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Nithya Boopathiraj,1 Isabella V Wagner,1 Paul Connor Lentz,2 Christian Draper,3 Chelsey Krambeer,1 Yazan S Abubaker,1 Bryan Chin Hou Ang,1,4,5 Darby D Miller,1 Syril Dorairaj1 1Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA; 2Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Jacksonville, FL, USA; 3Department of Ophthalmology, Eye Consultants, Spokane, WA, USA; 4Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore; 5Department of Ophthalmology, Woodlands Health, National Healthcare Group Eye Institute, SingaporeCorrespondence: Syril Dorairaj, Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA, Tel +1-904-953-2377, Fax +1-904-953-7040, Email dorairaj.syril@mayo.eduPurpose: To compare the safety and effectiveness of standalone Kahook Dual Blade (KDB) excisional goniotomy to standalone ab-interno Xen gel stent implantation in eyes with moderate-to-severe open-angle glaucoma (OAG).Methods: A single-center, retrospective study including eyes with moderate-to-severe OAG undergoing standalone KDB goniotomy or Xen gel stent implantation was conducted. Intraocular pressure (IOP), the number of antiglaucoma medications taken daily, and best-corrected visual acuity (BCVA) were recorded at baseline and for up to 36-months. Primary outcomes assessed included changes from baseline in IOP and the number of antiglaucoma medications taken. Intergroup comparisons were conducted using independent-samples Student’s t-tests. The incidence of intraoperative and postoperative adverse events and the need for glaucoma surgical re-interventions were also recorded.Results: Eyes receiving standalone KDB (n=26) or Xen gel stent (n=45) surgery were analyzed. The baseline mean IOP and number of antiglaucoma medications in both groups were as follows: KDB: 23.2 ± 6.0 mmHg, 2.2 ± 1.4 medications; Xen: 22.7 ± 8.8 mmHg, 3.0 ± 1.0 medications. At 36 months, IOP was reduced to 16.6 ± 5.4 mmHg in KDB eyes (n=23, − 23.5%; p=0.0004) and 15.3 ± 5.6 mmHg in Xen gel stent eyes (n=15, − 22.1%; p=0.006), while number of antiglaucoma medications was reduced to 1.1 ± 0.7 (− 30.8%; p=0.0005) and 2.2 ± 1.4 (− 25.6%; p=0.01), respectively. Three eyes (11.5%) in the KDB group and 19 eyes (42.2%) in the Xen gel stent group required additional surgery before month 36 due to refractory high IOP.Conclusion: Both KDB goniotomy and Xen gel stent implantation significantly lowered the IOP and antiglaucoma medication burden in patients with moderate-to-severe OAG. While the Xen gel stent is frequently used to treat moderate-to-severe OAG patients with uncontrolled IOP, standalone KDB goniotomy may be equally effective as a long-term intervention, reducing the need for subsequent glaucoma surgery.Keywords: kahook dual blade, micro-invasive glaucoma surgery, open angle glaucoma, xen gel stent

Wai Kitt Chee,1 Vivien Cherng Hui Yip,1 Ivan O’Neill Tecson,1 Chun Hau Chua,1 Bryan Chin Hou Ang,1 Ae Ra Kee,1 Jeremy Youwei Hu,1 Tsia-Chuen John Kan,1 Leonard Wei Leon Yip1,2 1Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore; 2Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, SingaporeCorrespondence: Vivien Cherng Hui Yip, Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore, Tel +65 62566011, Email vyip82@yahoo.co.ukAim: This study aims to compare the efficacy and safety of combined phacoemulsification with iStent inject (Phaco-iStent) and Hydrus microstent (Phaco-Hydrus).Methods: This was a retrospective comparative study of patients who underwent Phaco-iStent from April 2019 to August 2020 and Phaco-Hydrus from August 2019 to December 2020 at a tertiary eye centre in Singapore. Sixty-nine Phaco-iStent eyes and 49 Phaco-Hydrus eyes were included in this study. Complete surgical success was defined as freedom from second glaucoma surgery, Intraocular pressure (IOP) of 18 mmHg or less, and discontinuation of all antiglaucoma medications.Results: At 12 months, both Phaco-iStent and Phaco-Hydrus groups had comparable surgical success rate (68.1% vs 51%, p=0.061), reduction in antiglaucoma medication use (− 1.3 ± 0.1 vs − 1.4 ± 0.10, p=0.880) and intraocular pressure reduction (− 1.1 ± 0.5 mmHg vs – 1.6 ± 0.9 mmHg, p=0.323). Overall intraoperative and postoperative complications rate were similar in both groups, though hyphema was more commonly seen in early postoperative period in the Phaco-Hydrus compared to the Phaco-iStent group (8% vs 0%, p=0.028), with majority of cases resolving without any need for surgical intervention. Device obstruction was also more common in the Phaco-Hydrus group compared to the Phaco-iStent group (14% vs 4.3%, p=0.04).Conclusion: Phaco-iStent and Phaco-Hydrus have similar surgical efficacy and safety profiles at 12 months.Keywords: glaucoma, phacoemulsification, cataract extraction, iStent inject, Hydrus microstent

This review explores core-shell scaffolds in bone tissue engineering, highlighting their osteoconductive and osteoinductive properties critical for bone growth and regeneration. Key design factors include material selection, porosity, mechanical strength, biodegradation kinetics, and bioactivity. Electrospun core-shell nanofibrous scaffolds demonstrate potential in delivering therapeutic agents and enhancing bone regeneration. Critical characterization techniques include structural, surface, chemical composition, mechanical, and degradation analyses. Scaling up production poses challenges, addressed by innovative electrospinning techniques. Future research focuses on regulatory and commercial considerations, while exploring advanced materials and fabrication methods to optimize scaffold performance for improved clinical outcomes., (© 2024 Wiley‐VCH GmbH.)

Purpose: To examine the associations between higher order aberrations (HOAs), visual performance, demographics, and ocular characteristics in a young Asian population with high myopia., Methods: This was a retrospective review of military pre-enlistees conducted between March 2014 to September 2018. Visual acuity and contrast sensitivity were tested under photopic, mesopic and simulated night conditions. Ocular, corneal and internal HOAs were measured with a Hartmann-Shack wavefront aberrometer (KR-1W, Topcon Co., Tokyo, Japan)., Results: 522 eyes of 263 consecutive subjects with severe high myopia (defined as spherical equivalent refraction [SER] ≤ -10.00D) in at least one eye, and high myopia (SER ≤ -6.00D) in the fellow eye, [mean (SD) SER -11.85 (2.03D)] were analysed. The mean (SD) age of subjects was 18.5 (1.6) years. Chinese eyes had significantly greater internal total HOA root-mean-square (RMS) compared to Malay eyes [mean difference (SD) 0.0246 (0.007) μm, p < 0.001). More negative SER was associated with greater ocular total HOA (p = 0.038), primary coma (p = 0.003) and tetrafoil (p = 0.025) RMS, as well as more positive ocular (p = 0.003) and internal primary spherical aberration (p = 0.009). Greater ocular total HOAs was associated with reduced visual acuity in simulated night conditions and low contrast, decreased contrast sensitivity under mesopic and simulated night conditions (all p < 0.05)., Conclusions: Greater HOAs were associated with Chinese ethnicity and more negative SER in a young Asian population with high myopia. Greater HOAs were associated with poorer visual performance in low luminance and reduced contrast conditions., Competing Interests: No conflicting relationship exists for any author., (© 2023 The Authors.)

Poly(glycolide-co-caprolactone) (PGCL) has become a novice to the bioresorbable suture owing to the synergistic properties taken from the homo-polyglycolide (PGA) and polycaprolactone (PCL) such as excellent bioresorption and flexibility. In addition to under conventional monotonic loading, the understanding of mechanical responses of PGCL copolymers under complex loading conditions such as cyclic and stress relaxation is crucial for its application as a surgical suture. Consequently, the present work focuses on evaluating the mechanical responses of PGCL sutures under monotonic, cyclic, and stress relaxation loading conditions. Under monotonic loading, the stress-strain behavior of the PGCL suture was found to be non-linear with noticeable strain-rate dependence. Under cyclic loading, inelastic responses including stress-softening, hysteresis and permanent set were observed. During cyclic loading, both stress-softening and hysteresis were found to increase with the maximum strain. In multi-step stress relaxation, the PGCL sutures were observed to exhibit a strong viscoelastic response. In an attempt to describe the relationship between the stress-relaxation and strain-induced crystallization (SIC) occurring during the loading and relaxation processes, a schematic illustration of the conformational change of polymer chains in PGCL sutures was proposed in this work. Results showed that SIC was dependent on the strain level as well as the loading and relaxation durations. The inelastic phenomena observed in PGCL sutures can be thus correlated to the combined effect of stress relaxation and SIC., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Graphene-based fillers possess exceptional properties that encourage researchers toward their incorporation in glass-epoxy (GE) polymer composites. Regarding the mechanical and wear properties of glass-epoxy composites, the effect of graphene oxide (GO) reinforced in glass-epoxy was examined. A decrease in tensile modulus and increase in tensile strength was reported for 1 wt. % of GO. A shift in glass transition temperature T g was observed with the addition of GO. The cross-link density and storage modulus of the composite decreased with the addition of GO. The decrease in dissipation energy and wear rate was reported with the increase in GO concentration. A simple one-dimensional damage model of nonlinear nature was developed to capture the stress-strain behavior of the unfilled and filled glass-epoxy composite. Tensile modulus E , Weibull scale parameter σ o , and Weibull shape parameter β were considered to develop the model. Finally, to understand the failure mechanisms in GO-filled composites, a scanning electron microscopic (SEM) examination was carried out for tensile fractured composites.

The energy scarcity is exacerbating and needs an urgent solution. The most plausible solution to address the forthcoming energy scarcity is to diversify the energy sources. Developing the water-splitting process (WSP) efficiency depends on solar energy representing "21st-century dream technology". We present a comprehensive review of related papers employing graphitic carbon nitride (g-C 3 N 4 ) as pure, doped, or composite nanostructure in the evolution of hydrogen from water dissociation under simulated sunlight irradiation, mainly in the last ten years. Herein, after a concise introduction to the main principle of the water-splitting process, the methods to synthesize, modify and upgrade the photocatalytic performance of g-C 3 N 4 were reviewed in detail. Moreover, the main challenges of using g-C 3 N 4 -based photocatalytic material in WSP have been mentioned. The report mainly targets the g-C 3 N 4 character, synthesis method, photocatalytic activity, and strategies toward enhancing photoreactivity under visible light, along with the reusability of the fabricated nanohybrid catalysts. Above and over, this review suggests the potential of g-C 3 N 4 to produce green H 2 from water at a competitive price, which can contribute to satisfying the global energy sector demand and suppressing global warming., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: The XEN45 gel stent implant (Allergen, CA, USA) is one of many micro-invasive surgical options available to glaucomatologists. Our case series describes the presentation, treatment, and possible risk factors of XEN45 gel stent related endophthalmitis., Observations: A 71 year old Chinese man and a 88 year old Caucasian woman underwent XEN45 gel stent implantation for primary open angle glaucoma. They presented with endophthalmitis at 7 and 4 months post-surgery respectively. The first patient had stent exposure with blebitis while the second patient did not show any signs of conjunctival defect, stent exposure, bleb leak nor blebitis. Both patients were treated immediately with intravitreal, topical and systemic antibiotics, followed by early vitrectomy. The implant was removed in the first, but not in the second patient. Vitreous cultures grew Streptococcus Viridans in the first patient and Haemophilus influenzae in the other. Unfortunately, the first patient eventually sustained a total retinal detachment requiring surgery and did not recover his vision. The second patient however, recovered with a good Snellen's visual acuity of 6/9 and maintenance of good intraocular pressure and bleb formation., Conclusions: Exogenous endophthalmitis related to XEN45 gel stent implantation is a rare but devastating complication. The risks factors identified were multiple post-operative procedures, bleb exposure, conjunctival defect, use of antifibrotics, blepharitis and prolonged post-operative antibiotics. XEN45 gel stent implant provides a different challenge to ophthalmologists compared to trabeculectomy as more post-operative procedures are required to prevent subconjunctival scarring. Great care should be taken to individualize the use of antifibrotics in each patient to balance the risk of subconjunctival fibrosis with the risk of infection. In patients with stent exposure we propose early closure of the conjunctiva to close off the portal of entry for pathogens and reduce the need for prophylactic topical antibiotics., Competing Interests: Ang, Bryan C: Consultant and travel assistance (Allergan). Yip, Leonard W: Consultant and travel assistance (Allergan). The following authors have no financial disclosures: Ng, Aaron W. Yip, Vivien C. Lim, Boon Ang., (© 2022 The Authors.)

The development of advanced composite materials has taken center stage because of its advantages over traditional materials. Recently, carbon-based advanced additives have shown promising results in the development of advanced polymer composites. The inter- and intra-laminar fracture toughness in modes I and II, along with the thermal and electrical conductivities, were investigated. The HMWCNTs/epoxy composite was prepared using a multi-dispersion method, followed by uniform coating at the mid-layers of the CF/E prepregs interface using the spray coating technique. Analysis methods, such as double cantilever beam (DCB) and end notched flexure (ENF) tests, were carried out to study the mode I and II fracture toughness. The surface morphology of the composite was analyzed using field emission scanning electron microscopy (FESEM). The DCB test showed that the fracture toughness of the 0.2 wt.% and 0.4 wt.% HMWCNT composite laminates was improved by 39.15% and 115.05%, respectively, compared with the control sample. Furthermore, the ENF test showed that the mode II interlaminar fracture toughness for the composite laminate increased by 50.88% and 190%, respectively. The FESEM morphology results confirmed the HMWCNTs bridging at the fracture zones of the CF/E composite and the improved interlaminar fracture toughness. The thermogravimetric analysis (TGA) results demonstrated a strong intermolecular bonding between the epoxy and HMWCNTs, resulting in an improved thermal stability. Moreover, the differential scanning calorimetry (DSC) results confirmed that the addition of HMWCNT shifted the T g to a higher temperature. An electrical conductivity study demonstrated that a higher CNT concentration in the composite laminate resulted in a higher conductivity improvement. This study confirmed that the demonstrated dispersion technique could create composite laminates with a strong interfacial bond interaction between the epoxy and HMWCNT, and thus improve their properties.

Volumetric Muscle Loss (VML) is associated with muscle loss function and often untreated and considered part of the natural sequelae of trauma. Various types of biomaterials with different physical and properties have been developed to treat VML. However, much work remains yet to be done before the scaffolds can pass from the bench to the bedside. The present review aims to provide a comprehensive summary of the latest developments in the construction and application of natural polymers-based tissue scaffolding for volumetric muscle injury. Here, the tissue engineering approaches for treating volumetric muscle loss injury are highlighted and recent advances in cell-based therapies using various sources of stem cells are elaborated in detail. An overview of different strategies of tissue scaffolding and their efficacy on skeletal muscle cells regeneration and migration are presented. Furthermore, the present paper discusses a wide range of natural polymers with a special focus on proteins and polysaccharides that are major components of the extracellular matrices. The natural polymers are biologically active and excellently promote cell adhesion and growth. These bio-characteristics justify natural polymers as one of the most attractive options for developing scaffolds for muscle cell regeneration.

The key attributes of core-shell fibers are their ability to preserve bioactivity of incorporated-sensitive biomolecules (such as drug, protein, and growth factor) and subsequently control biomolecule release to the targeted microenvironments to achieve therapeutic effects. Such qualities are highly favorable for tissue engineering and drug delivery, and these features are not able to be offered by monolithic fibers. In this review, we begin with an overview on design requirement of core-shell fibers, followed by the summary of recent preparation methods of core-shell fibers, with focus on electrospinning-based techniques and other newly discovered fabrication approaches. We then highlight the importance and roles of core-shell fibers in tissue engineering and drug delivery, accompanied by thorough discussion on controllable release strategies of the incorporated bioactive molecules from the fibers. Ultimately, we touch on core-shell fibers-related challenges and offer perspectives on their future direction towards clinical applications., Competing Interests: The authors declare no conflicts of interest.

In this study, chitosan/polyvinyl alcohol/TiO 2 nanofiber was fabricated via electrospinning at a pump rate of 1.5 mL/h and voltage 6 kV. Field-emission scanning electron microscopic images showed bead free finer nanofiber. Fourier transform infrared spectra proved the formation of strong bond among chitosan, polyvinyl alcohol and TiO 2 . X-ray powder diffraction showed that TiO 2 became amorphous in the composite nanofiber. Toughness and thermal stability of the chitosan/PVA nanofibrous membrane was increased with addition TiO 2 . The chitosan/PVA/TiO 2 nanofibrous membrane was stable at basic medium. But degraded in acidic and water medium after 93 and 162 h, respectively. The adsorption mechanism of congo red obeyed the Langmuir isotherm model. On the other hand, adsorption characteristic of methyl orange fitted well with both Langmuir and Freundlich isotherm models. The maximum adsorption capacity of the resulting membrane for congo red and methyl orange is 131 and 314 mg/g, respectively. However, a high dose of adsorbent was required for congo red., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The chitosan/polyvinyl Alcohol/zeolite electrospun composite nanofibrous membrane was fabricated for adsorption of methyl orange. The EDX, TGA and tensile test were carried out for the characterization of the membrane. The Young's Modulus of the nanofibrous membranes increased by more than 100% with the addition of zeolite to chitosan/PVA. The batch adsorption tests were conducted by varying the initial concentration of methyl orange, contact time and pH of the dye solution. UV-vis results showed that most of the dye was adsorbed within 6 min. An adsorption kinetic study was carried out using the pseudo-second-order kinetic model, Lagergren-first-order model and intra particle diffusion model. The adsorption kinetics obeyed the Pseudo second order model. The adsorption mechanism was analyzed using the Langmuir and Freundlich isotherm model. The experimental data fits well with the Freundlich model. The adsorption capacity of the membrane was 153 mg/g. Adsorption capacity was decreased with increasing pH value. The resulting nanofiber became less active over methyl orange after several runs., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose: To report two cases of young immunocompetent males with herpes simplex acute retinal necrosis (HSV ARN) with initial diagnosis of unilateral disc swelling., Methods: Retrospective case series., Results: Two young immunocompetent males who were diagnosed to have unilateral disc swelling were treated as presumed optic neuritis and started on systemic steroids. On dilated fundal examination, unilateral retinitis and vasculitis was found after 2-3 days of systemic steroids and the diagnosis of ARN was made. Tetraplex vitreous tap subsequently returned as HSV-2 and HSV for the first and second patient, respectively. Both patients had no significant systemic medical history and tested negative for human immunodeficiency virus (HIV). Despite aggressive treatment, both patients developed profound visual morbidity., Conclusions: Close monitoring of patients with unilateral disc swelling and dilated fundus evaluation is critical, particularly upon initiation of systemic steroid therapy, even if immunocompetent, as misdiagnoses can result in potentially devastating consequences.

In this study, effect of degree of deacetylation on property and adsorption capacity of chitosan/polyvinyl Alcohol electrospun membrane has been investigated. Resulting nanofibers were characterized by FESEM, FTIR, XRD, TGA, tensile testing, weight loss test and adsorption test. FESEM result shows, finer nanofiber was fabricated from 42h hydrolyzed chitosan and PVA blend solution. FTIR and XRD result showed a strong interaction between chitosan and polyvinyl alcohol. Higher tensile strength was observed for the nanofiber having 42h hydrolyzed chitosan. Blend solution of chitosan/PVA having low DD chitosan had higher viscosity. The nanofibrous membrane was stable in distilled water, acidic and basic medium. The isotherm study shows that the adsorption capacity (q m ) of nanofiber containing higher DD chitosan was higher for Cr(VI). In contrary, the membrane containing chitosan with lower DD showed the higher adsorption capacity for Fe(III) and methyl orange. Moreover, the effect of DD on removal percentage of adsorbate was dependent on the initial concentration of the adsorbate., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The chitosan/polyvinyl alcohol/TiO 2 composite was synthesized. Two different degrees of deacetylation of chitosan were prepared by hydrolysis to compare the effectiveness of them. The composite was analyzed via field emission scanning electron microscopy, Fourier transform infrared, X-ray diffraction, thermal gravimetric analysis, weight loss test and adsorption study. The FTIR and XRD results proved the interaction among chitosan, PVA and TiO 2 without any chemical reaction. It was found that, chitosan with higher degree of deacetylation has better stability. Furthermore, it also showed that higher DD of chitosan required less time to reach equilibrium for methyl orange. The adsorption followed the pseudo-second-order kinetic model. The Langmuir and Freundlich isotherm models were fitted well for isotherm study. Adsorption capacity was higher for the composite containing chitosan with higher DD. The dye removal rate was independent of the dye's initial concentration. The adsorption capacity was increased with temperature and it was found from reusability test that the composite containing chitosan with higher DD is more reusable. It was notable that adsorption capacity was even after 15 runs. Therefore, chitosan/PVA/TiO 2 composite can be a very useful material for dye removal., (Copyright © 2017 Elsevier B.V. All rights reserved.)

A chitosan/polyvinyl alcohol (PVA)/zeolite composite was fabricated in this study. The composite was analyzed through field emission scanning electron microscopy, Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), thermogravimetric analysis, and weight loss test. FTIR and XRD results revealed a strong interaction among chitosan, PVA, and zeolite. Weight loss test results indicated that the composite was stable in acidic and basic media. Congo red was removed through flocculation, and the removal rate was 94% at an initial concentration of 100mg/L for a dose of 1g/L. The removal rate of methyl orange was controlled by adsorption at an initial concentration of less than 100mg/L. Flocculation occurred at high concentrations. The removal rate was also 94% at an initial concentration of 500mg/L for a dose of 5g/L. The adsorption behavior of the composite for the removal of methyl orange and Cr(VI) was described by using a pseudo-second-order kinetic model. The adsorption capacity of the composite for Cr(VI) was 450mg/g. Therefore, the synthesized composite exhibited versatility during the removal of dyes and heavy metals., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

In this study, chitosan/poly (ethylene oxide) nanofibres were fabricated at different chitosan:PEO weight ratio by electrospinning process. The effects of chitosan/PEO composition onto adsorption capability for Cu(II), Zn(II) and Pb(II) ions were studied. Formation of beadless fibres were achieved at 60:40 chitosan:PEO ratio. Average fiber diameter, maximum tensile strength and the specific surface area of the beadless fibres were found to be 115±31nm, 1.58MPa and 218m 2 /g, respectively. Chitosan/PEO composition that produced beadless fibres tend to possess higher hydrophilicity and maximum specific surface area. These characteristics lead the beadless fibres to the maximum adsorption capability. Adsorption equilibrium data were analysed by Langmuir and Freundlich isotherm. Freundlich isotherm showed the better fit with the experimental data and proved the existence of the monolayer adsorption conditions. The maximum adsorption capacity of the beadless fibres for Cu(II), Zn(II) and Pb(II) ions were found to be 120, 117 and 108mgg -1 , respectively., (Copyright © 2016. Published by Elsevier Ltd.)

Context: Rapid diagnosis and expeditious cooling of individuals with exertional heat stroke is paramount for survival., Objective: To evaluate the efficacy of various cooling systems after exercise-induced hyperthermia., Design: Crossover study., Setting: Laboratory., Patients or Other Participants: Twenty-two men (age = 24 ± 2 years, height = 1.76 ± 0.07 m, mass = 70.7 ± 9.5 kg) participated., Intervention(s): Each participant completed a treadmill walk until body core temperature reached 39.50°C. The treadmill walk was performed at 5.3 km/h on an 8.5% incline for 50 minutes and then at 5.0 km/h until the end of exercise. Each participant experienced 4 cooling phases in a randomized, repeated-crossover design: (1) no cooling (CON), (2) body-cooling unit (BCU), (3) EMCOOLS Flex.Pad (EC), and (4) ThermoSuit (TS). Cooling continued for 30 minutes or until body core temperature reached 38.00°C, whichever occurred earlier., Main Outcome Measure(s): Body core temperature (obtained via an ingestible telemetric temperature sensor) and heart rate were measured continuously during the exercise and cooling phases. Rating of perceived exertion was monitored every 5 minutes during the exercise phase and thermal sensation every minute during the cooling phase., Results: The absolute cooling rate was greatest with TS (0.16°C/min ± 0.06°C/min) followed by EC (0.12°C/min ± 0.04°C/min), BCU (0.09°C/min ± 0.06°C/min), and CON (0.06°C/min ± 0.02°C/min; P < .001). The TS offered a greater cooling rate than all other cooling modalities in this study, whereas EC offered a greater cooling rate than both CON and BCU (P < .0083 for all). Effect-size calculations, however, showed that EC and BCU were not clinically different., Conclusion: These findings provide objective evidence for selecting the most effective cooling system of those we evaluated for cooling individuals with exercise-induced hyperthermia. Nevertheless, factors other than cooling efficacy need to be considered when selecting an appropriate cooling system.

In this study, chitosan/polyvinyl alcohol (PVA)/zeolite nanofibrous composite membrane was fabricated via electrospinning. First, crude chitosan was hydrolyzed with NaOH for 24h. Afterward, hydrolyzed chitosan solution was blended with aqueous PVA solution in different weight ratios. Morphological analysis of chitosan/PVA electrospun nanofiber showed a defect-free nanofiber material with 50:50 weight ratio of chitosan/PVA. Subsequently, 1wt.% of zeolite was added to this blended solution of 50:50 chitosan/PVA. The resulting nanofiber was characterized with field emission scanning electron microscopy, X-Ray diffraction, Fourier transform infrared spectroscopy, swelling test, and adsorption test. Fine, bead-free nanofiber with homogeneous nanofiber was electrospun. The resulting membrane was stable in distilled water, acidic, and basic media in 20 days. Moreover, the adsorption ability of nanofibrous membrane was studied over Cr (VI), Fe (III), and Ni (II) ions using Langmuir isotherm. Kinetic parameters were estimated using the Lagergren first-order, pseudo-second-order, and intraparticle diffusion kinetic models. Kinetic study showed that adsorption rate was high. However, the resulting nanofiber membrane showed less adsorption capacity at high concentration. The adsorption capacity of nanofiber was unaltered after five recycling runs, which indicated the reusability of chitosan/PVA/zeolite nanofibrous membrane. Therefore, chitosan/PVA/zeolite nanofiber can be a useful material for water treatment at moderate concentration of heavy metals., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Chitosan/PVA/Na-titanate/TiO2 composite was synthesized by solution casting method. The composite was analyzed via Fourier Transform Infrared Spectroscopy, X-ray diffraction, Field Emission Scanning Electron Microscopy, Thermal gravimetric analysis and water stability test. Incorporation of Na-titanate shown decrease of crystallinity for chitosan but increase water stability. However, the composite structure was deteriorated with considerable weight loss in acidic medium. Two anionic dyes, methyl orange and congo red were used for the adsorption test. The adsorption behavior of the composites were described by pseudo-second-order kinetic model and Lagergren-first-order model for methyl orange and congo red, respectively. For methyl orange, adsorption was started with a promising decolorization rate. 99.9% of methyl orange dye was removed by the composite having higher weightage of chitosan and crystalline TiO2 phase. On the other hand, for the congo red the composite having higher chitosan and Na-titanate showed an efficient removal capacity of 95.76%. UV-vis results showed that the molecular backbone of methyl orange and congo red was almost destroyed when equilibrium was obtained, and the decolorization rate was reaching 100%. Kinetic study results showed that the photocatalytic degradation of methyl orange and congo red could be explained by Langmuir-Hinshelwood model. Thus, chitosan/PVA/Na-titanate/TiO2 possesses efficient adsorptivity and photocatalytic property for dye degradation., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Purpose: To assess the incidence and risk factors for early corneal haze after myopic photorefractive keratectomy (PRK)., Setting: Tertiary eye center, Singapore., Design: Retrospective case series., Methods: The refractive results and corneal haze severity 3 months after PRK were analyzed. Eyes were categorized into 4 groups based on haze severity. Multivariate ordinal logistic regression analysis adjusting for age, ethnicity, sex, use of intraoperative mitomycin-C (MMC), preoperative sphere, and preoperative cylinder was performed., Results: The study reviewed data from 177 patients (347 eyes) with a mean age of 22.6 years ± 4.1 (SD). The majority of the patients were Chinese (98.3%) and men (98.3%). The mean preoperative spherical equivalent (SE) was -3.34 ± 1.19 diopters (D). One hundred thirty-five eyes (38.9%) had PRK with MMC. Ten eyes (2.9%) had enhancement surgery. The overall efficacy index was 0.88 and the safety index was 1.07. At 3 months, 187 eyes (53.9%) had no haze, 76 eyes (21.9%) had a haze grade of more than 0 and less than 1, 76 eyes (21.9%) had a haze grade of 1 or more and less than 2, and 8 eyes (2.3%) had grade 2 haze. Higher degrees of myopia (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.13-1.63; P = .001) and astigmatism (OR, 1.56; 95% CI, 1.09-2.24; P = .014) were associated with increased severity of corneal haze, whereas older age (OR, 0.94; 95% CI, 0.88-0.99; P = .023) had a protective effect., Conclusion: Myopia and astigmatism were associated with increased severity of haze, and older age was protective against early corneal haze development after PRK in an Asian population., Financial Disclosure: None of the authors has a financial or proprietary interest in any material or method mentioned., (Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Background: The aim was to investigate the changes in anterior segment parameters, as assessed by anterior segment optical coherence tomography in Japanese subjects after laser peripheral iridotomy (LPI)., Design: This was a prospective observational study., Participants: The participants include 72 subjects with angle closure including primary angle closure suspect (PACS), primary angle closure (PAC), and primary angle closure glaucoma (PACG)., Methods: Anterior segment optical coherence tomography parameters was measured by customized software. Complete data of 51 subjects were available for final analysis., Main Outcome Measures: These were the following parameters: angle opening distance, trabecular-iris space area, anterior chamber depth, width, area and volume (iris thickness, curvature, and area, and lens vault (LV)., Results: A total of 25 PACS, 17 PAC and 9 PACG were included. Mean age was 74.7 ± 6.7 years, and majority were women (80.4%). Following LPI, there was a significant increase in mean gonioscopic angle width (1.16 vs. 1.93, P < 0.001) and a corresponding increase in angle opening distance, trabecular-iris space area, and angle recess area (all P < 0.001). The anterior chamber area (P < 0.001), anterior chamber volume (P < 0.001) and anterior chamber depth (P = 0.003) increased significantly; and iris curvature (P < 0.001) was significantly reduced. There were no significant changes in anterior chamber width, LV, iris thickness and area. Age-adjusted and gender-adjusted analysis for predictors of percentage change in angle opening distance 750 showed significant association with greater baseline LV (β = 0.32, P = 0.03). No significant differences were noted in the mean percentage change in parameters between the PACS and PAC-PACG., Conclusions: An increase in anterior chamber dimensions, angle widening and iris flattening; with a constant LV, iris thickness and iris area after LPI was demonstrated in Japanese eyes with angle closure., (© 2015 Royal Australian and New Zealand College of Ophthalmologists.)

The objective of this study was to investigate the effects of different species of oil palm shell (OPS) coarse aggregates on the properties of high strength lightweight concrete (HSLWC). Original and crushed OPS coarse aggregates of different species and age categories were investigated in this study. The research focused on two OPS species (dura and tenera), in which the coarse aggregates were taken from oil palm trees of the following age categories (3-5, 6-9, and 10-15 years old). The results showed that the workability and dry density of the oil palm shell concrete (OPSC) increase with an increase in age category of OPS species. The compressive strength of specimen CD3 increases significantly compared to specimen CT3 by 21.8%. The maximum achievable 28-day and 90-day compressive strength is 54 and 56 MPa, respectively, which is within the range for 10-15-year-old crushed dura OPS. The water absorption was determined to be within the range for good concrete for the different species of OPSC. In addition, the ultrasonic pulse velocity (UPV) results showed that the OPS HSLWC attain good condition at the age of 3 days.

Maghemite (γ-Fe2O3) nanoparticles have been synthesized using a chemical coprecipitation method at different nitric acid concentrations as an oxidizing agent. Characterization of all samples performed by several techniques including X-ray diffraction (XRD), transmission electron microscopy (TEM), alternating gradient magnetometry (AGM), thermogravimetric analysis (TGA), dynamic light scattering (DLS), and zeta potential. The XRD patterns confirmed that the particles were maghemite. The crystallite size of all samples decreases with the increasing concentration of nitric acid. TEM observation showed that the particles have spherical morphology with narrow particle size distribution. The particles showed superparamagnetic behavior with decreased magnetization values at the increasing concentration of nitric acid. TGA measurement showed that the stability temperature decreases with the increasing concentration of nitric acid. DLS measurement showed that the hydrodynamic particle sizes decrease with the increasing concentration of nitric acid. Zeta potential values show a decrease with the increasing concentration of nitric acid. The increasing concentration of nitric acid in synthesis of maghemite nanoparticles produced smaller size particles, lower magnetization, better thermal stability, and more stable maghemite nanoparticles suspension.

Objective: To report the 8-year outcomes of Asian subjects who underwent trabeculectomy augmented by intraoperative 5-fluorouracil (5-FU) or placebo., Design: Retrospective review of a randomized controlled trial., Participants: Subjects with primary open-angle or angle-closure glaucoma., Methods: Study subjects were prospectively followed up for 3 years. After the last subject recruited had completed 8 years of follow-up, the charts of all subjects were reviewed to capture data from the year 3 visit onward. Kaplan-Meier survival function with Cox regression was performed to identify risk factors associated with trabeculectomy failure at 8 years., Main Outcome Measures: The primary outcome was trabeculectomy failure defined as intraocular pressure (IOP) >21 or <6 mmHg on 2 consecutive occasions after the first 6 weeks after surgery, repeat glaucoma surgery, or loss of light perception. Further end points were defined at IOP levels >17 and >14 mmHg. Secondary outcomes included IOP at 8 years and number of glaucoma medications. Complete success was defined using IOP end points ≤ 21, ≤ 17, or ≤ 14 mmHg at 8 years without medications., Results: Of the 243 enrolled subjects, 170 (70.0%) completed 8 years follow-up, 86 in the 5-FU and 84 in the placebo group. There was no significant difference in failure rates at 8 years for the failure definitions of IOP >21 mmHg (11.6% of the 5-FU group vs. 16.7% of the placebo group; P = 1.00), IOP >17 mmHg (23.3% of the 5-FU group vs. 31% of the placebo group; P = 0.78), and IOP >14 mmHg (46.5% of the 5-FU group vs. 58.3% of the placebo group; P = 0.37). Mean IOP at 8 years was 13.7 mmHg in the 5-FU versus 14.4 mmHg in the placebo group (P = 0.24). Mean number of medications was 0.65 drops in the 5-FU versus 0.93 drops in the placebo group (P = 0.06). Complete success with IOP ≤ 21 mmHg at 8 years was achieved in 48 subjects (55.8%) in the 5-FU and 33 subjects (39.3%) in the placebo group (P = 0.09). Absence of bleb microcysts at 1 year, preoperative IOP, and number of bleb needlings performed within the first year were significantly associated with failure., Conclusions: There was no significant difference in IOP between the 5-FU and the placebo group at 8 years., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Introduction: A common approach to the surveillance of emerging infectious diseases and agents of bioterrorism is to analyse electronically captured data for disease syndromes. The Patient Care Enhancement System (PACES) is a form of electronic medical records presently in service in the Singapore Armed Forces (SAF). We assess the feasibility of PACES data for surveillance, describe time-trends, and identify methods of sub-analysis which could improve performance., Materials and Methods: Medical consults from July 2000 to June 2003 were extracted. Diagnosis codes were mapped to 7 infectious disease syndromes according to the categorisation in the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE): gastrointestinal (GI), fever (FEVER), respiratory, (RESP), coma (COMA), neurological (NEURO), dermatologic-haemorrhagic (DERMHEM) and dermatologic- infectious (DERM-INF)., Results: A total of 732,233 episodes of care were analysed. Weekly periodicity was observed, with decreased weekend consults; there were no obvious seasonal trends in any of the syndromes. RESP, FEVER and GI syndromes were common events. Sub-analyses, either by restricting to cases with a repeated consultation, or grouping the data by medical centres, could dramatically lower thresholds used to flag outbreaks., Conclusion: In spite of the level of background noise inherent in a system consisting mainly of primary care consults, sub-analysis by medical centre, or restriction to cases with repeated consults were able to yield sensitive thresholds for outbreak detection.

1. Whole-body protein turnover was measured using the [15N]glycine tracer technique in 10 post-absorptive healthy volunteers during normal daily activities and a period of bed rest. 2. Bed rest reduced whole-body protein turnover (25%), synthesis (26%) and breakdown (25%), but short-term urinary nitrogen excretion remained unchanged.

The work investigated fuel interrelationships in surgical patients infused with saline (Group I) or glucose (Group II) (13 patients in each group) on the day of surgery and subsequently maintained solely on saline until the fifth postoperative day. Blood concentrations of non-esterified fatty acids (NEFA) and ketone bodies were markedly increased in response to surgical stress on the day of surgery only in patients who were not administered carbohydrate. Increased concentrations of lactate and glucose were observed on the day of surgery in patients infused with either saline or glucose. As both fatty acid and ketone body concentrations were decreased by glucose infusion, impaired glucose utilization immediately after surgery is not a simple consequence of increased oxidation of lipid fuels. Glucose and lactate concentrations declined after the day of surgery. Despite a progressive fall in plasma non-esterified fatty acid concentrations from the first to fifth post-operative days, blood ketone body concentrations were strikingly elevated in both groups of patients. The findings emphasize the role of the liver in post-operative fatty acid turnover.

A low viscosity perfluorocarbon liquid (perfluorodecalin) known commercially as DKLine was used intraoperatively as a temporary vitreous substitute in 20 patients undergoing vitrectomy surgery for a variety of complicated vitreoretinal conditions. The indications for its use included giant retinal tears (9), proliferative vitreoretinopathies (2), dislocated lenses (2), dislocated posterior chamber implant (1), endophthalmitis with retinal detachment (2), traction retinal detachment (1), pseudophakic retinal detachment (2) and exudative retinal detachment (1). In all cases with retinal detachment, perfluorodecalin was successful in flattening the retina intraoperatively. It was also successful in permitting the safe removal of dislocated lenses that were lying on the retina. In all except four cases, removal of perfluorodecalin was complete. We observed no toxic effects from remnant bubbles of perfluorocarbon in the eye.

Diabetes mellitus as a disease is a dragon with many heads. To cope with it, each manifestation must be deftly handled by family physician and specialists in unison. Similarly, the spectre of diabetic retinopathy is best exorcised before it manifests - by effective prophylactic screening. This programme can only be successful through a co-ordinated effort of both physicians and ophthalmologists. In this paper, we present one such agenda which we have adopted, The result indicate that a fifth of diabetics have retinopathy, and that sight threatening disease affects 7% of those screened. More critically, it also establishes that a cost-effective method of screening can be achieved through a synergetic endeavour of primary care physician and specialist.

Thirty-five patients with diabetic retinopathy were treated with cryoapplication. This was used as an alternative to Argon laser or Zenon photocoagulation because the media was opaque from vitreous hemorrhage or cataract. It was difficult or impossible to treat with photocoagulation. The clinical impression indicates that cryoapplication is effective, showing adequate pigmentation and chorioretinal scarring with regression of diabetic retinopathy changes. However patients with vitreo-retinal fibrosis became frequently worse weeks later. This is considered a contraindication. The use of cryoapplication in diabetic retinopathy is recommended in situations where the ocular media is not clear, such as vitreous hemorrhage and cataract. It can also be used if there is difficulty with laser photocoagulation following lens implantation. It may be valuable in some developing countries where photocoagulation is not available. Cryomachines are frequently used in eye camps. It is inexpensive and does not necessarily require electricity.

Ocular disorders in the elderly have become more important because of increased longevity and the demand for good vision. Many serious ocular conditions are age-related and they include cataract, glaucoma, diabetic retinopathy and other retinal conditions. The most important ocular disorder is cataract which fortunately is curable with excellent results when a posterior chamber implant is inserted. Angle closure glaucoma is common in the elderly Singapore Chinese and can be effectively treated with microscopic peripheral iridectomy or trabeculectomy. Blindness from diabetic retinopathy can be prevented with argon laser photocoagulation. In most cases blindness is preventable with early diagnosis e.g. in glaucoma and diabetic retinopathy. Severe visual loss in the elderly requires careful explanation and compassion by doctors and social workers.

Idiopathic subretinal neovascularization is a potentially blinding condition and often strikes patients in their prime of life. It appears to be seen in more females, at an earlier age than males. Treatment is possible by photoablation of the subretinal new vessel by Argon or Yag laser. There is a clinical impression that Argon laser is more effective than the Yag laser for this purpose.

The outcome of cardio-pulmonary resuscitation within an acute geriatric unit was studied in 95 patients (mean age 77 years, range 65-90) who were involved in 106 consecutive cardio-respiratory arrest calls. In 58 patients (61%), initial resuscitation was unsuccessful and a further 21 (22%) died later in hospital. Fourteen patients (15%) were alive 3 months after hospital discharge, a success rate comparable to that of published series in younger patients. The probability of successful resuscitation was greater in patients in the High-dependency Unit, and ventricular fibrillation and a short duration of arrest were confirmed as good prognostic factors. Age had no influence on outcome. Although subjective levels of psychological and physical disability of survivors at 3 months were low, their domestic and social life was often excessively restricted. Selective, but positive, use of cardio-pulmonary resuscitation within acute geriatric units will benefit a significant minority of patients, but there is also a need for further measures to reduce unnecessary disability in long-term survivors.

This is a retrospective study of 525 posterior chamber implants in diabetics performed by A S M Lim and B C Ang of Singapore. The patients were reviewed by visiting ophthalmologists--J E Kennedy (Sydney), M Ngui (East Malaysia) and P M Hart (Belfast). This study did not show any significant difference in the complication of post-operative visual acuity between diabetics and non-diabetics. 95% obtained 6/12 vision or better when pre-existing disease was excluded. It also showed that posterior chamber implants can be inserted in eyes with maculopathy or proliferative retinopathy if laser treatment was effectively done before or after surgery.

Diabetic retinopathy has now become a common cause of blindness in Singapore. Fortunately, laser photocoagulation has prevented blindness in the majority of patients who were treated. An analysis of 872 patients treated with argon laser photocoagulation showed that 424 patients (48.6%) were for diabetic retinopathy. Patients with adequate treatment retained useful vision. Those who lost vision frequently had associated target organ involvement besides inadequate laser treatment. Patients with proliferative diabetic retinopathy were treated with peripheral retinal photocoagulation. Patients with diabetic maculopathy especially those with focal leaks were treated with localised photocoagulation. A common cause of blindness is failure to recognise the condition early. Physicians and general practitioners must, in the management of diabetics, examine their patients periodically with the pupils dilated in a darkened room.

The posterior chamber implant has increased safety in intraocular lens implantation. Implants are now inserted in one-eyed patients, in eyes with high myopia, endothelial corneal problems, senile macular degeneration, diabetic retinopathy and glaucoma. The percentage of implant from 1975-1981 was 10.3% but increased to 83.9% from 1983-1984. This is mainly because there are today fewer situations where lens implantation is contra-indicated in the hands of surgeons, skilled and experienced in posterior chamber implant surgery.