Spectral-domain optical coherence tomography use in macular diseases: a review

The introduction of spectral-domain optical coherence tomography (SD-OCT) has improved the clinical value for assessment of the eyes with macular disease. This article reviews the advances of SD-OCT for the diagnostic of various macular diseases. These include vitreomacular traction syndrome, cystoid macular edema/diabetic macular edema, epiretinal membranes, full-thickness macular holes, lamellar holes, pseudoholes, microholes, and schisis from myopia. Besides offering new insights into the pathogenesis of macular abnormalities, SD-OCT is a valuable tool for monitoring macular disease.

Macular edema: Miscellaneous

Abstract. This article provides the reader with practical information to be applied to the various remaining causes of macular edema. Some macular edemas linked to ocular diseases like radiotherapy after ocular melanomas remained of poor functional prognosis due to the primary disease. On the contrary, macular edemas occurring after retinal detachment or after some systemic or local treatment use are often temporary. Macular edema associated with epiretinal membranes or vitreomacular traction is the main cause of poor functional recovery. However, the delay to observe a significant improvement of vision after surgery should be long, as usually observed in tractional myopic vitreoschisis. Finally, some circumstances of macular edemas such as hemangiomas or macroaneurysms should be treated, if symptomatic, with the treatments currently used in diabetic macular edema or exudative macular degeneration.

Macular edema. Miscellaneous

This chapter provides the reader with practical information to be applied to the various remaining causes of macular edema. Some clinical cases of macular edema linked to ocular diseases like postradiotherapy for ocular melanomas remained of poor functional prognosis due to the primary disease. On the contrary, macular edema occurring after retinal detachment or after diverse systemic or local treatment use is often temporary. Macular edema associated with epiretinal membranes or vitreomacular traction is the main cause of poor functional recovery. In other cases, as in tractional myopic vitreoschisis, the delay to observe a significant improvement of the vision after surgery should be long. Finally, macular edema associated with hemangiomas or macroaneurysms should be treated, if symptomatic, using the same current treatment as in diabetic macular edema or exudative macular degeneration.

Investigation of the Design of a Bistable Micro-Chemical-Mechanical Device Utilizing Lateral Buckling

The Gracias Laboratory at Johns Hopkins University has developed microgrippers which utilize chemically-actuated joints to be used in micro-surgery. These grippers, however, take up to thirty minutes to close fully when activated biochemicals in the human body. This is very problematic and could limit the use of the devices in surgery. It is the goal of this research to develop a gripper that uses theGracias Laboratory's existing joints in conjunction with mechanical components to decrease the closing time. The purpose of including the mechanical components is to induce a state of instability at which time a small perturbation would cause the joint to close fully.The main concept of the research was to use the lateral buckling of a triangular gripper geometry and use a toggle mechanism to decrease the closure time of the device. This would create a snap-action device mimicking the quick closure of a Venus flytrap. All developed geometries were tested using finite element analysis to determine ifloading conditions produced the desired buckled shape. This research examines lateral buckling on the micro-scale and the possibility ofusing this phenomenon in a micro-gripper. Although a final geometry with the required deformed shaped was not found, this document contains suggestions for future geometries that may produce the correct deformed shape. It was determined through this work that in order to obtain the desired deformed shape, polymeric sections need to be added to the geometry. This simplifies the analysis and allows the triangular structure to buckle in the appropriate way due to the added joints. Future work for this project will be completed by undergraduate students at Bucknell University. Fabrication and testing of devices will be done at Johns Hopkins University in the Gracias Laboratory.

Oral misoprostol for third stage of labor: a randomized placebo-controlled trial

OBJECTIVE: To investigate whether orally administered misoprostol during the third stage of labor is efficient in reducing postpartum blood loss. METHODS: In a double-masked trial, during vaginal delivery women were randomly assigned to receive a single oral dose of misoprostol (600 microg) or placebo in third stage of labor, immediately after cord clamping. The third stage of labor was managed routinely by early cord clamping and controlled cord traction; oxytocin was administered only if blood loss seemed more than usual. Blood loss was estimated by the delivering physician and differences in hematocrit were measured before and after delivery. RESULTS: Mean (+/- standard error of the mean) estimated blood loss (345 +/- 19.5 mL versus 417 +/- 25.9 mL, P = .031) and hematocrit difference (4.5 +/- 0.9% versus 7.9 +/- 1.2%, P = .014) were significantly lower in women who received misoprostol than those who received placebo. Fewer women in the misoprostol group had postpartum hemorrhage (blood loss of at least 500 mL), but that difference was not statistically significant (7% versus 15%, P = .43). Additional oxytocin before or after placental separation was used less often in the misoprostol group (16% versus 38%, P = .047). There were no differences in the length of third stage of labor (8 +/- 0.9 minutes versus 9 +/- 1 minutes, P = .947). There were no differences in pain during third stage of labor, postpartum fever, or diarrhea, but shivering was more frequent in the misoprostol group. CONCLUSION: Oral misoprostol administered in the third stage of labor reduced postpartum blood loss and might be effective in reducing incidence of postpartum hemorrhage.

Adipogenic and myogenic gene expression in rotator cuff muscle of the sheep after tendon tear

Chronic rotator cuff tendon tears lead to fatty infiltration and muscle atrophy with impaired physiological functions of the affected muscles. However, the cellular and molecular mechanisms of corresponding pathophysiological processes remain unknown. The purpose of this study was to characterize the expression pattern of adipogenic (PPARgamma, C/EBPbeta) and myogenic (myostatin, myogenin, Myf-5) transcription factors in infraspinatus muscle of sheep after tenotomy, implantation of a tension device, refixation of the tendon, and rehabilitation, reflecting a model of chronic rotator cuff tears. In contrast to human patients, the presented sheep model allows a temporal evaluation of the expression of a given marker in the same individual over time. Semiquantitative RT/PCR analysis of PPARgammaã, myostatin, myogenin, Myf-5, and C/EBPbeta transcript levels was carried out with sheep muscle biopsy-derived total RNA. We found a significantly increased expression of Myf-5 and PPARgamma after tenotomy and a significant change for Myf-5 and C/EBPbeta after continuous traction and refixation. This experimental sheep model allows the molecular analysis of pathomechanisms of muscular changes after rotator cuff tear. The results point to a crucial role of the transcription factors PPARgamma, C/EBPbeta, and Myf-5 in impairment and regeneration of rotator cuff muscles after tendon tears in sheep.

Verfahren und Anlage zum automatisierten Kommissionieren von in Beuteln verpackten Gütern

Automatisiertes Kommissionieren von biegeschlaffen Teilen stellt seit jeher ein besonderes Problem für die Handhabungstechnik dar, und es sind bisher verschiedenartigste sondermaschinenbauliche Lösungen hervorgebracht worden. Auch für das Kommissionieren von in Folien verpackten Artikeln gibt es einige L��sungen. Diese sind aber hinsichtlich ihrer Anwendung für in Beuteln verpackte Güter eingeschränkt. Ein neuartiges, am Fraunhofer-IML entwickeltes Verfahren verspricht Abhilfe. Der folgende Beitrag stellt dieses Verfahren im Detail vor und zeigt vergangene und zukünftige Untersuchungsfelder auf, die im Rahmen der Entwicklung bearbeitet wurden bzw. werden und sich insbesondere mit der Dimensionierung der Gerätschaften und Hilfsmittel beschäftigen.

Entwicklung textiler Maschinenelemente für den Einsatz in Windkraftanlagen und Seilwinden

Es sollen hochfeste, gewichtreduzierte Zug- und Tragmittel aus hochmodularen (HM) und hochfesten (HT) Fasern validiert und dabei sowohl runde als auch flache, riemenartige Strukturen untersucht werden. Dadurch sind effizientere Fördersysteme und die Überwindung technischer Grenzen möglich. Darüber hinaus soll das Hauptkriterium für ein breites Anwendungsspektrum geschaffen werden: ein anerkanntes, zerstörungsfreies Prüfverfahren, mit dem der Austausch- bzw. Wartungszeitpunkt des textilen Tragmittels bestimmt werden kann. Können die o. g. Punkte erfolgreich bearbeitet werden, erfolgt eine Ausdehnung der textilen Strukturen in den Bereich kraftübertragender Maschinenelemente. Anhand von Feldversuchen in fördertechnischen Anlagen im Bergbau/ Intralogistik soll erstmals der vollständige Nachweis geführt werden, dass derartige textile Strukturen in technischen Anwendungen eingesetzt werden können. Der Nachweis umfasst die Validierung einer Vielzahl von Einzelschwerpunkten wie die Entwicklung einer Endlos-Herstellungstechnologie bzw. Endverbindung, die Tragmitteldimensionierung, die Erbringung von Festigkeitsnachweisen, die Erarbeitung von Vorschriften und die Erprobung der Verfahren zur Zustandsüberwachung.

Generierung von Konstruktionsmerkmalen zur Entwicklung eines bio-inspirierten Kommissionier- Greifers für die Intralogistik mittels Clusteranalyse

Kurzbeschreibung: In der Automatisierung von intralogistischen Kommissioniervorgängen ist ein großes Zukunftspotential erkennbar. Elementarer Bestandteil des Automatisierungsprozesses ist der Einsatz von Industrierobotern, die mit einem geeigneten Endeffektor, dem Greifer, ausgestattet werden müssen. Die Robotik ist in der Lage schneller, präziser und ausdauernder als die menschlichen Kommissionierer zu arbeiten und trägt damit entscheidend zur Effizienzsteigerung bei. Eine wesentliche Herausforderung für diesen Entwicklungsschritt zur Substitution der manuellen Kommissionierung ist die Konstruktion und Bereitstellung eines geeigneten Greifsystems. Am Lehrstuhl für Maschinenelemente und Technische Logistik der Helmut-Schmidt-Universität wurde mit der Erfahrung aus einem vorangegangenen Forschungsprojekt die Methode der Clusteranalyse erstmalig zur Untersuchung von Greifobjekten zur Entwicklung eines bionischen Universalgreifers für die Kommissionierung von Drogerieartikeln verwendet. Diese Abhandlung beschreibt einen Beitrag zur Entwicklung dieses Greifers am Beispiel handelsüblicher Drogerieartikel, die aktuell manuell kommissioniert werden. Diese werden hinsichtlich der für das Greifen relevanten Objektmerkmale geclustert und die daraus resultierenden Erkenntnisse in Form von Konstruktionsmerkmalen abgeleitet. Nach einer Analyse und Festlegung der greifrelevanten Merkmale der Greifobjekte wird eine Objektdatenbasis erstellt. Mit Hilfe geeigneter Methoden wird die gewonnene Datenbasis aufbereitet und reduziert. Im Anschluss werden die Greifobjekte bzw. deren Merkmalsausprägungen einer hierarchischen Clusteranalyse unterzogen. Hierbei werden die Grenzen der gebildeten Cluster mittels der zugehörigen Greifobjekte festgelegt und analysiert. Abschließend werden bestimmte greiferspezifische Merkmale auf die Anwendbarkeit in den Clustern überprüft und bewertet. Diese Betrachtungen ermöglichen es, dass spezielle Anforderungen an den Greifer, die direkt aus den Eigenschaften der Greifobjekte herrühren, zuverlässig erkannt und konstruktiv berücksichtigt werden können.

Neue Generation von Aufzügen mit Faserseil

Energieeffiziente und leistungsfähige Zug- und Tragmittel aus hochmoduligen (HM) und hochfesten (HT) Fasern rücken seit einigen Jahren in den Fokus von Aufzugherstellern und Betreibern. Hauptgrund dafür ist, das die bisher eingesetzten Stahldrahtseile auf Grund ihrer vergleichsweise hohen Eigenmasse an technische Grenzen stoßen. Seile aus hochfesten Polymerfasern haben gegenüber Stahldrahtseilen eine vergleichbare oder sogar höhere Zugfestigkeit und ein vier- bis sechsfach geringeres Gewicht. Um das Potential dieser Fasern optimal auszunutzen, sind sowohl die Anordnung der Fasern als auch die Schmierstoffeinbringung zu untersuchen. Diesbezüglich wurden verschiedenen Seilkonstruktions- und Schmierstoffvarianten entwickelt und im Dauerbiegeversuch validiert.

Konstruktive Gestaltung eines bioinspirierten Kommissionier-Greifers für intralogistische Handhabungsaufgaben

In diesem Beitrag wird ein neuartiger biologisch inspirierter Universalgreifer beschrieben. Dieser soll in einem automatisierten Kommissionier-Szenario selbstständig Waren aus Kisten greifen, anheben und an anderer Stelle ablegen um somit das manuelle Kommissionieren von Hand zu substituieren. Auf dem Weg zu einer ausgereiften Konstruktion werden zahlreiche Fragestellungen zur Gestaltung und Anordnung der Finger und deren Antrieb gelöst. Ein für diesen Anwendungsfall entwickelter Biegeaktor wird zur Krümmung der Finger eingesetzt und bietet als Alleinstellungsmerkmal ein nahezu verschleißfreies Gelenk bei einem sehr einfachen konstruktiven Aufbau.

Operative treatment of congenital hip osteoarthritis with high hip luxation (Crowe type IV)

OBJECTIVE The aim of the therapy is mechanical and functional stabilization of high dislocated hips with dysplasia coxarthrosis using total hip arthroplasty (THA). INDICATIONS Developmental dysplasia of the hip (DDH) in adults, symptomatic dysplasia coxarthrosis, high hip dislocation according to Crowe type III/IV, and symptomatic leg length inequality. CONTRAINDICATIONS Cerebrospinal dysfunction, muscular dystrophy, apparent disturbance of bone metabolism, acute or chronic infections, and immunocompromised patients. SURGICAL TECHNIQUE With the patient in a lateral decubitus position an incision is made between the anterior border of the gluteus maximus muscle and the posterior border of the gluteus medius muscle (Gibson interval). Identification of the sciatic nerve to protect the nerve from traction disorders by visual control. After performing trochanter flip osteotomy, preparation of the true actetabulum if possible. Implantation of the reinforcement ring, preparation of the femur and if necessary for mobilization, resection until the trochanter minor. Test repositioning under control of the sciatic nerve. Finally, refixation of the trochanteric crest. POSTOPERATIVE MANAGEMENT During hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with maximum flexion of 70°. No active abduction and passive adduction over the body midline. Maximum weight bearing 10-15 kg for 8 weeks, subsequently, first clinical and radiographic follow-up and deep venous thrombosis prophylaxis until full weight bearing. RESULTS From 1995 to 2012, 28 THAs of a Crow type IV high hip-dislocation were performed in our institute. Until now 14 patients have been analyzed during a follow-up of 8 years in 2012. Mid-term results showed an improvement of the postoperative clinical score (Merle d'Aubigné score) in 86 % of patients. Good to excellent results were obtained in 79 % of cases. Long-term results are not yet available. In one case an iatrogenic neuropraxia of the sciatic nerve was observed and after trauma a redislocation of the arthroplasty appeared in another case. In 2 cases an infection of the THA appeared 8 and 15 months after index surgery. No pseudoarthrosis of the trochanter or aseptic loosening was noticed.

Vitreoretinal Interface Changes in Geographic Atrophy.

PURPOSE Geographic atrophy (GA) is the end-stage manifestation of atrophic age-related macular degeneration (AMD). The disease progresses slowly over time, eventually causing loss of central vision. Its cause and pathomechanism are not fully known. Previous studies have suggested that vitreoretinal traction (VRT) may contribute to the progression of neovascular AMD. The aim of this study was to examine whether an association between changes at the vitreoretinal interface (VRI), in particular traction (VRT), and the characteristics and progression of GA in eyes with dry AMD can be established. DESIGN Clinic-based prospective cohort study. PARTICIPANTS A total of 97 patients (age range, 61-90 years; mean, 78.4 years) with GA secondary to dry AMD were enrolled. Patients exhibiting neovascular signs on fluorescein angiography in either eye were excluded. METHODS The VRI changes were examined using spectral-domain optical coherence tomography (SD-OCT). Characteristics of GA were examined using fundus autofluorescence (FAF) imaging. All imaging was performed using a Spectralis SLO+OCT device (Heidelberg Engineering, Heidelberg, Germany); GA area was measured using the Region Finder (Heidelberg Engineering) software native to the Spectralis platform. MAIN OUTCOME MEASURES Area and increase in area of GA. RESULTS A total of 97 eyes were examined. Vitreoretinal traction was found in 39 eyes (40%). The GA area at baseline was 6.65±5.64 mm(2) in eyes with VRT and 5.73±4.72 mm(2) in eyes with no VRT. The annual rate of progression of GA area progression was 2.99±0.66 mm(2) in eyes with VRT and 1.45±0.67mm(2) in eyes without VRT. Differences between groups in both parameters were statistically significant (n = 97 total number of eyes; P<0.001). Multiple regression analysis confirmed this finding (B = 0.714, P<0.001; F3,93 = 72.542, P<0.001; adjusted R(2) = 0.691) CONCLUSIONS: Our results indicate an association between VRT and an increased rate of progression of GA area in dry AMD. Monitoring VRT may contribute to an improved estimate of the prospective time of visual loss and to a better timing of emerging therapies in dry AMD.

Cell force measurements in 3D microfabricated environments based on compliant cantilevers.

We report the fabrication, functionalization and testing of microdevices for cell culture and cell traction force measurements in three-dimensions (3D). The devices are composed of bent cantilevers patterned with cell-adhesive spots not lying on the same plane, and thus suspending cells in 3D. The cantilevers are soft enough to undergo micrometric deflections when cells pull on them, allowing cell forces to be measured by means of optical microscopy. Since individual cantilevers are mechanically independent of each other, cell traction forces are determined directly from cantilever deflections. This proves the potential of these new devices as a tool for the quantification of cell mechanics in a system with well-defined 3D geometry and mechanical properties.

X-ray image calibration and its application to clinical orthopedics.

X-ray imaging is one of the most commonly used medical imaging modality. Albeit X-ray radiographs provide important clinical information for diagnosis, planning and post-operative follow-up, the challenging interpretation due to its 2D projection characteristics and the unknown magnification factor constrain the full benefit of X-ray imaging. In order to overcome these drawbacks, we proposed here an easy-to-use X-ray calibration object and developed an optimization method to robustly find correspondences between the 3D fiducials of the calibration object and their 2D projections. In this work we present all the details of this outlined concept. Moreover, we demonstrate the potential of using such a method to precisely extract information from calibrated X-ray radiographs for two different orthopedic applications: post-operative acetabular cup implant orientation measurement and 3D vertebral body displacement measurement during preoperative traction tests. In the first application, we have achieved a clinically acceptable accuracy of below 1° for both anteversion and inclination angles, where in the second application an average displacement of 8.06±3.71 mm was measured. The results of both applications indicate the importance of using X-ray calibration in the clinical routine.