Phacoemulsification combined with posterior capsulorhexis and anterior vitrectomy in the management of malignant glaucoma in phakic eyes

Purpose: To describe sequential phacoemulsification-intraocular lens (IOL) implantation-posterior capsulorhexis-anterior vitrectomy in the management of phakic malignant glaucoma. Methods: Twenty consecutive patients (25 eyes) with phakic malignant glaucoma were enrolled at the Zhongshan Ophthalmic Center, Sun Yat-sen University. All patients underwent phacoemulsification, IOL implantation and posterior capsulorhexis together with anterior vitrectomy via a clear corneal paracentesis. Visual acuity, intraocular pressure (IOP), anterior chamber depth (ACD), surgical complications and medications required after the surgery were recorded. Results: After surgery, the mean LogMAR visual acuity and ACD increased significantly (visual acuity from -1.56 ± 1.17 to -0.54 ± 0.81, p < 0.001; ACD from 0.367 ± 0.397 mm to 2.390 ± 0.575 mm, p < 0.001), and mean IOP decreased significantly (from 39.6 ± 10.6 mm Hg to 14.5 ± 4.1 mmHg, p < 0.001). No serious perioperative complications occurred, and only five eyes required topical glaucoma medications after surgery. Conclusion: Combined phacoemulsification-IOL implantation-posterior capsulorhexis-anterior vitrectomy surgery is a safe and effective method for treating patients with phakic malignant glaucoma. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

Effect of technique on intraocular pressure after combined cataract and glaucoma surgery: An evidence-based review.

TOPIC:

To analyze the literature pertaining to the techniques used in combined cataract and glaucoma surgery, including the technique of cataract extraction, the timing of the surgery (staged procedure versus combined procedure), the anatomic location of the operation, and the use of antifibrosis agents.

CLINICAL RELEVANCE:

Cataract and glaucoma are both common conditions and are often present in the same patient. There is no agreement concerning the optimal surgical management of these disorders when they coexist.

METHODS/LITERATURE REVIEWED:

Electronic searches of English language articles published since 1964 were conducted in Pub MED and CENTRAL, the Cochrane Collaboration's database. These were augmented by a hand search of six ophthalmology journals and the reference lists of a sample of studies included in the literature review. Evidence grades (A, strong; B, moderate; C, weak; I, insufficient) were assigned to the evidence that involved a direct comparison of alternative techniques.

RESULTS:

The preponderance of evidence from the literature suggests a small (2-4 mmHg) benefit from the use of mitomycin-C (MMC), but not 5-fluorouracil (5-FU), in combined cataract and glaucoma surgery (evidence grade B). Two-site surgery provides slightly lower (1-3 mmHg) intraocular pressure (IOP) than one-site surgery (evidence grade C), and IOP is lowered more (1-3 mmHg) by phacoemulsification than by nuclear expression in combined procedures (evidence grade C). There is insufficient evidence to conclude either that staged or combined procedures give better results or that alternative glaucoma procedures are superior to trabeculectomy in combined procedures.

CONCLUSIONS:

In the literature on surgical techniques and adjuvants used in the management of coexisting cataract and glaucoma, the strongest evidence of efficacy exists for using MMC, separating the incisions for cataract and glaucoma surgery, and removing the nucleus by phacoemulsification.

A randomized controlled trial on the effects of combined aerobic-resistance exercise on muscle strength and fatigue, glycemic control and health-related quality of life of type 2 diabetes patients

Aim: to evaluate the effects of a 12-weeks combined aerobic-resistance exercise therapy on fatigue and isokinetic muscle strength, glycemic control and health-related quality of life (HRQoL) in moderately affected type 2 diabetes (T2DM) patients. Methods: a randomized controlled trial design was employed. Forty-three T2DM patients were assigned to an exercise group (n = 22), performing 3 weekly sessions of 60 minutes of combined aerobic-resistance exercise for 12-weeks; or a no exercise control group (n = 21). Both groups were evaluated at a baseline and after 12-weeks of exercise therapy for: 1) muscle strength and fatigue by isokinetic dynamometry; 2) plasma glycated hemoglobin A1C (HbA1C); and 3) HRQoL utilizing the SF-36 questionnaire. Results: the exercise therapy led to improvements in muscle fatigue in knee extensors (-55%) and increased muscle strength in knee flexors and extensors (+15 to +30%), while HbA1C decreased (-18%). In addition, the exercising patients showed sizeable improvements in HRQoL: physical function (+53%), vitality (+21%) and mental health (+40%). Conclusion: 12-weeks of combined aerobic-resistance exercise was highly effective to improve muscle strength and fatigue, glycemic control and several aspects of HRQoL in T2DM patients. These data encourage the use of aerobic and resistance exercise in the good clinical care of T2DM.

Assessing the combined effect of land management and wildfire on runoff and soil erosion in north central Portugal

Strong and sometimes extreme responses in runoff and soil erosion following wildfires have been reported worldwide. However, in the case of North-Central Portugal, little research had been carried out regarding the hydrologic and erosive impacts of several land management activities in recently burnt areas (such as ground preparation, post-fire logging or post-fire mitigation treatments). This study aims to assess post-fire runoff and soil erosion response on Eucalypt and Maritime pine plantations during the first, second and third years following wildfires. The effect of several pre-fire ground preparation operations (ploughed down-slope, contour ploughed and inclined terraces), post-fire logging activities (on both the eucalypt and pine plantations), as well as the application of hydromulch (a post-fire emergency treatment) on overland flow and soil erosion were compared to burnt but undisturbed and untreated areas. The intensive monitoring of runoff, soil erosion and selected soil properties served to determine the main factors involved in post-fire runoff and soil erosion and their spatial and temporal variation. Soil water repellency deserved special attention, due to its supposed important role for overland flow generation. Repeated rainfall simulation experiments (RSE’s), micro-scale runoff plots and bounded sediment fences were carried out and/or installed immediately after the wildfire on seven burnt slopes. Micro-scale runoff plots results under natural rainfall conditions were also compared to the RSE’s results, which was useful for assessing the representativeness of the data obtained with artificial rainfall. The results showed comparable runoff coefficient (20-60%) but lower sediment losses (125-1000 g m-2) than prior studies in Portugal, but especially outside Portugal. Lower sediment losses were related with the historic intensive land use in the area. In evaluating these losses, however, the shallowness and stoniness of the soils, as well as the high organic matter fraction of the eroded sediments (50%) must not be overlooked. Sediment limited erosion was measured in all the ploughed sites, probably due to the time since ploughing (several years). The disturbance of the soil surface cover due to post-fire logging and wood extraction substantially increased sediment losses at both the pine and eucalypt sites. Hydromulch effectiveness in reducing the runoff (70%) and sediment losses (83%) was attributed to the protective high coverage provided by hydromulch. The hydromulch significantly affected the soil cover and other soil properties and these changes also reduced the soil erosion risk. The rainfall amount was the main factor explaining the variance in runoff. However, a shift from rainfall amount to rainfall intensity was detected when either the surface cover or the infiltration capacity (hydrophilic conditions) increased. Sediment losses were controlled by rainfall intensity and surface cover. The role of soil water repellency on runoff generation was not consistent; the overall repellency levels alone were not enough to assess its hydrological impact. Soil water repellency explained runoff generation in the specific-sites model better than in the overall model. Additionally, soil moisture content was a better predictor for soil water repellency than antecedent rainfall. The natural rainfall results confirmed that RSE’s were able to capture the specific sediment losses and its organic matter content as well as the differences between the ploughed and unploughed sites. Repeated RSE’s also captured the seasonal variations in runoff and sediment losses attributed to soil water repellency. These results have implications for post-fire soil erosion modelling and soil conservation practices in the region, or areas with the same land use, climate and soil characteristics. The measured sediment loss, as well as the increasing frequency of ploughing in recently burnt and unburnt eucalypt stands, suggests ploughing is not an effective as a soil conservation measure. Logging activities with less impact are recommended in order to maintain the forest litter protecting the soil surface. Due to its high effectiveness in reducing runoff and soil erosion, hydromulch is recommended for highly sensitive and vulnerable areas.

Combined effects of chemical and natural stressors to soil organisms and plants

Nas últimas décadas, a Terra tem experimentado um aquecimento global e mudanças nos padrões de precipitação. Muitos estudos sobre a avaliação de risco de agrotóxicos em organismos não-alvo foram realizados com base em protocolos padronizados, com condições abióticas controladas. Mas, em campo, os organismos são expostos a flutuações de vários fatores ambientais, bem como a poluentes, que podem alterar os limites de tolerância dos organismos aos stressores naturais, bem como alterar a toxicidade ou biodisponibilidade do químico em causa. Considerando isso, o principal objetivo deste trabalho foi o de avaliar de que modo e em que medida os fatores ambientais (temperatura, humidade do solo e radiação UV) podem interagir uns com os outros ou afetar a toxicidade do carbaril para invertebrados do solo e plantas. Para isso, foram utilizadas quatro espécies padrão: Folsomia candida, Eisenia andrei, Triticum aestivum e Brassica rapa, e simulados diferentes cenários climáticos, com vários parâmetros letais e subletais analisados. A exposição combinada foi analisada utilizando, quando possível, a ferramenta MIXTOX, com base no modelo de referência de acção independente (IA) e possíveis desvios, assim como rácios sinergísticos/antagonísticos (a partir de valores de EC50/LC50), quando a dose-resposta de um dos stressores não foi obtida. Todos os fatores de stress aplicados isoladamente causaram efeitos significativos sobre as espécies testadas e sua exposição combinada com carbaril, apresentaram respostas diferenciadas: para as minhocas, a seca e temperaturas elevadas aumentaram os efeitos deletérios do carbaril (sinergismo), enquanto o alagamento e temperaturas baixas diminuíram sua toxicidade (antagonismo). Para os colêmbolos, o modelo IA mostrou ser uma boa ferramenta para prever a toxicidade do carbaril tanto para temperaturas altas como para as baixas. Para as duas espécies de plantas foram encontradas diferenças significativas entre elas: em termos gerais, as interações entre carbaril e os stressores naturais foram observadas, com sinergismo aparecendo como o padrão principal relacionado com a radiação UV, solos secos e temperaturas elevadas, enquanto o padrão principal relacionado com temperaturas baixas e stress de alagamento foi o antagonismo. Quando os efeitos de dois stressores naturais (radiação UV e humidade do solo) em plantas foram avaliados, uma interação significativa foi encontrada: a seca aliviou o efeito deletério da radiação UV em T. aestivum e o alagamento aumentou os seus efeitos, mas para B. rapa a adição de ambos os stresses de água causou um aumento (sinergismo) dos efeitos deletérios da radiação UV para todos os parâmetros avaliados. Portanto é necessário que as diferenças sazonais e latitudinais, bem como as mudanças climáticas globais, sejam integradas na avaliação de risco de contaminantes do solo.

A new combined joules supercritical rankine cycle exergetic analysis and optimization

The application of a supercritical Rankine cycle in combined cycles does not happen in today’s thermoelectric power stations. Nevertheless, the most recent development in gas turbines, that allows a high efficiency and high exhaust gases temperatures, and the improvement of high pressure and temperature alloys, makes this cycle possible. This study’s intent is to prove the viability of this combined cycle, since it can break the 60% efficiency barrier, which is the plafond in actual power stations. To attain this target, several configurations for this cycle have been simulated, optimized and analyzed [1]. The simulations were done with the computational program IPSEpro [2] and the optimizations were effectuated with software developed for the effect, using the DFP method [3]. In parallel with the optimization that claims the cycle’s efficiency maximization, an exergetic analysis was also made [4] to all the cycle components. In opposite to what happens in subcritical combined cycles, it was demonstrated that in supercritical combined cycles the higher efficiency takes place with a single steam pressure in the heat recovery steam generator (HRSG).

Combined disaggregation of agricultural land uses, livestock numbers and crops' production: an entropy approach

This paper presents several combined agricultural data disaggregation models in order to recover the farms' land uses, the livestock numbers and main crops' productions. The proposed approach estimates incomplete information at disaggregated level through entropy, using an information prior, and generating information for a combined calculation use of data in the estimation of other variables. The models were applied to the region of Algarve, to some rural pilot areas (Salir-Ameixial-Cachopo and Alcoutim) for livestock data, since this data in some Algarve's inland areas is needed for a European forest fire prevention project, and to the agrarian zones in a more complex framework. The results are promising. They were validated, in cross reference to real data, having proven to be valid and reliable. The total error was small and a considerable level of information heterogeneity was recovered. The total error was about 27,9% for the counties' land uses and 21% for the agrarian zones, and for the livestock it was also acceptable. The level of heterogeneity recovered was always higher than 50%, revealing some improvements regarding previous studies.

Forecasting Methodologies for Ganoderma Spore Concentration Using Combined Statistical Approaches and Model Evaluations

High concentration levels of Ganoderma spp. spores were observed in Worcester, UK, during 2006–2010.These basidiospores are known to cause sensitization due to the allergen content and their small dimensions. This enables them to penetrate the lower part of the respiratory tract in humans. Establishment of a link between occurring symptoms of sensitization to Ganoderma spp. and other basidiospores is challenging due to lack of information regarding spore concentration in the air. Hence, aerobiological monitoring should be conducted, and if possible extended with the construction of forecast models. Daily mean concentration of allergenic Ganoderma spp. spores in the atmosphere of Worcester was measured using 7-day volumetric spore sampler through five consecutive years. The relationships between the presence of spores in the air and the weather parameters were examined. Forecast models were constructed for Ganoderma spp. spores using advanced statistical techniques, i.e. multivariate regression trees and artificial neural networks. Dew point temperature along with maximumtemperature was the most important factor influencing the presence of spores in the air of Worcester. Based on these two major factors and several others of lesser importance, thresholds for certain levels of fungal spore concentration, i.e. low (0–49 s m−3), moderate(50–99 s m−3), high (100–149 s m−3) and very high (150

Characterization of metabolites of sweroside in rat urine using ultra-high-performance liquid chromatography combined with electrospray ionization quadrupole time-of-flight tandem mass spectrometry and NMR spectroscopy

Sweroside, a major active iridoid in Swertia pseudochinensis Hara, is recognized as an effective agent in the treatment of liver injury. Based on previous reports, the relatively short half-life (64 min) and poor bioavailability (approximately 0.31%) in rats suggested that not only sweroside itself but also its metabolites could be responsible for the observed hepato-protective effect. However, few studies have been carried out on the metabolism of sweroside. Therefore, the present study aimed at identifying the metabolites of sweroside in rat urine after a single oral dose (100 mg/kg). With ultra-high-performance liquid chromatography coupled with electrospray ionization quadrupole time-of-flight tandem mass spectrometry (UHPLC/Q-TOF-MS), the metabolic profile revealed 11 metabolites in rat urine, including phase I, phase II and aglycone-related products. The chemical structures of metabolites were proposed based on accurate mass measurements of protonated or deprotonated molecules and their fragmentation patterns. Our findings showed that the aglycone of sweroside (M05) and its glucuronide conjugate (M06) were principal circulating metabolites in rats. While several other metabolic transformations, occurring via reduction, N-heterocyclization and N-acetylation after deglycosylation, were also observed. Two metabolites (M05 and M06) were isolated from the rat urine for structural elucidation and identifcation of reaction sites. Both M05 and M06 were characterized by 1H, 13C and two-dimensional nuclear magnetic resonance (NMR) spectroscopy. UHPLC/Q-TOF-MS analysis has provided an important analytical platform to gather metabolic profile of sweroside.

Combined heat and power and consumption optimization in a SCADA-based system

The operation of power systems in a Smart Grid (SG) context brings new opportunities to consumers as active players, in order to fully reach the SG advantages. In this context, concepts as smart homes or smart buildings are promising approaches to perform the optimization of the consumption, while reducing the electricity costs. This paper proposes an intelligent methodology to support the consumption optimization of an industrial consumer, which has a Combined Heat and Power (CHP) facility. A SCADA (Supervisory Control and Data Acquisition) system developed by the authors is used to support the implementation of the proposed methodology. An optimization algorithm implemented in the system in order to perform the determination of the optimal consumption and CHP levels in each instant, according to the Demand Response (DR) opportunities. The paper includes a case study with several scenarios of consumption and heat demand in the context of a DR event which specifies a maximum demand level for the consumer.

Data Processing at the Flaw Detector with Combined Multisector Eddy-Current Transducer

There is described data processing at the flaw detector with combined multisectional eddy-current transducer and heterofrequency magnetic field. The application of this method for detecting flaws in rods and pipes under the conditions of significant transverse displacements is described.