3rd Injection Research Articles

Real-World 1-Year Outcomes of Treatment-Intensive Neovascular Age-Related Macular Degeneration Switched to Faricimab

PurposeTo report one-year anatomical and functional real-world outcomes of treatment intensive neovascular age related macular degeneration (nAMD) patients switched to faricimab DesignRetrospective multi-centre cohort study SubjectsConsecutive nAMD patients on 4-weekly treatment interval with either ranibizumab or aflibercept 2mg in the last three visits within a treat and extend protocol (high treatment burden) prior to switch to faricimab at Moorfields Eye Hospital between 5/9/2022- 5/12/2022. MethodsTotal number of nAMD patients switched to faricimab were identified from electronic medical records and those who met criteria of high treatment burden were included. Data collected included pre and post-switch visual acuity (VA), treatment intervals, length of follow-up, baseline macular morphology, changes in central subfield thickness (CST), macular fluid status and adverse events. Main outcome measuresVA, CST, presence of intraretinal fluid (IRF), subretinal fluid (SRF) and injection intervals over one-year following switch to faricimab. ResultsA total of 130/ 286 (45.5%) eyes met inclusion criteria of being switched due to high treatment burden and 117 were included in analysis. Prior to switch to faricimab, these eyes received mean total number of injections of 33.4±19.6 over mean of 51.3±34.9 months. Mean number of injections in 12 months preceding switch was 10.1±1.6 and mean interval of the preceding three injections was 4.2±0.3 weeks. Mean VA, CST and percentage of patients with dry macula prior to switch were 66.0±11.9 ETDRS letters, 259.6±76.0μm and 18.3% respectively. Following switch, there was no statistical difference in mean VA after each visit and at 12 months. Mean CST statistically significantly reduced following the 3rd faricimab injection and at 12 months by 20.0μm (p=0.035) and 22.1μm (p=0.041) respectively. Mean treatment intervals increased to 6.9±2.3 weeks (p<0.005) at 12 months with 42.9% and 11.4% of patients being on ≥8 weekly and ≥12 weekly treatment intervals respectively. ConclusionAt 12 months, patients with nAMD with previous record of high treatment burden when switched to faricimab maintained visual acuities and improved anatomical outcomes on extended treatment intervals. Physician bias is inherent in these types of observational studies so a prospective randomised controlled trial is recommended to validate these findings.

New control scheme for a dynamic voltage restorer based on selective harmonic injection technique with repetitive controller

Repetitive controller and selective harmonic injection technique (SHI) in medium and low voltage distribution networks improve dynamic voltage restorer (DVR) DC bus voltages as well as nullify power quality (PQ) problems. DVRs use sinusoidal pulse width modulation (SPWM) firing control, but DC bus use seems to be limited, affecting density, cost, and power packaging. By adding 1/6th of the 3rd harmonic waveform to the basic waveform, SPWM yields the developed model. According to the findings, 15% of DC bus usage improves and produces high voltage AC. Nevertheless, just control systems perturb PQ. The proposed controller uses feed forward and feedback to enhance transient response and justify stable zero error. 3rd third harmonic injection pulse width modulation (THIPWM) improves total harmonic distortion (THD) in the proposed scheme. Power system computer aided design (PSCAD) simulation produced high accuracy for THIPWM and repetitive controllers.

Near vision in patients with DME and RVO treated with aflibercept and correlation with NEI VFQ-25 questionnaire

BackgroundThe aim of this study is to evaluate near and distance visual acuity (VA) and their correlation with the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) outcomes in patients with diabetic macular edema (DME) and macular edema due to retinal vein occlusion (RVO) treated with aflibercept.MethodsIn this prospective study, we included 87 eyes of patients diagnosed with DME (n = 61) and RVO (n = 26), who received aflibercept treatment and were followed until the 8th injection. Near VA was examined on the 1st, 2nd, 3rd, 4th, 6th, and 8th injection, and patients completed the NEI VFQ-25 on the 1st, 4th, and 8th aflibercept injection.ResultsThe mean near VA at baseline in all eyes was 0.89 ± 0.12 logMAR. With every administration, there was a statistically significant improvement; on the 4th (0.70 ± 0.19; p = 0.000) and the 8th application (0.60 ± 0.19; p = 0.000). At baseline, the mean NEI VFQ-25 total score was 71 ± 14%, and improved to 81 ± 13% (p = 0.000) on the 8th injection. The most significant score gain was recorded in the near VA subscale (+ 20 ± 14%, p = 0.000). There was no statistically significant difference between DME and RVO group in the questionnaire or near VA outcomes.ConclusionAflibercept treatment resulted in a remarkable improvement of near vision by 4 lines of logMAR optotype after the 8th application. The near vision questionnaire subscale, initially scoring the lowest, exhibited the greatest gain during the treatment period. This underscores the importance of near vision and reading ability for patients with DME and RVO.

CSF1R blockade in fructose-fed rhesus macaques improves clinical parameters of prediabetes.

Abstract We have previously found that depletion of CSF1Rhi macrophages (Mθ) using a rhesus IgG1 recombinant antibody against CSF1R (α-CSF1R) reduced total cholesterol and improved insulin sensitivity in naturally prediabetic rhesus macaques (RM). High fructose diet (HFD)-fed RMs have been established as a model of metabolic syndrome, with increased insulin resistance (IR) and increased monocyte chemoattractant protein 1 (MCP-1). We hypothesize that depletion of CSF1Rhi tissue Mθ using a monoclonal α-CSF1R and replacement with freshly differentiated Mθ will alleviate inflammation in tissues and ameliorate prediabetic disease in HFD-fed RMs. We induced IR and heightened hbA1C, indicating prediabetes in eight aged Indian RMs through administration of a HFD for 6 months. RMs were treated with either α-CSF1R or an IgG1 control administered intravenously (15 mg/kg) once every 2 weeks for 6 weeks. Clinical parameters such as plasma levels of total cholesterol, glucose, insulin, adiponectin, CSF1, IL1β, MCP-1 were monitored throughout treatment and up to 8 weeks after the 3rd injection. Mθ subsets were quantified by immunofluorescent (IF) staining. Treatment with α-CSF1R resulted in decreased total cholesterol and insulin, increased adiponectin and CSF1. IF staining confirmed the depletion of CSF1Rhi macrophages in insulin sensitive tissues. Treatment with α-CSF1R resulted in improvement in multiple clinical parameters associated with prediabetes.

Long-term dynamic changes and influencing factors of corneal morphology after multiple intravitreal injections of anti-VEGF drugs.

To observe alterations in corneal morphology caused by repeated intravitreal injections of anti-vascular endothelial growth factor (VEGF). Prospective cohort study. Seventy-seven eyes were treated with intravitreal injection of anti-VEGF from June 2021 to March 2023. There were 25 eyes of neovascular age-related macular degeneration (nAMD), 24 eyes of diabetic macular edema (DME), and 28 eyes of retinal vein occlusion (RVO). Aflibercept was used in 37 eyes and Ranibizumab was used in 40 eyes. 3 + PRN was used. Corneal endothelium and corneal thickness were measured using a corneal endothelial microscope. The data related to central corneal thickness, corneal endothelial cell density (ECD), average cell size, coefficient of variation (CV), proportion of hexagonal cells (Hex%) was collected. A comparison was also made between baseline and the dynamic changes of all indexes 1 year following the last injection. It was observed that in comparison to baseline, ECD and Hex% decreased significantly after the 3rd injection of Aflibercept and Ranibizumab. However, ECD did not decrease further and remained at the same level as after the last injection. Hex% and average cell size increased to a certain extent in comparison to the last injection. All the changes were found to be statistically significant (P < .01). After 3 injections, ECD in DME group was markedly lower than that in nAMD and RVO group, but the CV in DME group was higher than that in nAMD as well as RVO groups, and all the differences were statistically significant (P < .05). Following intravitreal anti-VEGF therapy, DME is more likely than other disorders to result in a decrease in ECD. Repeated intravitreal injections of anti-VEGF drugs can reduce the Hex% and ECD to a certain extent. After the last injection, Hex% can progressively recover, and ECD can remain stable without further declining. After injections, ECD in DME group was found to be significantly lower than that in nAMD and RVO groups, but CV in DME group was significantly higher in comparison to the other 2 groups. In patients with macular edema, repeated intravitreal injections of anti-VEGF may have certain effects on corneal morphology. Patients with diabetes mellitus in particular should pay special attention to corneal safety following repeated intravitreal injections if they have significantly reduced ECD at baseline.

Non-Neovascular Subretinal Fluid with Serous Retinal Pigment Epithelial Detachment: Wait or Treat

Introduction: To describe the course of subretinal fluid (SRF) in eye with serous pigment epithelial detachment (serous PED) in the absence of macular neovascularization (non-neovascular AMD). Method: This is a retrospective case study included one eye with non-neovascular SRF associated with serous PED. Swept source optical coherence tomography (SS-OCT) and optical coherence angiography (OCTA) were obtained at baseline and follow up with qualitative and quantitative analysis of macula, pigment epithelial detachment (PED), subretinal fluid (SRF) and the presence or absence of macular neovascular membrane (MNV) in addition to other multimodal imaging modalities like fluorescein angiography (FA) and fundus auto fluorescence (FAF). Results: Our 66-year-old female has presented with left serous (PED) with apical (SRF) and no MNV on OCTA with baseline best corrected vision (BCVA) in Log MAR = 0.5. The SS-OCT, OCTA, and BCVA were stable over the initial five-month follow-up observation period with no MNV (non-neovascular SRF). One month later, the patient received an intravitreal anti-VEGF injection outside our clinic. 1-month post-outside clinic anti-VEGF injection, SS-OCT showed a small RPE tear with flattening of RPE detachment and preservation of BCVA =0.5. In the 3rd month post-outside clinic anti-VEGF injection, the SS-OCT showed slight flattening of RPE detachment with an obvious increase in SRF, still negative MNV on the OCTA associated with a drop in BCVA to 0.3. The decision was made to give the patient an initial three loading doses of aflibercept injections .The SS-OCT post 2nd aflibercept injection showed complete resolution and drying out of SRF, with an improvement of BCVA to 0.5. we continue completing the loading phase and then the patient was placed on treat and extend regimen (T&amp;E). After the fifth aflibercept injection, the PED was completely flattened with appearance of MNV on OCTA after resolution of SRF. Conclusion: Many published studies provide preliminary data about non-neovascular AMD with SRF. SRF could be present in the absence of MNV due to RPE decompensation or RPE pump failure. However, the non-neovascular SRF could be transformed with time into a neovascular one with the presence of MNV. Multimodal imaging approach is essential in differentiating non-neovascular versus neovascular SRF and avoiding unnecessary antiVEGF injections.

Prediction of neovascular age-related macular degeneration recurrence using optical coherence tomography images with a deep neural network

Neovascular age-related macular degeneration (nAMD) can result in blindness if left untreated, and patients often require repeated anti-vascular endothelial growth factor injections. Although, the treat-and-extend method is becoming popular to reduce vision loss attributed to recurrence, it may pose a risk of overtreatment. This study aimed to develop a deep learning model based on DenseNet201 to predict nAMD recurrence within 3 months after confirming dry-up 1 month following three loading injections in treatment-naïve patients. A dataset of 1076 spectral domain optical coherence tomography (OCT) images from 269 patients diagnosed with nAMD was used. The performance of the model was compared with that of 6 ophthalmologists, using 100 randomly selected samples. The DenseNet201-based model achieved 53.0% accuracy in predicting nAMD recurrence using a single pre-injection image and 60.2% accuracy after viewing all the images immediately after the 1st, 2nd, and 3rd injections. The model outperformed experienced ophthalmologists, with an average accuracy of 52.17% using a single pre-injection image and 53.3% after examining four images before and after three loading injections. In conclusion, the artificial intelligence model demonstrated a promising ability to predict nAMD recurrence using OCT images and outperformed experienced ophthalmologists. These findings suggest that deep learning models can assist in nAMD recurrence prediction, thus improving patient outcomes and optimizing treatment strategies.

Laser flare photometry in eyes receiving brolucizumab intravitreal injections for age related macular degeneration.

To measure aqueous flare levels in treatment naïve eyes suffering from wet age- related macular degeneration (wAMD) treated with intravitreal brolucizumab. Patients with treatment naïve wAMD in one eye were prospectively enrolled. Flare levels were measured with laser flare photometry at baseline, 1 day and 1 month after each of the 3 monthly injections during the loading phase. Twenty-two eyes from 22 patients aged 76.7 ± 6.0 years were enrolled. Flare values were 10.6 ± 3.7 photons/msec at baseline and 12.6 ± 5.8 photons/msec at the last follow up visit, 1 month after the third injection (p = 0.289, repeated measures ANOVA). The mean change in flare after the first injection was 4.2 ± 3.6. photons/msec, 6.6 ± 8.9 photons/msec after the 2nd and 8.6 ± 20.8 photons/msec after the 3rd injection (p = 0.640, repeated measures ANOVA). No patient had clinical signs of intraocular inflammation. Eyes receiving brolucizumab injections for wAMD showed similar flare at baseline, during and 1 month after completion of three-monthly intravitreal injections. There was no evidence of subclinical inflammation during the loading phase of brolucizumab based on laser flare photometry measurements.

Costoclavicular block – single to double injection – time to see the premiere of triple injection

Sir,Securing the phrenic nerve when achieving effective anesthesia block for the upper limb has been a topic intriguing regional anesthesia enthusiasts ever since. Interscalene brachial plexus block is known to involve the phrenic nerve in 100% of the cases and costoclavicular block which has gained momentum since 2015 is declared to involve the phrenic nerve in 0% of the cases. Besides this the compact, reliable topography of the cords in the triangular costoclavicular space along with an expedited sensorimotor block with local anesthesia deposited in the center of the three cords makes costoclavicular block an attractive option for elbow and below elbow surgeries. According to the studies, the success rate of the blockade is 92.5% with single injection in the center of the cords. Another study by Sebastian, where apart from classical single injection, another injection was given after redirecting the needle, between the medial cord and subclavian artery (labeling it a corner pocket technique) for costoclavicular block. They concluded that the block’s onset time and total anesthesia-related time were significantly shortened with the double injection technique compared with single injection. The basis of this was explanation laid by Dr. Monzo and Hadzic where they proposed in a series of 40 patients a linear septum arising from the lateral part of axillary artery separating the lateral code from the posterior and the medial code, thus compartmentalizing the costoclavicular space. They reported a success rate of 97.5% in their study on 40 patients.4 Hence,double injection is used to overcome the septum “issue.” Pornpatra is defined a high definition ultrasonographic presence of paraneural sheath and facial compartments surrounding the brachial plexus cords at the lateral infraclavicular fossa and the costoclavicular space. We propose that a triple injection with 3rd injection in the vicinity of the lateral cord just before withdrawing the needle apart from the other two injections significantly shortens the onset time of sensory block from 16 min to 9 min. The various sites for injection are shown in the figure below, but the exact point of injection of the second and third is more prominent after giving the first injection. The chances of the median nerve sparing as has been reported in some cases in previous studies are almost nil by this technique - the corner pocket injection that involves the medial root of the median nerve and the lateral cord that is specifically blocked separately covering the lateral root of the median nerve. CONCLUSIONWe did a case series in 15 cases and although the sample size is small and this is definitely not a randomized control trial, to make such a bold statement, we would like to decipher a positive future of the costoclavicular block with triple injection technique with an RCT already underway.

Vascular development analysis: a study for tertiary anti-vascular endothelial growth factor therapy after second reactivation of retinopathy of prematurity.

To observe the vascular development results of tertiary anti-vascular endothelial growth factor (anti-VEGF) therapy following spontaneous second reactivation of retinopathy of prematurity (ROP). This retrospective study included 22 infants (42 eyes) with Type 1 or aggressive ROP (A-ROP) who received three anti-VEGF drug treatments for ROP from January 2018 to December 2022. The vascular growth, possible associated risk factors, and the retinal vascularization (DB/DF ratio) were assessed. The mean follow-up was 17.6 months. After the 3rd intravitreal injection, seven eyes showed complete vascularization (Group 1), while the remaining 35 eyes demonstrated persistent avascular retina (PAR) (Group 2). In Group 2, 17 eyes maintained a stable state and were classified in the regression subgroup. The other 18 eyes developed a 3rd reactivation (reactivation subgroup) and were treated with laser photocoagulation (LPC).Birth weight (BW) was significantly lower in Group 2 than in Group 1 (p < 0.001). The decision tree analysis shows that only infants weighing more than 1,250 g (17.50%) had a chance to achieve complete retinal vascularization. The possibility of PAR was higher in patients with BW <1,250 g than ≥1,250 g (70.00% vs. 12.50%). In addition, most infants with BW ≥ 1,290 g and initial ROP disease in Zone I or posterior Zone II developed PAR. Tertiary IVR can successfully treat a second ROP reactivation and improve peripheral retinal vascularization. BW is the most significant factor related to complete retinal vascularization. Our decision tree model may be helpful in predicting the prognosis of anti-VEGF drugs in the event of a second ROP reactivation.

A PROSPECTIVE STUDY OF EFFICACY AND OUTCOME ANALYSIS OF ROLE OF PRP INJECTION IN OSTEOARTHRITIS OF KNEE JOINT 40 CASES PROSPECTIVE ANALYSIS

Background: Knee osteoarthritis is a progressive debilitation degenerative disease of the cartilage of the knee. In severe conditions, the patient is unable to do basic activities of daily living also. The pain associated with severe cartilage degeneration is excruciating. Platelet rich plasma being autologous in nature, the chances of disease transmission are also very less. This study aims to evaluate the efficacy in terms of pain relief and functional outcome of platelet rich plasma in patients with knee osteoarthritis with Kellgren-Lawrence Grade I, II and III. Material and Method: This study was conducted in the Department of Orthopedics, Arihant Hospital and Research Centre, Indore during the study period of 2 years. We included 29 patients with primary osteoarthritis of knee with age more than 35 years and who were willing to undergo this procedure. After preliminary evaluation of the knee with radiograph and confirming the fitness of the patient for the procedure, these patients were given injection of PRP and were instructed on post procedure precautions. The second injection was given at 3rd week and 3rd injection at 6th week, and these patients were followed up till 12 months. At each follow-up WOMAC score and VAS scores were evaluated. Pairedt test was applied to evaluate the change in mean WOMAC and VAS scores at each follow-up. A p value of &lt; 0.05 was taken as statistically significant. Result and Conclusion: We had included 40 knees (29 patients) with a mean age of 55.89 ± 9.14 years. Female predominance was seen in our study (75.9%). Only Kellgren-Lawrence osteoarthritis grades I, II and III were included and Grade IV were excluded. The left knee involvement (52.5%) was slightly higher in comparison to the right knee. The mean WOMAC score preinjection was 75.65 ± 5.54, at 3 weeks it was 66.23 ± 6.95 and at 6 weeks and 43.93 ± 14.11 at 6 months. There was a significant improvement (P&lt;0.05) in WOMAC scores over the follow-up till 6 months. The mean WOMAC score along with its 3 subscales showed significant deterioration at 12 months in comparison to 6 months, scores (P&lt;0.05). Likewise, the mean VAS preinjection was 7.18 ± 0.93, which significantly decreased at postinjection (at 6 months) to 3.90 ± 1.19 (P&lt;0.05), but by 12 months the mean VAS showed significant increase to 6.38 ± 1.01 (P&lt;0.05). No major complications were noted, except for pain and swelling at the site of injection. These were managed conservatively and responded well to the given treatment.

Use of botox for sialorrhea and dysphagia in the neonatal population

IntroductionBotox is frequently used for sialorrhea in patients with compromised airways and those with etiologies causing difficulty with secretion management (i.e. strokes, neurologic disorders, etc.). There are no published studies regarding the use of botulinum toxin (BoNT) in the neonate population. We aim to discuss our experience and safety of BoNT use in the neonate population in regards to alleviating secretion management and airway protection. MethodsRetrospective review of neonates admitted to the neonatal intensive care unit (NICU) ≤12 months of age who received BoNT injection to submandibular (SMG) and parotid (PG) glands for sialorrhea/dysphagia. BoNT was administered under ultrasound (u/s) guidance by interventional radiology. Results6 children were examined. 2 (33 %) were male. Avg NICU stay was 87.5 ± 33.1 days. 2 underwent surgical airway intervention prior to injection. Mean age at initial BoNT was 1.5 ± 0.7 months. Avg weight at injection was 4 ± 1.1 kg. Each PG and SMG were injected in 5/6 cases. Bilateral SMG were unidentified on u/s in 1 case and thus not injected. Dose range injected per gland was 5-15u. 100 % required tube feeds, 50 % with tubes distal to stomach (NJT/NDT). 83 % were completely NPO prior to injection and there was no noted clinical improvement in oral skills post injection. All had noted desats/apneas prior to injection and 83 % had reported decreased events post injection. 50 % had reported decrease O2 requirements and frequent suctioning 2wks after injection, however 2 (33 %) required surgical airway intervention after injection (trach, SGP/MDO). 4/6 (67 %) trialed medical therapy, anticholinergics being the most common. 50 % underwent 2nd injection (age = 6.5 ± 0.3 months) avg. 4.7 ± 0.7mo after 1st injection, and the same 3pts underwent 3rd injection (age = 12.5 ± 2.4 months) avg. 6.1 ± 2.5mo after 2nd injection. 1 pt. had a total 6 injections. There were no injection related complications. ConclusionBoNT injection is a safe, non-invasive alterative for management of sialorrhea in neonates. Further extensive study needs to be performed to identify the optimal dose per gland in this population.

Early decrease of ionized calcium and static symmetric dimethylarginine concentration in a model of renal tubular necrosis in corn snakes (Pantherophis guttatus).

To determine if plasma concentrations of symmetric dimethylarginine (SDMA), N-acetyl-beta-d-glucosaminidase (NAG), GGT, ALT, AST, lactate, total calcium, and ionized calcium (iCa) and the calcium:phosphorus ratio are clinically relevant biomarkers to detect early stages of tubular lesions in snakes. 6 adult corn snakes (Pantherophis guttatus). Corn snakes were administered 11 injections of gentamicin at 50 mg/kg, SC, q 24 h in an experimental model of induced tubular necrosis. Plasma biochemistry and blood gas analyses were performed at baseline and after the 3rd and 11th injections. Parameters were compared between time points using a paired Wilcoxon test. In 3 individuals, renal biopsies were collected at baseline before starting injections and at the 3rd and 11th injections, while renal tissue samples were procured after euthanasia in all individuals. Renal proximal and distal tubular necrosis and hepatic steatosis were present in all individuals at necropsy. Compared to baseline, decreased blood concentrations of lactate, ionized calcium, and total calcium and a decreased calcium:phosphorus ratio were noted. A significant decrease of lactate and ionized calcium was observed after 3 days. Conversely, no changes in SDMA, NAG, ALT, AST, GGT, and sodium were detected. Ionized calcium and lactate concentrations were the earliest parameters to decrease compared to baseline values in this experimental model. While SDMA is a sensitive indicator of renal disease in mammals, this biomarker did not increase in a model of induced acute tubular necrosis in corn snakes.

Control technique for power quality improvement of isolated wind power generation system

Power quality (PQ) problems for renewable energy system (RES) is major challenge for using these systems. Amplitude, frequency, and waveform is important PQ parameters especially for standalone or isolated systems. In this paper we propose RES with wind turbine (WT) and permanent magnet synchronous generator (PMSG) to feed different loads (liner, non-liner) through AC-DC-AC converter. The PMSG operate with fuzzy logic inertia controller, to convert turbine torque form PU to Nm. The inverter stage in the converter operate according to proportional integral derivative (PID) controller with 3rd harmonic injection pulse width modulation (PWM) to regulate the AC voltage in load side. For the same case study and operating condition, we compared the result for system parameters when using ordinary PWM and using PID with 3rd harmonic injection. Voltages total harmonics distortion (THD) was less than 2% with liner loads, and 3.5% with non-liner load and the same was for current load, the voltage amplitude was between (1-1.03) PU under different wind speed by using the proposed controller.

Control technique for power quality improvement of isolated wind power generation system

Power quality (PQ) problems for renewable energy system (RES) is major challenge for using these systems. Amplitude, frequency, and waveform is important PQ parameters especially for standalone or isolated systems. In this paper we propose RES with wind turbine (WT) and permanent magnet synchronous generator (PMSG) to feed different loads (liner, non-liner) through AC-DC-AC converter. The PMSG operate with fuzzy logic inertia controller, to convert turbine torque form PU to Nm. The inverter stage in the converter operate according to proportional integral derivative (PID) controller with 3rd harmonic injection pulse width modulation (PWM) to regulate the AC voltage in load side. For the same case study and operating condition, we compared the result for system parameters when using ordinary PWM and using PID with 3rd harmonic injection. Voltages total harmonics distortion (THD) was less than 2% with liner loads, and 3.5% with non-liner load and the same was for current load, the voltage amplitude was between (1-1.03) PU under different wind speed by using the proposed controller.

Effect of repeated intravitreal anti-vascular endothelial growth factor drugs on corneal nerves.

To investigate the potential effect of repeated intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs on corneal nerves. A total of 64 patients were treated with intravitreal injection of anti-VEGF drugs. There were 19 cases of neovascular age-related macular degeneration (AMD), 20 cases of diabetic macular edema (DME) and 25 cases of retinal vein occlusion (RVO). Twenty-nine cases were treated with aflibercept (2 mg/0.05 mL) whereas 35 cases were managed with ranibizumab (0.5 mg/0.05 mL). A corneal confocal microscope was used to collect images of corneal subbasal nerve plexus, and Image J was used for image analysis. The changes in corneal nerve were compared between 1 month after each injection and before injection. There were no significant differences in the density and length of corneal nerve at specific time after the surgery in comparison with baseline in patients who were given 3 intravitreal injections. There was no significant correlation between the numbers of injections and the changes of the corneal nerves. After 3rd injection, the nerve length of the DME group was markedly lower than that of AMD and RVO groups, the difference was statistically significant (P < .05). The nerve density of the DME group was not significantly different from that of AMD and RVO groups, whereas the nerve length and nerve density of the AMD and RVO groups were not statistically significant between each other also. The corneal nerve length after the 2nd and 3rd injections of Aflibercept were lower than that before surgery, the difference was statistically significant. There were no significant differences in nerve density and nerve length at each time point after Ranibizumab injection. The length and density of the corneal nerve after multiple injections in contralateral eye displayed no significant changes compared with the baseline. Repeated intravitreal anti-VEGF drug can reduce the length of corneal nerves. For patients who need repeated intravitreal injections of anti-VEGF drugs, especially in DM, attention should be paid on the changes affecting the corneal nerves. It is also needed to strengthen the local anti-inflammatory therapy to avoid infection and to use artificial tears to protect the microenvironment of the ocular surface after the surgery.

EFFECT OF PRE- AND POST-MATING VITAMINS AD3E TREATMENT ON REPRODUCTIVE PERFORMANCE OF AWASSI EWES

This study was designed to investigate the influence of pre-estrus (PE) synchronization and post-mating (PM) vitamins AD3E treatment on the reproductive performance of Awassi ewes raised at four Iraqi provinces. Seventy six Awassi ewes were randomly divided within each province into two groups. The first group (n=15, except for Karbala, n= 11) were im injected with five AD3E injections (150 IU / dose), biweekly interval. The 1st injection was 1.5 months PM, while the 2nd and 3rd injections were at the time of progestagen-impregnated vaginal sponges insertion. The 4th injection was at the time of the vaginal sponge’s removal, whereas the 5th injection was 14 days PM. The control group (n=5) was intramuscularly injected with 5 ml normal saline at similar periods. The AD3E groups exhibited higher (P≤0.01) fertility and conception rates as compared to the control groups in Al-Najaf and Karbala provinces. Higher (P≤0.01) lambing rate and liter size were noticed in AD3E groups than those of the control group for all provinces. In conclusion, pre-estrus synchronization and post-mating vitamin AD3E treatment improved the reproductive performance of Awassi ewes.

Experimental research on the effect caused by effective stress change in injection production capacity of carbonate reservoir

The effective stress of the reservoir rock in the underground gas storage (UGS) changes with the multi cycle injection and production, which changes the physical characteristics of the reservoir and affects the injection production capacity of the UGS. Taking carbonate fracture-pore type gas storage as the research object, combined with the actual production of UGS, establish a set of experimental evaluation methods based on production characteristics; Core damage evaluator, overburden pressure porosimeter and scanning electron microscope are used to carry out experimental research on the impact of effective stress change on injection production capacity, quantitative analysis of reservoir internal characteristics, multi cycle injection and production and effect of effective stress action time on injection-production capacity. The results show, the experimental method established based on the actual production characteristics of the UGS, simulation of multi cycle injection and production by forward and reverse displacement, simulation of effective stress change under constant confining pressure and variable internal pressure, the experimental evaluation of the injection production capacity of the simulation multi cycle injection and production of the UGS is realized; The change of effective stress makes the reservoir seepage characteristics worse and the reservoir space smaller, injection-production coefficient (Szc) is positively correlated with the internal characteristic value of the reservoir, the larger the internal characteristic value of the reservoir, the higher Szc, and the better the injection production capacity; The injection production capacity of the UGS reservoir deteriorates with the increase of the injection production cycle, in the 4th injection production cycle, the injection production capacity of the UGS changes from moderately strong to moderately weak; The damage of effective stress to the injection production capacity of UGS mainly occurs in the initial stage of injection production, and the damage tends to be stable with the progress of injection production. The conclusion is that the change of effective stress in carbonate fracture-pore type gas storage makes the injection-production capacity of the reservoir worse, it is proposed to carry out reservoir reconstruction before the UGS is put into operation, and expand the capacity of the gas storage after the completion of the 3rd injection and production cycle, which can effectively offset the impact of the decline of injection production capacity of the UGS and play the role of reservoir protection, it provides a constructive idea for improving the operation efficiency of the UGS.

An evaluation of patients with neovascular age‐related macular degeneration (nAMD) and receival of the first intravitreal injection at Rochdale Eye Unit, United Kingdom

AbstractPurpose: Both the National Institute for Health and Care Excellence (NICE)1, United Kingdom (UK), and the Royal College of Ophthalmologists2 guidelines for neovascular age‐related macular degeneration (nAMD) recommend that all patients referred with suspected nAMD should be reviewed and offered treatment within 14 days of referral. Therefore, the aim of our study was to evaluate the current percentage of patients with nAMD being referred to the Rochdale Eye Unit, UK, who are reviewed and offered therapy within 14 days and to establish any causes of delays.Methods: A retrospective study of all patients newly referred for assessment and treatment of nAMD between 1st September 2021 – 30th April 2022 was performed. For each patient, data were collected (OpenEyes™) on dates of referral, review in medical retina clinic, 1st, 2nd, 3rd intravitreal injection (IVI), follow‐up, visual acuity at presentation and follow‐up, and any causes of delay in receiving injections or follow‐up. A total of 74 eyes were identified.Results: Of the 74 eyes, 17 (23%) received the 1st IVI within 14 of days of referral. 42 eyes (56%) received the first IVI within 1 month of referral. The number of days between referral to 1st IVI varied considerably, with an average of 74 days, and mode of 25 days. The causes for delay included patients being lost to follow up (25%), awaiting fundus fluorescein angiography (5%), being re‐booked due to other health concerns (7%), and incapacity to meet demands (63%).Conclusions: A growing aging population has increased the demands on Ophthalmology departments, such as Rochdale Eye Unit, to provide a robust nAMD service. We recommend establishment of an independent referral system for patients with suspected/known nAMD and higher training of senior registrars and advanced nurse practitioners, using college approved courses, to meet the demands of such service in order to avoid delaying treatment for these patients.

Electrothermal Multicriteria Comparative Analysis of Two Competitive Powertrains Applied to a Two Front Wheel Driven Electric Vehicle during Extreme Regenerative Braking Operations

The powertrain performance in an electric vehicle is fully dependent on the electrical and thermal constraints of the static converters ensuring the power transfer taking place between the energy storage systems and the electromechanical machines. These constraints depend on the architectures of the power converters, and their control strategies. Particularly, the maximal limits are reached in maneuvers such as hard regenerative braking circumstances. Indeed, braking recovery is a critical phase in the vehicle’s operation, and its duration and intensity may strongly impact the vehicle’s battery behavior or integrated hybrid storage system. The innovative objective of the paper is to propose an electrothermal multicriteria comparative study based on electrical and thermal criteria for two competitive powertrains. These semi-active power configurations (a 3-level DC/DC converter-based, and a Z-source converter-based) are implemented in a two-front wheel driven electric vehicle during extreme regenerative braking conditions. Open-loop and closed-loop controls were implemented in the Z-source using the maximal constant boost control with 3rd harmonic injection modulation technique. We considered two paralleled IGBT modules instead of the single shoot-through structure. Our approach is based on simulation during an extreme braking maneuver leading to heavy repercussions on the overall powertrain system. The aim is to investigate the challenging structure of the Z-source. Results showed that the proposed 3-level DC/DC-based topology has better performances in terms of power losses, efficiency, thermal behavior, and electromagnetic interference.