Deep Anterior Lamellar Keratoplasty versus Penetrating Keratoplasty for Macular Corneal Dystrophy: A Randomized Trial

Purpose: To compare outcomes of big-bubble deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for macular corneal dystrophy. Design: Prospective, randomized, interventional case series. Methods: Setting: Single hospital. Patients: Eighty-two eyes of 54 patients requiring keratoplasty for the treatment of macular corneal dystrophy without endothelial involvement were included. Main outcome measures: Operative complications, uncorrected visual acuity, best-corrected visual acuity, contrast sensitivity function, higher-order aberrations, and endothelial cell density were evaluated. Results: The DALK and PK group consisted of 35 and 41 eyes, respectively. Best-corrected visual acuity after surgery was 20/40 or better 68.5% and 70.7% of the eyes in the DALK and PK groups, respectively (P > .05). No statistically significant differences between groups were found in contrast sensitivity function with and without glare for any spatial frequency (P > .05). Significantly higher levels of higher-order aberrations were found in the DALK group (P < .01). In both groups, a progressive and statistically significant reduction in endothelial cell density was found (P < .01). At the last follow-up, the mean endothelial cell loss was 18.1% and 26.9% in DALK and PK groups, respectively (P = .03). Graft rejection episodes were seen in 5 eyes (12.1%) in the PK group, and regrafting was necessary in 3 eyes (7.3%). Recurrence of the disease was documented in 5.7% and 4.8% of the eyes in the DALK and PK groups, respectively. Conclusions: Deep anterior lamellar keratoplasty with the big-bubble technique provided comparable visual and optical results as PK and resulted in less endothelial damage, as well as eliminating endothelial rejection in macular corneal dystrophy. Deep anterior lamellar keratoplasty surgery is a viable option for macular corneal dystrophy without endothelial involvement.

Retinal ganglion cell layer change in patients treated with anti-VEGF for neovascular age related macular degeneration.

PURPOSE To evaluate macular retinal ganglion cell thickness in patients with neovascular age-related macular degeneration (AMD) and intravitreal anti-vascular endothelial growth factor (VEGF) therapy. DESIGN Retrospective case series with fellow-eye comparison METHODS: Patients with continuous unilateral anti-VEGF treatment for sub- and juxtafoveal neovascular AMD and a minimum follow-up of 24 months were included. The retinal nerve fiber (RNFL) and retinal ganglion cell layer (RGCL) in the macula were segmented using an ETDRS grid. RNFL and RGCL thickness of the outer ring of the ETDRS grid were quantified at baseline and after repeated anti-VEGF injections, and compared to the patients' untreated fellow eye. Furthermore, best-corrected visual acuity (BCVA), age, and retinal pigment epithelium (RPE) atrophy were recorded and correlated with RNFL and RGCL. RESULTS Sixty eight eyes of 34 patients (23 female and 11 male; mean age 76.7 (SD±8.2) with a mean number of 31.5 (SD ±9.8) anti-VEGF injections and a mean follow-up period of 45.3 months (SD±10.5) were included. Whereas the RGCL thickness decreased significantly compared to the non-injected fellow eye (p=0.01) the decrease of the RNFL was not significant. Visual acuity gain was significantly correlated with RGCL thickness (r=0.52, p<0.05) at follow-up and negatively correlated (r=-0.41, p<0.05) with age. Presence of RPE atrophy correlated negatively with the RGCL thickness at follow-up (r= -0.37, p=0.03). CONCLUSION During the course of long term anti-VEGF therapy there is a significant decrease of the RGCL in patients with neovascular AMD to the fellow (untreated) eye.

Ardschuna's Reise zu Indra's Himmel : nebst anderen Episoden des Maha-bharata /

Sanskrit title at head of title-page.

Sündflut : nebst drei anderen der wichtigsten Episoden des Mahâ-Bhârata.

Mode of access: Internet.

Teatro italiano scelto : commedie di Carlo Goldoni, Albergati Capacelli, Giovanni Giraud ed Alberto Nota, scelte ad uso degli studiosi della lingua italiana. --

Goldoni, C. Le smanie per la villeggiatura. Le avventure della villeggiatura. Il padre di famiglia.--Albergati Capacelli, F. La tarantola.--Giraud, G. L'ajo nell'imbarazzo.--Nota, A. Il nuovo ricco.

Nala. Eine Indische Dichtung.

German translation of part of the Mahābhārata.

Warranty cost analysis for second-hand products

For second-hand products sold with warranty, the expected warranty cost for an item to the manufacturer, depends on (i) the age and/or usage as well as the maintenance history for the item and (ii) the terms of the warranty policy. The paper develops probabilistic models to compute the expected warranty cost to the manufacturer when the items are sold with free replacement or pro rata warranties. (C) 2000 Elsevier Science Ltd. All rights reserved.

Mortalidade segundo sua causa de morte e seus determinantes: uma análise para as capitais brasileiras e municípios do nordeste do Brasil, 2000 e 2010

This dissertation considered the development of two papers, both related to mortality in Brazil. In the first article, "The context of mortality according to the three broad groups of causes of death in Brazilian capitals, 2000 and 2010", the objective was to analyze the mortality rate according to the three major groups of causes of death in Brazilian capitals. In the second article, "Typology and characteristics of mortality from external causes in the municipalities in the Northeast of Brazil, 2000 and 2010", it was built up a typology for the Northeastern municipalities taking into account information on mortality from external causes and a set of indicators related to socioeconomic, demographic, and infrastructure aspects of such municipalities, both articles for the years 2000 and 2010. Thus, we used data from the Mortality Information System of the Ministry of Health. Furthermore, it was used information from the Demographic Census for those years. The variables relating to socioeconomic and demographic conditions used in this study were those available on the home page of the United Nations Program for Development. The variables relating to socioeconomic and demographic conditions used in this study were those available on the home page of the United Nations Program for Development. Was used in Article 1 the pro-rata distribution method to accomplish the redistribution of ill-defined causes. Moreover, made use of the technique of cluster analysis with the aim of grouping the capital that had proportions of deaths from ill-defined causes similar to each other. Already in Section 2, we used the technique of Empirical Bayesian estimation; spatial statistics technique; and finally, the Grade of Membership method to find types of municipalities from information on mortality from external causes associated with socioeconomic, demographic and infrastructure variables. As the main results, it stands out in Article 1, in relation to data quality, we observed the formation of four groups of similar capital between themselves, as the proportion of illdefined causes. Regarding the behavior of mortality, according to the three major groups of causes of death, it was noted both for 2000 and for 2010 the prevalence of deaths from noncommunicable diseases for both sexes, although the reduction was identified rates in some of the capitals. Communicable diseases stood out as the second cause of death among women. Also, we found that deaths due to external causes are responsible for the second cause of death among men, as well as presenting an increase among women. As for the Article 2, stands out, in general, not just an extension of mortality from external causes in the municipalities, as well as an enlargement of the configurator stain existence of external cause deaths for the whole area of Northeast. Regarding the typology of municipalities, three vi extreme profiles were buit: the profile 1, which comprises municipalities with high rates of mortality from external causes and the best social indicators; the profile 2, that was composed of municipalities that are characterized by having low mortality rates from external causes and the lowest social indicators; and the profile 3, that brings together municipalities with intermediate mortality rates and median values considered in relation to social indicators. Although we have not seen changes in the characteristics of the profiles, we observed an increase in the proportion of municipalities that belong to the extreme profile 3, taking into account the mixed profiles.

Efectos sobre el metabolismo lipoproteico y estrés oxidativo en ratas zucker fa/fa de cárnicos enriquecidos con glucomanano y espirulina

Esta memoria doctoral versa sobre los estudios que se realizaron para evaluar los efectos de reestructurados cárnicos (RP) enriquecidos con glucomanano y espirulina sobre crecimiento, tamaño y estructura de órganos, glucemia, insulinemia, resistencia a la insulina, metabolismo lipoproteico y estrés oxidativo en un modelo de síndrome metabólico como es la rata Zucker fa/fa. Para ello se diseñaron diferentes dietas hipersaturadas, añadidas o no con agente hipercolesterolemiante, conteniendo 15% de RP control, 15% de RP enriquecido con glucomanano o 15% de RP con glucomanano más 3 g de espirulina/kg. Los animales, de cinco semanas de edad y aproximadamente 120 g de peso, se mantuvieron en jaulas metabólicas individuales a una temperatura de 22,3 ± 1,8 2C, en ciclos de 12 horas de luz/oscuridad. Las ratas recibieron pienso estándar de crecimiento durante un periodo de adaptación de una semana a las condiciones ambientales. Posteriormente se distribuyeron en seis grupos experimentales homogéneos y se sometieron durante 7 semanas a las dietas experimentales. Al finalizar dicho periodo se procedió a su sacrificio y extracción de sangre y órganos seleccionados para su estudio...

Discrimination of honey of different floral origins by a combination of various chemical parameters

Abstract Honey is a high value food commodity with recognized nutraceutical properties. A primary driver of the value of honey is its floral origin. The feasibility of applying multivariate data analysis to various chemical parameters for the discrimination of honeys was explored. This approach was applied to four authentic honeys with different floral origins (rata, kamahi, clover and manuka) obtained from producers in New Zealand. Results from elemental profiling, stable isotope analysis, metabolomics (UPLC-QToF MS), and NIR, FT-IR, and Raman spectroscopic fingerprinting were analyzed. Orthogonal partial least square discriminant analysis (OPLS-DA) was used to determine which technique or combination of techniques provided the best classification and prediction abilities. Good prediction values were achieved using metabolite data (for all four honeys, Q² = 0.52; for manuka and clover, Q² = 0.76) and the trace element/isotopic data (for manuka and clover, Q² = 0.65), while the other chemical parameters showed promise when combined (for manuka and clover, Q² = 0.43).

Building Owner vs. Energy User: a Split Incentive for Energy Reduction

The UK’s historically low cost of energy has encouraged a culture that considers energy to be in limitless supply and excessive levels of consumption acceptable. Now that supplies are becoming restricted and costs rising, it is becoming recognised this energy culture has created a legacy stock of buildings with poor building fabric, limited energy efficiency equipment and even lower levels of energy awareness. Cost effective technologies are readily available but not adopted by UK SMEs in non-domestic buildings, as rational economic theory would expect. Policy-makers attribute this to inaccessibility of information and investment and design policies accordingly. However, as escalation of demand continues an alternative driver of this paradox must exist. This research hypothesises that this is the ownership structures of non-domestic buildings. Tenure of business premises is found to prevent adoption of energy conservation opportunities; 64% of SME surveyed encountered barriers to energy efficiency related to building ownership. When increased pro rata to reflect the UK SME population, almost 2.5 million businesses appear unable to benefit from energy improvements.

“Opciones alimenticias para mitigar problemas de inseguridad alimentaria y nutricional en familias pobres de comunidades rurales del municipio de Tisma, Masaya Nicaragua en el año 2014”

El estudio valor a el estado nutricional de las familias en las siguientes comunidades: Santa Cruz, Tisma Grande y la Montañita N o 2, pertenecientes al municipio de Masaya. Se inició con el análisis de sus patro nes de consumo, dando valor al aporte nut ricional de las plantas locales . En esta investigación cualit ativa se aplicaron los siguientes instrumentos : Entrevistas y recorr idos de fincas . De estos se derivan dos estudios de casos. El primero reflejó que los 9 patr ones de consumo poseen suficiencia en cuanto al acceso a alimentos nutritivos superando el 110%. El índice de di versidad de la dieta ( suficiencia ) en la semana, alcanza un rango de 0.89 en Tisma Grande, con valoración deficiente, en Santa Cruz de 0.92 con valoración aceptable y l a Montañita N o 2 de 1.08, con valoración adecuad a . En el aspecto de la diversidad de l a dieta en la semana , los resultados fuer on rangos promedios entre 9.3 y 9.7 significando la existencia de una diver sidad de dieta aceptable. El segundo estudio de caso refleja info rmac ión sobre los tipos de plantas locales con valor nutritivo y las formas de consumo diario determina n do así las siguientes plantas: Espinaca ( Spinacia oleracea ), Quelite ( Amaranthus hybridus ), Espadillo ( Yucca elephantipes ), Verdolaga ( Portulaca olerac ea ), Mora ( Morus nigra), Cojombro (Sicana odorífera), Batata (Ipomoea batatas), Piñuela (Bromelia baratas), Panamá (Sterculia apetala, Tempisque (Sideroxylon capiri), Caimito (Chrysophyllum cainito) entre otras . Definitivamente , podemos detallar que las f amilias consumen alimentos con mayo r aporte calórico que proteínico, ya que consumen alimentos derivados de los lácteos, car nes y dulces. Sin embargo, es importante mencion ar que esto no indica que exista una mala calidad nu tricional en las familias, puest o que el consumo de proteínas no es tan defi ci ente, por eso hace necesario incluir a limentos que permitan compleme ntar el consumo de proteínas al organismo de las familias, logrando así un a dieta balanceada que les permita a las familias mejorar sus condic iones de salud y de vida satisfaciendo así sus necesidades nutricionales diarias en relación al tr ab ajo que realizan día a día en sus pequeñas parcelas productivas.

Evaluación de insecticidas químicos alternados con botánicos como opciones de manejo de mosca blanca (Bemisia tabaci, Gennadius) y otros insectos plagas en tomate (Solanum lycopersicum L.), en Tisma, Masaya 2016

La mosca blanca (Bemisia tabaci, Genn.) y los Geminivirus son los principales agentes de daño causantes de problemas fitosanitarios severos para los productores de tomate (Solanum lycopersicum, L.), este insecto provoca importantes pérdidas económicas, disminuyendo los rendimientos al afectar la calidad de frutos. En base a esta esta situación se realizó un estudio en el municipio de Tisma, Masaya en el período comprendido entre Julio y Septiembre del 2015 para evaluar la efectividad que tiene para controlar plagas los insecticidas químicos alternados con botánicos, los tratamientos evaluados fueron: Engeo alternado con Chile+Ajo+Jabón, Imidacloprid alternado con Madero Negro, Abamectina alternado con Neem, Monarca alternado con Chile+ajo y testigo (agua). Las variables evaluadas fueron, número de mosca blanca por planta, incidencia y severidad del daño de virosis por planta, número de Halticus sp por planta, número de Aphis sp por planta, número de Liriomyza sp por planta, numero de Arañas por planta, rendimiento en kg/ha. De los tratamientos evaluados, el menor número de moscas blancas, Halticus sp y menor porcentaje de incidencia y severidad lo presentó el tratamiento Abamectina alternado con Neem. El análisis económico determinó que el tratamiento que obtuvo el mayor rendimiento comercial fue Abamectina alternado con Neem. Se concluye que Abamectina alternado con Neem es el tratamiento que resultó más efectivo para el manejo de mosca blanca y otros insectos plagas.

Productos botánicos para el manejo del ácaro blanco (Polyphagotarsonemus latus, Banks.) (Acarina; Tarsonemidae, en chiltoma (Capsicum annuum L.), en Masaya, Nicaragua

Con el objetivo de evaluar cinco productos botánicos para el manejo del ácaro blanco de la chiltoma, se realizó un estudio en el Municipio de Tisma, Masaya en el período comprendido de Septiembre a Noviembre del año 2014. Las alternativas evaluadas fueron: Eucalipto, Neem, Crisantemo, Madero Negro y Chile+Ajo+Jabon en comparación con el testigo que fue solamente aplicación de agua. Las variables evaluadas fueron: Número de ácaro blanco por planta, porcentaje de severidad del daño de ácaro blanco por planta, además de algunas variables económicas como el rendimiento en kg/ha por tratamiento evaluado, análisis de presupuesto parcial, análisis de dominancia y tasa de retorno marginal. Los resultados obtenidos en el estudio determinan que los tratamientos Madero Negro y chile+ajo+jabon fueron los que presentaron el mejor efecto de control del ácaro blanco, los mejores rendimientos comerciales lo obtuvieron los tratamientos madero negro y chile+ajo+jabon, las mejores tasas de retorno marginal fueron obtenidas en los tratamientos madero negro seguido del chile+ajo+jabon.

Outcome analysis of intracorneal ring segments for the treatment of keratoconus based on visual, refractive, and aberrometric impairment

PURPOSE: To analyze the outcomes of intracorneal ring segment (ICRS) implantation for the treatment of keratoconus based on preoperative visual impairment. DESIGN: Multicenter, retrospective, nonrandomized study. METHODS: A total of 611 eyes of 361 keratoconic patients were evaluated. Subjects were classified according to their preoperative corrected distance visual acuity (CDVA) into 5 different groups: grade I, CDVA of 0.90 or better; grade II, CDVA equal to or better than 0.60 and worse than 0.90; grade III, CDVA equal to or better than 0.40 and worse than 0.60; grade IV, CDVA equal to or better than 0.20 and worse than 0.40; and grade plus, CDVA worse than 0.20. Success and failure indices were defined based on visual, refractive, corneal topographic, and aberrometric data and evaluated in each group 6 months after ICRS implantation. RESULTS: Significant improvement after the procedure was observed regarding uncorrected distance visual acuity in all grades (P < .05). CDVA significantly decreased in grade I (P < .01) but significantly increased in all other grades (P < .05). A total of 37.9% of patients with preoperative CDVA 0.6 or better gained 1 or more lines of CDVA, whereas 82.8% of patients with preoperative CDVA 0.4 or worse gained 1 or more lines of CDVA (P < .01). Spherical equivalent and keratometry readings showed a significant reduction in all grades (P ≤ .02). Corneal higher-order aberrations did not change after the procedure (P ≥ .05). CONCLUSIONS: Based on preoperative visual impairment, ICRS implantation provides significantly better results in patients with a severe form of the disease. A notable loss of CDVA lines can be expected in patients with a milder form of keratoconus.