonols, fisetin and quercetin, known for their potential pharmacological relevance. Also, efforts have been made to bring together most of the concrete studies pertaining to the bioactive potential of fisetin and quercetin, especially in the modulation of a range of cancer signaling pathways. Further emphasis has also been made to highlight the molecular action of quercetin and fisetin so that one could explore cancer initiation pathways and progression, which could be helpful in designing effective treatment strategies.

Background: Clinical evaluation of male lower urinary tract symptoms (MLUTS) in secondary care uses a range of assessments. It is unknown how MLUTS evaluation influences outcome of therapy recommendations and choice, notably urodynamics (UDS; filling cystometry and pressure flow studies)., Objective: To report participants' sociodemographic and clinical characteristics, and initial diagnostic findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM). UPSTREAM is a randomised controlled trial evaluating whether symptoms are noninferior and surgery rates are lower if UDS is included., Design, Setting, and Participants: A total of 820 men (≥18 yr of age) seeking treatment for bothersome LUTS were recruited from 26 National Health Service hospital urology departments., Intervention: Care pathway based on routine, noninvasive tests (control) or routine care plus UDS (intervention arm)., Outcome Measurements and Statistical Analysis: The primary outcome is International Prostate Symptom Score (IPSS) and the key secondary outcome is surgery rates 18 mo after randomisation. International Consultation on Incontinence Questionnaires were captured for MLUTS, sexual function, and UDS satisfaction. Baseline clinical and patient-reported outcome measures (PROMs), and UDS findings were informally compared between arms. Trends across age groups for urinary and sexual PROMs were evaluated with a Cuzick's test, and questionnaire items were compared using Pearson's correlation coefficient., Results and Limitations: Storage LUTS, notably nocturia, and impaired sexual function are prominent in men being assessed for surgery. Sociodemographic and clinical evaluations were similar between arms. Overall mean IPSS and quality of life scores were 18.94 and 4.13, respectively. Trends were found across age groups, with older men suffering from higher rates of incontinence, nocturia, and erectile dysfunction, and younger men suffering from increased daytime frequency and voiding symptoms. Men undergoing UDS testing expressed high satisfaction with the procedure., Conclusions: Men being considered for surgery have additional clinical features that may affect treatment decision making and outcomes, notably storage LUTS and impaired sexual function., Patient Summary: We describe initial assessment findings from a large clinical study of the treatment pathway for men suffering with bothersome urinary symptoms who were referred to hospital for further treatment, potentially including surgery. We report the patient characteristics and diagnostic test results, including symptom questionnaires, bladder diaries, flow rate tests, and urodynamics., (Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Influenza seasonality in equatorial countries is little understood. Seasonal and alert influenza thresholds were determined for Malaysia, using laboratory-based data obtained from the Malaysia Influenza Surveillance System and a major teaching hospital, from 2011 to 2016. Influenza was present year-round, with no clear annual seasons. Variable periods of higher transmission occurred inconsistently, in November to December, January to March, July to September, or a combination of these. These coincide with seasons in the nearby southeast Asian countries or winter seasons of the northern and southern hemispheres. Changes in the predominant circulating influenza type were only sometimes associated with increased transmission. The data can provide public health interventions such as vaccines., (© 2018 Wiley Periodicals, Inc.)

Background: Povidone-Iodine (PI) may be diluted when used as an antiseptic prior to an intravitreal injection in an attempt to decrease patient discomfort. This study aims to investigate the effect of diluting povidone-iodine (PI) on bacterial growth from bacterial droplet dispersal associated with speech., Methods: Participants read a standardised script for 5 min over a blood agar plate positioned at 20 cm in a simulated position of an intravitreal injection procedure. The blood agar plates were subject to a randomised pre-application of 1% PI; 2.5% PI; 5% PI and no pre-application (control). The plates were incubated at 37 °C for 72 h and the number of Colony Forming Units (CFUs) was determined. CFUs were summarised as median and interquartile range (IQR). Wilcoxon rank sum test was used to assess pairwise comparisons of the various PI concentrations to the control group. Any trend across PI concentration was assessed using Kendall's tau rank correlation., Results: Twenty-one subjects participated. Control plates had a median growth of 25 CFUs (interquartile range [IQR]:15-40), 1% PI plates had a median growth of 30 CFUs (IQR:15-82), 2.5% PI had a median growth of 18 CFUs (IQR:10-32) and 5% PI had a median growth of 2 CFUs (IQR:0-5). There was significantly less bacterial growth with 5% PI compared to control (P < 0.001). Bacterial growth at 2.5% PI and 1% PI did not differ significantly from control. There was a statistically significant trend for decreasing colony count as PI concentration increased (P < 0.001)., Conclusions: PI concentrations less than 5% are not effective at reducing bacterial growth from bacterial droplet dispersal associated with speech. When using PI for pre-injection antisepsis, concentrations below 5% should be avoided.

Background: Rapid identification of Gram-positive cocci in clusters (GPCC) in positive blood cultures (pBC) may limit exposure to unnecessary or inappropriate antibiotics., Methods: Inpatients with pBC showing GPCC between October 2013 and December 2017 were included. In the baseline period (BL), final ID and susceptibility results were reported in the electronic medical record (EMR) within 48 h of telephoned Gram stain report. The laboratory introduced rapid phenotypic identification and direct susceptibility testing (INT1), later replaced by PCR (INT2). In the last Intervention (INT3), Antimicrobial Stewardship Response Team (ASRT) contacted providers with PCR results and recommendations., Results: Time to directed therapy (TDT) for MSSA and coagulase-negative Staphylococci (CoNS) decreased from BL to INT3 (48.5-17.9 h, 50.3-16.4 h, respectively). Time to ID from BL to INT3 for MSSA and CoNS also decreased (23.2-1.9 h, 44.7-2.8, respectively)., Conclusions: TDT can be improved by modification of reporting methods with utilization of an ASRT., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Cancer is generally caused by the molecular alterations which lead to specific mutations. Advances in molecular biology have provided an impetus to the study of cancers with valuable prognostic and predictive significance. Over the hindsight various attempts have been undertaken by scientists worldwide, in the management of cancer; where, we have witnessed a number of molecular markers which allow the early detection of cancers and lead to a decrease in its mortality rate. Recent advances in oncology have led to the discovery of cancer markers that has allowed early detection and targeted therapy of tumors. In this context, current review provides a detail outlook on various molecular markers for diagnosis, prognosis and management of therapeutic response in cancer patients., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Experimental investigation has been carried out to utilize biogas as an alternative source of energy in compression ignition (CI) engine under dual fuel operational mode. Biogas was inducted into the inlet manifold at different flow rates along with fresh air through inlet manifold and diesel was injected as a pilot fuel to initiate combustion under dual fuel mode. The engine performance and emission characteristics of dual fuel operational mode were analyzed at different biogas flow rates and compared with baseline conventional diesel fuel. Based upon the improved performance and lower emission characteristics under the dual fuel operation, the optimum flow rate of biogas was observed to be 2.2 kg/h. The lower brake thermal efficiency (BTE) and higher brake-specific energy consumption (BSEC) were noticed with biogas-diesel fuel under dual fuel mode when compared with neat diesel operation. Test results showed reduced NO x emissions and smoke opacity level in the exhaust tailpipe emissions. However, higher hydrocarbon (HC) and carbon monoxide (CO) emissions were noticed under dual fuel mode at entire engine loads when compared with baseline fossil petro-diesel. Hence, the use of low-cost gaseous fuel such as biogas would be an economically viable proposition to address the current and future problems of energy scarcity and associated environmental concerns.

Aim: The aim of this study is to perform three-point bend test on submicron hybrid composite fabricated with direct and indirect veneer technique., Materials and Methods: A total of 20 maxillary anterior teeth were selected, and labial reduction of 0.5 to 0.75 mm with a chamfered finish line for veneer preparation was done. Teeth were divided into two groups depending on fabrication technique being used: group I-veneers fabricated with light and group II-veneers fabricated with light and heat (PHOTOPOL). Specimens were tested under universal testing machine (UTM) where load was applied at a crosshead speed of 1 mm/min with a pointer of 1 mm diameter. Data were statistically analyzed., Results: The results showed highly significant difference between the two groups with the mean value of group I (246.7 ± 2.285 N) and group II (531.1 ± 4.411 N)., Conclusion: The curing mechanism involving light and heat increases the fracture resistance of the veneers., Clinical Significance: Within the limitations of this study, the results led to the conclusion that the association of common composites with a simple postcure heat treatment may be an alternative for current indirect composite systems, although more studies are needed to assess other properties of the composites for this application.

Background: To determine alignment of proposed international standard outcomes sets for ophthalmic conditions to metrics currently reported by eye hospitals., Methods: Mixed methods comparative benchmark study, including eight eye hospitals in Australia, India, Singapore, Sweden, U.K., and U.S. All are major international tertiary care and training centers in ophthalmology. Main outcome measure is consistency of ophthalmic outcomes measures reported., Results: International agreed standard outcomes (ICHOM) sets are available for cataract surgery (10 metrics) and macular degeneration (7 metrics). The eight hospitals reported 22 different metrics for cataract surgery and 2 for macular degeneration, which showed only limited overlap with the proposed ICHOM metrics. None of the hospitals reported patient reported visual functioning or vision-related quality of life outcomes measures (PROMs). Three hospitals (38%) reported rates for uncomplicated cataract surgeries only. There was marked variation in how and at what point postoperatively visual outcomes following cataract, cornea, glaucoma, strabismus and oculoplastics procedures were reported. Seven (87.5%) measured post-operative infections and four (50%) measured 30 day unplanned reoperation rates., Conclusions: Outcomes reporting for ophthalmic conditions currently widely varies across hospitals internationally and does not include patient-reported outcomes. Reaching consensus on measures and consistency in data collection will allow meaningful comparisons and provide an evidence base enabling improved sharing of "best practices" to improve eye care globally. Implementation of international standards is still a major challenge and practice-based knowledge on measures should be one of the inputs of the international standardization process.

Purpose: To conduct a nationwide survey on the prevalence and causes of vision loss in Indigenous and non-Indigenous Australians., Design: Nationwide, cross-sectional, population-based survey., Participants: Indigenous Australians aged 40 years or older and non-Indigenous Australians aged 50 years and older., Methods: Multistage random-cluster sampling was used to select 3098 non-Indigenous Australians and 1738 Indigenous Australians from 30 sites across 5 remoteness strata (response rate of 71.5%). Sociodemographic and health data were collected using an interviewer-administered questionnaire. Trained examiners conducted standardized eye examinations, including visual acuity, perimetry, slit-lamp examination, intraocular pressure, and fundus photography. The prevalence and main causes of bilateral presenting vision loss (visual acuity <6/12 in the better eye) were determined, and risk factors were identified., Main Outcome Measures: Prevalence and main causes of vision loss., Results: The overall prevalence of vision loss in Australia was 6.6% (95% confidence interval [CI], 5.4-7.8). The prevalence of vision loss was 11.2% (95% CI, 9.5-13.1) in Indigenous Australians and 6.5% (95% CI, 5.3-7.9) in non-Indigenous Australians. Vision loss was 2.8 times more prevalent in Indigenous Australians than in non-Indigenous Australians after age and gender adjustment (17.7%, 95% CI, 14.5-21.0 vs. 6.4%, 95% CI, 5.2-7.6, P < 0.001). In non-Indigenous Australians, the leading causes of vision loss were uncorrected refractive error (61.3%), cataract (13.2%), and age-related macular degeneration (10.3%). In Indigenous Australians, the leading causes of vision loss were uncorrected refractive error (60.8%), cataract (20.1%), and diabetic retinopathy (5.2%). In non-Indigenous Australians, increasing age (odds ratio [OR], 1.72 per decade) and having not had an eye examination within the past year (OR, 1.61) were risk factors for vision loss. Risk factors in Indigenous Australians included older age (OR, 1.61 per decade), remoteness (OR, 2.02), gender (OR, 0.60 for men), and diabetes in combination with never having had an eye examination (OR, 14.47)., Conclusions: Vision loss is more prevalent in Indigenous Australians than in non-Indigenous Australians, highlighting that improvements in eye healthcare in Indigenous communities are required. The leading causes of vision loss were uncorrected refractive error and cataract, which are readily treatable. Other countries with Indigenous communities may benefit from conducting similar surveys of Indigenous and non-Indigenous populations., (Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: We compare the effectiveness profile of various analgesics used for orthodontic pain relief over a 1-week time period by conducting a longitudinal network meta-analysis (NMA)., Search Methods: The MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases were searched till 31st December 2015 to identify the relevant studies. Additional studies were identified by hand searching journals and reference lists. Unpublished literature was also searched., Selection Criteria: Eligible studies were randomized-controlled trials (RCTs) evaluating the effectiveness of pharmacological interventions for pain relief after placement of separator or initial aligning arch wire., Data Collection and Analysis: Pain intensity data at 2, 6, 12, 24, 36, 48, 72, 96, and 168 hours was collected. In addition, data were also extracted for potential covariates (age, sex, and procedure). A covariate-adjusted arm-based multilevel random coefficient model was used for evidence synthesis., Results: Fifteen RCTs (1341 participants; male/females 595, 44.6%/746 55.4%; mean age 17.3 years, SD 4.1) were included. A total of 11 nodes (Acetaminophen, Aspirin, Etoricoxib, Flurbiprofen, Ibuprofen, Lumiracoxib, Meloxicam, Naproxen, Piroxicam, Placebo, and Control) were identified out of which five nodes (Placebo, Ibuprofen, Naproxen, Acetaminophen, and Aspirin) had subnodes (based on timing of administration). Compared to Control, Placebo, Flurbiprofen, Lumiracoxib, and Meloxicam were not significantly effective. Etoricoxib (most effective) and Piroxicam (second most effective) were effective over a long period which lasted up to 96 and 72 hours, respectively. Ibuprofen, Acetaminophen, Naproxen, and Aspirin were effective at 6, 12, and 24 hours. The effectiveness of these analgesics was significantly influenced by the timing of administration. Assessment of heterogeneity, transitivity, inconsistency, and publication bias revealed no major threat to the NMA derived estimates., Conclusion: Compared to the Control, Placebo was least effective whereas Etoricoxib was the most effective analgesic in reducing orthodontic pain. Administration timing has significant influence on the effectiveness profile of analgesics routinely used for managing orthodontic pain., (© The Author 2017. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com)

The system that protects body from infectious agents is immune system. On occasions, the system seldom reacts with some foreign particles and causes allergy. Allergies of the ear, nose and throat (ENT) often have serious consequences, including impairment and emotional strain that lowers the quality of life of patients. This is further responsible for the common cold, cough, tonsillitis, dermal infection, chest pain and asthma-like conditions which disturb one's day to day life. The present review enlightens some common ENT allergies which one can suffer more frequently in one's lifetime, and ignorance leads to making the condition chronic. Information regarding pathophysiology and the management of ENT allergy by this review could help clinicians and common people to better understand the circumstances and treatment of ENT allergy., (Copyright © 2016 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.)

Biochar is a solid material obtained when biomass is thermochemically converted in an oxygen-limited environment. In most previous studies, the impacts of biochar on soil properties and organic carbon (C) were investigated under controlled conditions, mainly laboratory incubation or greenhouse studies. This 2-year field study was conducted to evaluate the influence of biochar on selected soil physical and chemical properties and carbon and nitrogen fractions for two selected soil types (clay loam and a sandy loam soil) under a corn (Zea mays L.)-soybean (Glycine max L.) rotation. The three plant based biochar materials used for this study were corn stover (CS), ponderosa pine (Pinus ponderosa Lawson and C. Lawson) wood residue (PW), and switchgrass (Panicum virgatum L.) (SG). Data showed that CS and SG significantly increased the pH of acidic soil at the eroded landscape position but produced no significant change in soil pH at the depositional landscape position. The effects of biochar treatments on cold water extractable C (WSC) and nitrogen (WSN) fractions for the 0-7.5 cm depth were depended on biochar and soil type. Results suggested that alkaline biochars applied at 10 Mg ha -1 can increase the pH and WSC fraction of acidic sandy loam soil, but the 10 Mg ha -1 rate might be low to substantially improve physical properties and hot water extractable C and N fractions of soil. Application of higher rates of biochar and long-term monitoring is needed to quantify the benefits of biochar under field conditions on soils in different environmental conditions., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Importance: This study highlights the efficacy and safety of trabeculectomy in Victoria, Australia., Background: Trabeculectomy is currently the gold standard in glaucoma surgery. However, its role has been increasingly questioned because of its associated risks and complications. This audit aimed to assess the efficacy and safety of trabeculectomy surgery in the state of Victoria, Australia., Design: A cross-sectional, retrospective and voluntary statewide audit of trabeculectomy surgery by individual surgeons in 2012 with 24 months follow-up., Participants: Twenty-four surgeons in the state of Victoria submitted data on 227 trabeculectomies., Methods: Basic preoperative and perioperative data were collected. Post-operative data collected included intra-ocular pressure measurements, glaucoma medications, associated complications and subsequent surgery up to 24 months post-trabeculectomy., Main Outcome Measures: The main outcome measures were post-operative intra-ocular pressure and surgical complications., Results: At 12 months, the mean intra-ocular pressure was 12.6 ± 4.1 mmHg (range 3-28 mmHg). A total of 91% of eyes had an intra-ocular pressure ≤18 mmHg with or without ocular hypotensive medications. One-third of eyes that were phakic at the time of trabeculectomy underwent cataract extraction within the 24 months of follow-up. Eyes that underwent combined cataract extraction and trabeculectomy (23% of trabeculectomies) had a significantly higher mean 12-month intra-ocular pressure than eyes that underwent trabeculectomy alone (13.9 vs. 12.2 mmHg, P = 0.01). At 24 months, there were no cases of blebitis/endophthalmitis., Conclusions and Relevance: The Victorian Trabeculectomy Audit demonstrates excellent efficacy and safety results that are comparable with international standards. Combined cataract extraction and trabeculectomy tended to result in a higher mean post-operative intra-ocular pressure than trabeculectomy alone., (© 2017 Royal Australian and New Zealand College of Ophthalmologists.)

Importance: Paracentral acute middle maculopathy (PAMM) diagnosed by spectral domain optical coherence tomography (SD-OCT) in patients with poor visual outcome post cataract surgery., Background: Case series of severe vision loss due to PAMM after cataract surgery., Design: Retrospective case series., Participants: Cases from five surgical centres in Victoria, Australia., Methods: Retrospective analysis of cases with unexplained 'patch-off' vision loss post cataract surgery. All patients in our cohort had PAMM and presumed diagnosis of central or transient retinal artery occlusion., Main Outcome Measures: A review of the patient histories focusing on pre-operative ocular and systemic vascular risk factors, anaesthetic and operative factors., Results: Ten cases were included. All patients had 6/72 Snellen visual acuity or worse noted on day one post surgery. Three patients had features of central retinal artery occlusion consisting of retinal pallor with a 'cherry red' macula but absent relative afferent pupillary defect. Seven had no features of retinal pallor or attenuation of retinal arterioles. On SD-OCT, all eyes had evident PAMM. Six patients had a history of cardiovascular disease or blood dyscrasia., Conclusions and Relevance: PAMM should be considered in patients with 'patch off' visual loss and absence of other fundal signs. We hypothesise that spasm or transient occlusion of central retinal artery leads to arterial hypoperfusion with subsequent ischaemia or infarction of the retina. Underlying arterial disease may have led to pre-existing hypoperfusion that may have been further compromised by raised intraocular pressure during the procedure itself or via raised orbital pressure from the anaesthesia., (© 2017 Royal Australian and New Zealand College of Ophthalmologists.)

Objective: To validate the factor structure of recently modified Short-Form McGill Pain Questionnaire (Ortho-SF-MPQ) to assess orthodontic pain; and to test its Measurement Invariance (MI) across gender., Methods: 180 orthodontic patients were enrolled in this study. 0.016 inch Super-elastic NiTi arch wire was used in 0.022″ × 0.028″ slot pre-adjusted edgewise appliance. After initial arch wire placement, pain was assessed at T1 (24 hours), T2 (day 3), and T3 (day 7) by using the Ortho-SF-MPQ which consists of seven sensory (pressure, sore, aching, tight, throbbing, pulling, miserable) and four affective (uncomfortable, strange, frustrating, annoying) descriptors. Confirmatory factor analysis (CFA) models were fitted for analysis. Multiple-groups CFA (MG-CFA) approach was used for MI testing., Results: Data from 172 patients (85 male, 87 female) with mean age 14.2 years (SD 1.4) was analysed. CFA model fit indices value at T1 (RMSEA 0.048; CFI 0.995; TLI 0.995), T2 (RMSEA 0.051; CFI 0.998; TLI 0.997), and T3 (RMSEA 0.040; CFI 0.998; TLI 0.998) confirmed the validity of two-factor structure of Ortho-SF-MPQ in assessing orthodontic pain. MG-CFA model based non-significant scaled chi-square difference test (Satorra-Bentler method) for weak invariance (T1: χ 2  = 6.566, df = 9, p = 0.682; T2: χ 2  = 14.637, df = 9, p = 0.101; T3 (χ 2  = 14.248, df = 9, p = 0.114) and strong invariance (T1: χ 2  = 25.874, df = 20, p = 0.170; T2: χ 2  = 25.052, df = 20, p = 0.199; T3: χ 2  = 18.889, df = 20, p = 0.529) confirmed MI across male and female groups., Conclusion: Two-factor structure (sensory and affective) of Ortho-SF-MPQ is structurally valid and invariant to measure pain in male and female orthodontic patents after initial arch wire placement.

Background: Endophytic fungi are taxonomically and ecologically heterogeneous group of organisms, mainly belonging to the Ascomycotina and Deuteromycotina. Endophytes usually produce the enzymes necessary for the colonization of plant tissues. Endophytes are able to utilize components of plant cells without disturbing host metabolism, which is confirmed by isozyme analysis and studies on substrate utilization. The patents related to enzymes and metabolites produced by endophytic fungi are associated with their ecological significance. Application of metabolites and growth promoting factors produced from endophytic fungi, in the pharmaceutical and agricultural industries, is now well established. The patents on secretion of extracellular enzymes in vitro by endophytic fungi needed for cell wall degradation, support the hypothesis that fungal endophytes represent a group of organisms specialized to live within plant tissue., Objective: This review presents the patents granted on different aspects of endophytic fungi for the last 11 years. This expresses the scenario and impact of these patents regarding significance in human society., Conclusion: In the last few years, research and inventions regarding the different aspects of endophytic fungi beneficial for host plant as well as for human beings have been carried out, which is supported by the increasing number of patents granted on endophytic fungi., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Background: Induced Pluripotent Stem Cell (IPSC) Technology is the most advanced research as it offers an attractive alternative for establishing patient-specific IPSCs to recapitulate phenotypes of not only monogenic diseases (viz. Thalassaemia, Sickle cell anemia, Haemophilia, Tay-Sachs disease), but also late-onset polygenic diseases (viz. Parkinson's disease, Alzheimer's disease, schizophrenia). Over the hindsight, numerous studies of the past and current scientists have led to the production, maturation and understanding of induced pluripotent stem cell technology and its use in basic and clinical research., Methods: A systematic search of peer-reviewed scientific literature and clinical trials in public databases were carried out to summarize the evidence on the use of IPSC., Results: Current review sheds light upon the use of patient-derived iPSC models in drug toxicity, screening and discovery which have been derived after referring to more than 200 articles in literature. Furthermore, their use as disease models was also studied signifying the versatility of iPSC lines., Conclusion: Through this review, we describe the advent of iPSC technology, where we comprehensively cover the generation of iPSCs and their characterization along with their prospective applications using IPSC banks in disease modeling and drug screening., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)