The effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle-closure glaucoma (EAGLE): Study protocol for a randomized controlled trial

<p>BACKGROUND: Glaucoma is the leading cause of irreversible blindness. Although primary open-angle glaucoma is more common, primary angle-closure glaucoma (PACG) is more likely to result in irreversible blindness. By 2020, 5·3 million people worldwide will be blind because of PACG. The current standard care for PACG is a stepped approach of a combination of laser iridotomy surgery (to open the drainage angle) and medical treatment (to reduce intraocular pressure). If these treatments fail, glaucoma surgery (eg, trabeculectomy) is indicated. It has been proposed that, because the lens of the eye plays a major role in the mechanisms leading to PACG, early clear lens extraction will improve glaucoma control by opening the drainage angle. This procedure might reduce the need for drugs and glaucoma surgery, maintain good visual acuity, and improve quality of life compared with standard care.EAGLE aims to evaluate whether early lens extraction improves patient-reported, clinical outcomes, and cost-effectiveness, compared with standard care.p><p>METHODS/DESIGN: EAGLE is a multicentre pragmatic randomized trial. All people presenting to the recruitment centres in the UK and east Asia with newly diagnosed PACG and who are at least 50 years old are eligible.The primary outcomes are EQ-5D, intraocular pressure, and incremental cost per quality adjusted life year (QALY) gained. Other outcomes are: vision and glaucoma-specific patient-reported outcomes, visual acuity, visual field, angle closure, number of medications, additional surgery (e.g., trabeculectomy), costs to the health services and patients, and adverse events.A single main analysis will be done at the end of the trial, after three years of follow-up. The analysis will be based on all participants as randomized (intention to treat). 400 participants (200 in each group) will be recruited, to have 90% power at 5% significance level to detect a difference in EQ-5D score between the two groups of 0·05, and a mean difference in intraocular pressure of 1·75 mm Hg. The study will have 80% power to detect a difference of 15% in the glaucoma surgery rate.p><p>TRIAL REGISTRATION: ISRCTN44464607.p>

Arsenic uptake and speciation in the rootless duckweed Wolffia globosa

<p>Duckweeds are a common macrophyte in paddy and aquatic environments. Here, we investigated arsenic (As) accumulation, speciation and tolerance of the rootless duckweed Wolffia globosa and its potential for As phytofiltration.p><p>When grown with 1 mu M arsenate, W. globosa accumulated two to 10 times more As than four other duckweed or Azolla species tested. W. globosa was able to accumulate > 1000 mg As kg(-1) in frond dry weight (DW), and tolerate up to 400 mg As kg-1 DW. At the low concentration range, uptake rate was similar for arsenate and arsenite, but at the high concentration range, arsenite was taken up at a faster rate.p><p>Arsenite was the predominant As species (c. 90% of the total extractable As) in both arsenate-and arsenite-exposed duckweed. W. globosa was more resistant to external arsenate than arsenite, but showed a similar degree of tolerance internally. W. globosa decreased arsenate in solution rapidly, but also effluxed arsenite.p><p>Wolffia globosa is a strong As accumulator and an interesting model plant to study As uptake and metabolism because of the lack of a root-to-frond translocationp>

A current-driven instability in parallel, relativistic shocks

<p>Recently, Bell ( 2004 Mon. Not. R. Astron. Soc. 353 550) has reanalysed the problem of wave excitation by cosmic rays propagating in the pre-cursor region of a supernova remnant shock front. He pointed out a strong, non-resonant, current-driven instability that had been overlooked in the kinetic treatments by Achterberg ( 1983 Astron. Astrophys. 119 274) and McKenzie and Volk ( 1982 Astron. Astrophys. 116 191), and suggested that it is responsible for substantial amplification of the ambient magnetic field. Magnetic field amplification is also an important issue in the problem of the formation and structure of relativistic shock fronts, particularly in relation to models of gamma-ray bursts. We have therefore generalized the linear analysis to apply to this case, assuming a relativistic background plasma and a monoenergetic, unidirectional incoming proton beam. We find essentially the same non-resonant instability observed by Bell and show that also, under GRB conditions, it grows much faster than the resonant waves. We quantify the extent to which thermal effects in the background plasma limit the maximum growth rate.p>

Fetal Umbilical Artery Doppler Pulsatility Index as a Predictor of Cardiovascular Risk Factors in Children - A Long-Term Follow Up Study

Abstract Objective To determine if high umbilical artery Doppler (UAD) pulsatility index (PI) is associated with cardio-vascular (CV) risk-factors in children at age 12 years. Methods We studied 195 children at age 12 years who had had in-utero UAD studies performed at 28 weeks gestation. The children were grouped according to whether their umbilical Doppler PI was high (indicating poor feto-placental circulation) or normal. At age 12 years we assessed CV risk factors, including anthropometric measures, blood pressure, pulse wave velocity (a measure of arterial compliance), cardio-respiratory fitness and homocysteine and cholesterol serum levels. Results Compared with children with a normal UAD PI (N=88), the children (N=107) with high UAD PI had higher resting pulse rate (p=0.04), higher pulse wave velocity (p=0.046), higher serum homocysteine levels (p=0.032) and reduced arterial compliance (7.58 v 8.50 m/sec, p=0.029) using univariate analysis. These differences were not present when adjusting for cofounders was modelled. Conclusion High PI on UAD testing in-utero may be associated with increased likelihood of some cardio-vascular risk factors at age 12-years but confounding variables may be as important. Our study raises possible long-term benefits of in-utero UAD measurements.

Systolic two-port adaptor for high performance wave digital filtering

<p>The authors present a VLSI circuit for implementing wave digital filter (WDF) two-port adaptors. Considerable speedups over conventional designs have been obtained using fine grained pipelining. This has been achieved through the use of most significant bit (MSB) first carry-save arithmetic, which allows systems to be designed in which latency L is small and independent of either coefficient or input data wordlength. L is determined by the online delay associated with the computation required at each node in the circuit (in this case a multiply/add plus two separate additions). This in turn means that pipelining can be used to considerably enhance the sampling rate of a recursive digital filter. The level of pipelining which will offer enhancement is determined by L and is fine-grained rather than bit level. In the case of the circuit considered, L = 3. For this reason pipeline delays (half latches) have been introduced between every two rows of cells to produce a system with a once every cycle sample rate.p>

Deflagrations in hybrid CONe white dwarfs: a route to explain the faint Type Iax supernova 2008ha

<p>Stellar evolution models predict the existence of hybrid white dwarfs (WDs) with a carbon-oxygen core surrounded by an oxygen-neon mantle. Being born with masses similar to 1.1 M-aS (TM), hybrid WDs in a binary system may easily approach the Chandrasekhar mass (M-Ch) by accretion and give rise to a thermonuclear explosion. Here, we investigate an off-centre deflagration in a near-M-Ch hybrid WD under the assumption that nuclear burning only occurs in carbon-rich material. Performing hydrodynamics simulations of the explosion and detailed nucleosynthesis post-processing calculations, we find that only 0.014 M-aS (TM) of material is ejected while the remainder of the mass stays bound. The ejecta consist predominantly of iron-group elements, O, C, Si and S. We also calculate synthetic observables for our model and find reasonable agreement with the faint Type Iax SN 2008ha. This shows for the first time that deflagrations in near-M-Ch WDs can in principle explain the observed diversity of Type Iax supernovae. Leaving behind a near-M-Ch bound remnant opens the possibility for recurrent explosions or a subsequent accretion-induced collapse in faint Type Iax SNe, if further accretion episodes occur. From binary population synthesis calculations, we find the rate of hybrid WDs approaching M-Ch to be of the order of 1 per cent of the Galactic SN Ia rate.p>

Does altering brachial artery tone with lower-body negative pressure and flow-mediated dilation affect arterial stiffness?

Although medium sized, muscular vessels normally respond to sympathetic stimulation by reducing compliance, it is unclear whether the large brachial artery is similarly affected by sympathetic stimulation induced via lower-body negative pressure (LBNP). Similarly, the impact of flow-mediated dilation (FMD) on brachial artery compliance and distensibility remains unresolved, hi addition, before such measures can be used as prognostic tools, it is important to investigate the reliability and repeatability of both techniques. Using a randomized order design, the effects of LBNP and FMD on the mechanical properties of the brachial artery were examined in nine healthy male subjects (mean age 24y). Non-invasive Doppler ultrasound and a Finometer were used to measure simultaneously the variation in systolic and diastolic diameter, and brachial blood pressure, respectively. These values were used to calculate compliance and distensibility values at baseline, and during both LBNP and FMD. The within-day and between-day repeatability of arterial diameter, compliance, distensibility, and FMD measures were assessed using the error coefficient and intra-class correlation coefficient (ICC). While heart rate (P<0.01) and peripheral resistance increased during LBNP (P<0.05), forearm blood flow and pulse pressure decreased (P<0.01). hi terms of mechanical properties, vessel diameters decreased (P<0.05), but both compliance and distensibility were not changed. On the other hand, FMD resulted in a significant increase in diameter (P<0.001), with no change in compliance or distensibility. hi summary, LBNP and FMD do not appear to alter brachial artery compliance or distensibility in young, healthy males. Whereas measures ofFMD were not found to be repeatable between days, the ICC indicated that compliance and distensibility were repeatable only within-day.

The effects of thermal stress on glucoregulation during exercise in participants with Type 1 Diabetes Mellitus

Type 1 Diabetes Mellitus (T1DM) is an autoimmune disease that destroys pancreatic beta cells, affecting glucose homeostasis. In T1DM, glucoregulation and carbohydrate oxidation may be altered in different ambient temperatures; however, current literature has yet to explore these mechanisms. This study examines the effects of 30 minutes of exercise at 65% VO2max in 5ºC, 20ºC and 35ºC in individuals with T1DM. No significant differences were observed for blood glucose across the 3 conditions (p = 0.442), but significance was found for core temperature, heat storage, and sweat rate (p < 0.01). Blood glucose was also shown to vary greatly between individuals among conditions. The mechanisms behind the differences in blood glucose may be due to the lack of significant glucagon production among conditions. These findings suggest that T1DM individuals may exercise submaximally for 30 minutes in different ambient temperatures without significant differences in glucoregulation.

Comparaison des réponses physiologiques lors d’un exercice incrémental maximal sur vélo immergé et sur terrain sec : aspects biomécaniques, cardiopulmonaires et hémodynamiques.

L’exercice en immersion dans l'eau peut générer des réponses hémodynamiques et cardiorespiratoires différentes à celles de l’exercice sur terraine sec. Cependant, aucune étude n’a comparé ces réponses sur vélo aquatique (VA) à celles sur vélo sur terrain sec (VS) à une même puissance mécanique externe (Pext). À cet égard, le premier travail de cette thèse visait, d’abord, à trouver les équivalences de Pext lors du pédalage sur VA en immersion à la poitrine par rapport au VS au laboratoire, en considérant que cela restait non déterminé à ce jour. Une équation de mécanique des fluides fut utilisée pour calculer la force déployée pour le système de pédalage (pales, leviers, pédales) et des jambes à chaque tour de pédale. Ensuite, cette force totale a été multipliée par la vitesse de pédalage pour estimer la Pext sur VA. Ayant trouvé les équivalences de Pext sur VA et VS, nous nous sommes fixés comme objectif dans la deuxième étude de comparer les réponses hémodynamiques et cardiorespiratoires lors d'un exercice maximal progressif sur VS par rapport au VA à une même Pext. Les résultats ont montré que le VO2 (p<0.0001) et la différence artério-veineuse (C(a-v)O2) (p<0.0001) étaient diminués lors de l’exercice sur VA comparativement à celui sur VS. Parmi les variables hémodynamiques, le volume d’éjection systolique (VES) (p˂0.05) et le débit cardiaque (Qc) (p˂0.05) étaient plus élevés sur VA. En plus, on nota une diminution significative de la fréquence cardiaque (FC) (p˂0.05). Étant donné qu’à une même Pext les réponses physiologiques sont différentes sur VA par rapport à celles sur VS, nous avons effectué une troisième étude pour établir la relation entre les différentes expressions de l'intensité relative de l'exercice (% du VO2max,% de la FCmax,% du VO2 de réserve (% de VO2R) et % de la FC réserve (% FCR)). Les résultats ont démontré que la relation % FCR vs % VO2R était la plus corrélée (régression linéaire) et la plus proche de la ligne d’identité. Ces résultats pourraient aider à mieux prescrire et contrôler l’intensité de l'exercice sur VA pour des sujets sains. Finalement, une dernière étude comparant la réactivation parasympathique après un exercice maximal incrémental effectué sur VA et VS en immersion au niveau de la poitrine a montré que la réactivation parasympathique à court terme était plus prédominante sur VA (i,e. t, delta 10 à delta 60 et T30, p<0.05). Cela suggérait, qu’après un exercice maximal sur VA, la réactivation parasympathique à court terme était accélérée par rapport à celle après l'effort maximal sur VS chez de jeunes sujets sains. En conclusion, nous proposons une méthode de calcul de la puissance mécanique externe sur VA en fonction de la cadence de pédalage. Nous avons démontré que pendant l’exercice sur VA les réponses hémodynamiques et cardiorespiratoires sont différentes de celles sur VS à une même Pext et nous proposons des équations pour le calcul du VO2 dans l’eau ainsi qu’une méthode pour la prescription et le contrôle de l’exercice sur VA. Finalement, la réactivation parasympathique à court terme s’est trouvée accélérée après un effort maximal incrémental sur VA comparativement à celle sur VS.

Estudio de asociación entre genotipo de DAT1 y transtorno por déficit de atención / hiperactividad

Introducción: El TDAH tiene un componente genético importante; el gen de transportador de Dopamina (DAT1) se ha asociado con susceptibilidad al TDAH y con sus endofenotipos. El VNTR de 40pb en la región 3’UTR aumenta la expresión del DAT1. En Colombia no hay ningún estudio previo que indique evidencia de la asociación genética entre TDAH y el gen DAT1. Objetivo: Determinar asociación entre el VNTR del DAT1 y el fenotipo y/o endofenotipos del TDAH. Métodos: Se seleccionaron 73 pacientes con TDAH y 75 controles, se valoró en los casos inteligencia y funciones ejecutivas. Mediante (PCR) se amplificó el VNTR DAT1. Se establecieron estadísticos genético poblacionales, análisis de asociación y de regresión logística entre las pruebas neuropsicológicas y genotipo. Resultado: El polimorfismo del DAT1 no mostró asociación con TDAH, ni con alteraciones en las funciones ejecutivas. El genotipo 10/10 del VNTR DAT1 se encontró asociado con el índice de velocidad de procesamiento (p <0,05). En el subgrupo hiperactividad hubo asociación con algunas subpruebas de flexibilidad cognitiva, número de respuestas correctas, total de errores, número de respuestas perseverativas (p ≤ 0.01). En el subgrupo mixto se asoció con índice de comprensión verbal (p <0,05). Conclusiones: No hubo asociación entre el polimorfismo VNTR (DAT1) y el fenotipo de TDAH. Se encontraron asociaciones entre genotipo y algunos test de flexibilidad cognitiva e índice de comprensión verbal. Se establecieron los estadísticos genético poblacionales de este polimorfismo para la población analizada, el cual corresponde al primer reporte de una muestra de nuestro país.

Bayesian sample size for exploratory clinical trials incorporating historical data

This paper presents a simple Bayesian approach to sample size determination in clinical trials. It is required that the trial should be large enough to ensure that the data collected will provide convincing evidence either that an experimental treatment is better than a control or that it fails to improve upon control by some clinically relevant difference. The method resembles standard frequentist formulations of the problem, and indeed in certain circumstances involving 'non-informative' prior information it leads to identical answers. In particular, unlike many Bayesian approaches to sample size determination, use is made of an alternative hypothesis that an experimental treatment is better than a control treatment by some specified magnitude. The approach is introduced in the context of testing whether a single stream of binary observations are consistent with a given success rate p(0). Next the case of comparing two independent streams of normally distributed responses is considered, first under the assumption that their common variance is known and then for unknown variance. Finally, the more general situation in which a large sample is to be collected and analysed according to the asymptotic properties of the score statistic is explored. Copyright (C) 2007 John Wiley & Sons, Ltd.

Decreasing the interference of visual-based P300 BCI using facial expression changes

Interferences from the spatially adjacent non-target stimuli evoke ERPs during non-target sub-trials and lead to false positives. This phenomenon is commonly seen in visual attention based BCIs and affects the performance of BCI system. Although, users or subjects tried to focus on the target stimulus, they still could not help being affected by conspicuous changes of the stimuli (flashes or presenting images) which were adjacent to the target stimulus. In view of this case, the aim of this study is to reduce the adjacent interference using new stimulus presentation pattern based on facial expression changes. Positive facial expressions can be changed to negative facial expressions by minor changes to the original facial image. Although the changes are minor, the contrast will be big enough to evoke strong ERPs. In this paper, two different conditions (Pattern_1, Pattern_2) were used to compare across objective measures such as classification accuracy and information transfer rate as well as subjective measures. Pattern_1 was a “flash-only” pattern and Pattern_2 was a facial expression change of a dummy face. In the facial expression change patterns, the background is a positive facial expression and the stimulus is a negative facial expression. The results showed that the interferences from adjacent stimuli could be reduced significantly (P<;0.05) by using the facial expression change patterns. The online performance of the BCI system using the facial expression change patterns was significantly better than that using the “flash-only” patterns in terms of classification accuracy (p<;0.01), bit rate (p<;0.01), and practical bit rate (p<;0.01). Subjects reported that the annoyance and fatigue could be significantly decreased (p<;0.05) using the new stimulus presentation pattern presented in this paper.

Exploring combinations of different color and facial expression stimuli for gaze-independent BCIs

Background: Some studies have proven that a conventional visual brain computer interface (BCI) based on overt attention cannot be used effectively when eye movement control is not possible. To solve this problem, a novel visual-based BCI system based on covert attention and feature attention has been proposed and was called the gaze-independent BCI. Color and shape difference between stimuli and backgrounds have generally been used in examples of gaze-independent BCIs. Recently, a new paradigm based on facial expression changes has been presented, and obtained high performance. However, some facial expressions were so similar that users couldn't tell them apart, especially when they were presented at the same position in a rapid serial visual presentation (RSVP) paradigm. Consequently, the performance of the BCI is reduced. New Method: In this paper, we combined facial expressions and colors to optimize the stimuli presentation in the gaze-independent BCI. This optimized paradigm was called the colored dummy face pattern. It is suggested that different colors and facial expressions could help users to locate the target and evoke larger event-related potentials (ERPs). In order to evaluate the performance of this new paradigm, two other paradigms were presented, called the gray dummy face pattern and the colored ball pattern. Comparison with Existing Method(s): The key point that determined the value of the colored dummy faces stimuli in BCI systems was whether the dummy face stimuli could obtain higher performance than gray faces or colored balls stimuli. Ten healthy participants (seven male, aged 21–26 years, mean 24.5 ± 1.25) participated in our experiment. Online and offline results of four different paradigms were obtained and comparatively analyzed. Results: The results showed that the colored dummy face pattern could evoke higher P300 and N400 ERP amplitudes, compared with the gray dummy face pattern and the colored ball pattern. Online results showed that the colored dummy face pattern had a significant advantage in terms of classification accuracy (p < 0.05) and information transfer rate (p < 0.05) compared to the other two patterns. Conclusions: The stimuli used in the colored dummy face paradigm combined color and facial expressions. This had a significant advantage in terms of the evoked P300 and N400 amplitudes and resulted in high classification accuracies and information transfer rates. It was compared with colored ball and gray dummy face stimuli.

Cultivo de Ankistrodesmus gracilis (Reisch) Korsikov (Chlorophyta) em laboratório utilizando meio CHU12 e de macrófita com NPK

Two different culture media, namely CHU12 and inorganic fertilizer NPK (20-5-20) associated with macrophyte (Eichhornia crassipes) extract, were used to evaluate the development of A. gracilis. Growth rate, development, nutritional value and medium water quality were analyzed. A. gracilis in macrophyte+NPK medium had mean cell density (333x10(5) cells/mL) higher than medium CHU12 (302x10(5) cells/mL). Protein rate (12.52% PS), dry weight (397x10(7) pg/cell) and ashes (4.08x10(7) pg/cell) in A. gracilis was higher (p<0.05) than medium macrophyte+NPK. on the other hand, lipids, carbohydrates and fibers had the same rate (p>0.05) in both media. When hydrological variables in the culture medium of A. gracilis are taken into account, dissolved oxygen and free CO2 alone failed to have any significant difference (p>0.05) between the media employed. A. gracilis in the macrophyte+NPK medium had the same nutritional rate as the commercial medium CHU12, with excellent results for alga growth. Macrophyte medium may be used for large scale alga culture in the feed of fish larvae.

Avaliação da sensibilidade de diversas espécies de plantas daninhas aquáticas ao carfentrazone-ethyl, em ambiente controlado

Plantas aquáticas, especialmente macrófitas, tornam-se sério problema em hidrelétricas, afetando a múltipla utilização dos corpos d'água, incluindo produção de peixes e atividades de pesca, perdas d'água por evapotranspiração, esportes aquáticos, canoagem, irrigação e produção de energia nas usinas hidrelétricas. Com o objetivo de analisar o potencial de uso do carfentrazone-ethyl no controle das principais plantas daninhas aquáticas no Brasil, foi instalado um experimento em vasos com água. Utilizaram-se os seguintes tratamentos herbicidas (g i.a. ha-1): carfentrazone-ethyl a 15, 30 e 60; glyphosate a 4.536; 2,4-D a 4.690; imazapyr a 1.250; e uma testemunha sem herbicida. Esses tratamentos foram testados nas seguintes espécies: Eichhornia crassipes, Salvinia auriculata, Pistia stratiotes, Myriophyllum aquaticum, Brachiaria arrecta, Hydrocotyle umbellata, Typha sp. e Echinochloa polystachya. As avaliações foram efetuadas aos 7, 14, 21 e 28 dias após os tratamentos. Os resultados mostraram que o carfentrazone-ethyl foi eficiente no controle de E. crassipes (maior dose) e P. stratiotes (duas maiores doses), com efeito supressivo sobre S. auriculata. Foi observado que nas outras plantas daninhas estudadas não houve eficiência de controle.