Risk Of Damage Research Articles

Treatment of Endophytic Fungal Extracts in Candida albicans-Infected Wounds with Collagen Regeneration

Background: Infected wounds, particularly those caused by Candida albicans, are difficult to treat due to the lack of effective antifungal agents with minimal toxicity. Wound healing involves several phases, including inflammation, proliferation, and remodeling, with collagen playing a crucial role in tissue repair. The use of natural compounds, such as endophytic fungal extracts rich in secondary metabolites like terpenoids, has shown promise in promoting wound healing and inhibiting microbial growth. This study aimed to evaluate the effects of endophytic fungal extracts on Candida albicans-infected wounds, focusing on collagen formation and tissue regeneration. Methods: Endophytic fungal extracts were applied at different concentrations (5%, 10%, 15%) to rat skin wounds infected with Candida albicans. Histopathological analysis was conducted at 7 and 14 days post-treatment to assess collagen density, fungal presence, and tissue regeneration. Collagen density scores were recorded, and the structure of collagen fibers was examined using computerized microscopy. Results: The negative control group exhibited normal collagen fibers and a collagen density score of 4. Infected tissues in the positive control group, without treatment, showed severe fungal infiltration and no collagen fibers, with a score of 0. At 7 days post-treatment, 5% extract showed partial collagen regeneration with a score of 1, while the 10% and 15% concentrations exhibited minimal tissue improvement. After 14 days, the 5% extract significantly improved collagen density to a score of 3, indicating better tissue regeneration. However, yeast cells were still present in the dermis, suggesting incomplete infection resolution. Conclusion: The study demonstrated that the 5% endophytic fungal extract effectively promoted collagen formation and tissue regeneration in Candida albicans-infected wounds. Higher concentrations did not significantly improve outcomes and may pose risks of tissue damage.

Microfluidic device-assisted 3D cell spheroids isolation, staining and embedding

3D cell spheroids have emerged as indispensable tools in cell biology research. In this study, the efficacy of an open-close switchable microfluidic device for on-chip staining and agar-embedding of 3D spheroids was thoroughly validated, especially in preparation for immunohistochemistry (IHC) analysis. The on-chip staining procedure, employing Trypan blue and Calcein-AM/PI staining, was demonstrated to evaluate the cell viability of spheroids. During overextended culture periods, a discernible decline in cell viability was observed at the central region of the spheroids, offering valuable information on the temporal aspects of spheroid development. On-chip agar embedding stands out for its precise control over the location and orientation of three-dimensional spheroids, a key factor in exploring cellular architecture, especially in fused spheroids using IHC analysis. In comparison to tube-based staining, this method significantly cuts down on reagent use and analysis time. This not only boosts efficiency but also lowers the risk of spheroid damage or loss during staining, highlighting its potential for handling miniaturized tissue samples and biopsies in cell assays. The on-chip staining and agar-embedding techniques presented here not only provide valuable insights into spheroids’ behavior but also pave the way for further developments in miniaturized tissue analysis and cell-based assays.

Transient Diagnostics and Therapeutic-Related Increase in Intraocular Pressure and Risk to the Glaucoma Patient.

This review evaluates the impact of transient intraocular pressure (IOP) elevations during common ophthalmic surgical and diagnostic procedures on glaucoma patients. Elevated IOP is a key risk factor in glaucoma, and while transient IOP spikes are frequently encountered during surgeries like cataract extraction, laser in situ keratomileusis (LASIK), and femtosecond laser-assisted cataract surgery (FLACS), the clinical significance of these short-term elevations remains uncertain, particularly for eyes with compromised optic nerves. There is still a lack of data on which IOP level and duration of IOP insult the glaucoma damage occurs. Still, it is known that the combination of the degree of IOP elevation, duration of the insult and optic nerve susceptibility are important determinants of this event.While transient IOP elevations during these procedures are generally well tolerated, patients with advanced glaucoma and severely compromised optic nerves may be at greater risk for further damage. More research is needed to fully understand the long-term implications of acute IOP spikes, particularly in patients with advanced disease.

Long-term Functional Outcomes of Giant Cell Tumours around the Knee treated by Extended Curettage followed by Bone Grafting, Cementation, or a Combination.

Recurrence after Giant Cell Tumour (GCT) treatment depends on the type of treatment used. Poly-Methyl-Meth-Acrylate (PMMA) after extended curettage provides structural support and allows for early identification of recurrence but carries a risk of thermal damage to the surrounding healthy tissue. The aim of this study was to compare long-term functional outcomes and complications in patients with GCT around the knee treated with extended curettage and bone grafting or cementation. All patients with biopsy-proven GCT, involving either the distal femur or proximal tibia, and treated with either curettage with bone grafting (CBG), curettage with bone cementation (CBC), or curettage combined with grafting and cementation (the Sandwich technique) were included. They were further classified according to Campanacci grading. Patients were followed for a minimum of two years, and all complications were recorded. The three groups showed a statistically significant difference in terms of persistent pain after surgery (p=0.03), development of long-term arthritis (p=0.01), as well as overall complications (p=0.005). There was no significant difference in terms of the overall recurrence rate between each group (p>0.05). For Campanacci Grade II lesions, there was a statistically significant difference in terms of local recurrence (p=0.01), with lower recurrence rates observed after cementation procedures. The study indicates that the Sandwich technique was associated with a lower rate of complications compared to CBG or CBC. Patients in the CBG group reported persistent pain, while those in the CBC group exhibited early arthritic changes within five years of the index surgery. Although there was no overall difference in recurrence rates, cementation procedures had a significantly lower rate of recurrence in Campanacci Grade II lesions.

Hypertension.

Resistant and uncontrolled hypertension are common presentations to the nephrology clinic. Many of these patients benefit from evaluation for secondary hypertension in order to optimize antihypertensive therapy and reduce the risks of target organ damage from uncontrolled hypertension. The purpose of this review is to present several cases of difficult-to-control and/or secondary hypertension and to identify optimal approaches to evaluating and managing hypertension in these high-risk patients.

Abstract 203: Awake n‐BCA Embolization Of Complex Subcortical AVM In Elderly Patient With Cardiac Comorbidities: Case Report

Introduction Cerebral arteriovenous malformations (AVM) are an abnormal tangle of blood vessels in the brain that connects arteries to veins directly. This can lead to a variety of symptoms, including headaches, hemorrhages, seizures, and progressive neurological deficits. Effective treatment requires a multidisciplinary, individualized approach to maximize positive outcomes. We present the successful case of an 86‐year‐old male with a complex cardiac history who developed acute‐onset weakness and refractory focal motor seizures due to a large subcortical AVM in an eloquent location, treated with n‐Butyl Cyanoacrylate (nBCA) embolization while awake. Results 86‐yo male with a significant cardiac history, including hypertension, persistent atrial fibrillation on Xarelto, and heart failure, presented to the emergency department (ED) two hours after developing left facial droop, dysarthria, followed by a left‐sided focal motor seizure. Computerized tomography (CT) scan of the brain revealed a hypodense area in the right fronto‐parietal lobe, associated with vasogenic edema. Magnetic resonance imaging (MRI) indicated a possible AVM, with subtle nodular enhancement along the cortex and evidence of prior microhemorrhages. A diagnostic cerebral angiogram confirmed the presence of a Spetzler‐Martin grade 2 pial AVM in the posterior right frontal region, with a nidus measuring 6.2 mm by 4.29 mm. The AVM was supplied by the distal arterial pedicle from the inferior branch of the middle cerebral artery (MCA) and drained into the vein of Trolard. No aneurysm, varix, or venous congestion was identified. Following optimization of the patient's heart failure and seizure management, a multidisciplinary team discussed treatment options with the patient and his family. Given the AVM's eloquent location, n‐Butyl Cyanoacrylate (nBCA) embolization was performed while the patient was awake to allow for continuous neurological monitoring. Propofol was slowly injected into the arterial pedicle supplying the nidus, followed by a thorough neurological examination, which revealed no deficits. The nBCA embolization was then completed. Post‐procedural angiography showed significant obliteration of the AVM nidus and reduced arteriovenous shunting. The patient did not experience any parenchymal perfusion defects, thromboembolic complications, or vascular injuries. He was monitored in the neurointensive care unit and exhibited only mild left‐sided weakness and facial droop. Repeat CT imaging was stable. At a five‐month follow‐up, a cerebral angiogram demonstrated complete obliteration of the AVM, with no residual shunting. The patient remained neurologically intact and seizure‐free. A follow‐up angiogram is planned for six to twelve months to monitor for ongoing stability. Conclusion The successful treatment of this complex cerebral AVM using n‐BCA embolization in an awake state underscores the importance of a carefully tailored, multidisciplinary approach to managing such cases. Performing the procedure while the patient is awake allowed for continuous neurological monitoring, significantly reducing the risk of inadvertent damage. This case illustrates that, even in patients with significant comorbidities and high procedural risks, a well‐coordinated, individualized treatment strategy can lead to favorable outcomes. Ongoing follow‐up will be essential to maintain long‐term stability and address any potential complications.

Initial results of hard X-ray spectroscopy by LaBr[formula omitted](Ce) detector for runaway electron study in Thailand Tokamak-1

Thailand Tokamak-1 (TT-1) successfully achieved its first plasma operation in early 2023. Understanding the behavior of high-energy runaway electrons (RE) during plasma discharges is crucial in TT-1 due to the potential risk of significant damage to in-vessel components. To study the RE behavior and analyze its characteristics, the LaBr3(Ce) detector was employed for measuring hard X-ray emissions in TT-1. In this study, we first characterized the LaBr3(Ce) detector in the laboratory and then performed hard X-ray spectroscopy in TT-1. Calibration sources, including 133Ba, 137Cs, 22Na, and 60Co, with energies up to 1.33 MeV, were used in the laboratory. The detector was calibrated using biased high voltage of -1000 V. It was found to have an energy resolution of approximately 6.2% at an energy of 0.662 MeV. After calibration, the detector was installed at TT-1 to measure hard X-ray. We analyze the hard X-ray emission from discharge #2183 during a selected time interval. It is found that the high-energy hard X-ray emissions reach up to approximately 500 keV. Assuming a simple Maxwellian distribution of the RE population, their temperature is estimated to be 224±5 keV. These findings confirm the presence of high-energy runaway electrons during TT-1’s plasma discharges. However, to accurately derive the runaway electron energy spectrum from the hard X-ray energy spectrum, the unfolding technique is required. In future work, we plan to apply the unfolding method, conduct numerical simulations on the physics of runaway electrons, and employ Monte Carlo simulations on the hard X-ray emissions.

CHLOROQUINE INDUCED MACULAR TOXICITY IN A PATIENT LATER DEVELOPING SECTOR RETINITIS PIGMENTOSA: A CASE REPORT.

To describe how underlying retinal diseases, such as retinitis pigmentosa, increase the risk of chloroquine-induced macular toxicity. Observational case report. We present the case of a 57-year-old woman being annually followed-up in the Ophthalmology service due to a systemic treatment with chloroquine (CQ). The explorations were successive normal, until a 10:2 visual field (VF) shows central defects in both eyes. Despite CQ treatment is discontinued, 10:2 VF reveal slowly progressive macular defects. During follow-up, fundus examination disclosed bone spicules in the inferonasal middle periphery: the electroretinogram (ERG) shows slow amplitude responses under scotopic conditions and the electrooculogram (EOG) also shows pathological responses. Therefore, the diagnosis of sector retinitis pigmentosa plus chloroquine maculopathy is made. Currently, the slow but constant progression of both peripheral and central defects is evident, despite having discontinued CQ treatment more than 15 years ago. Underlying retinal diseases seem to increase the risk of photoreceptor damage when undergoing a toxic insult. Thus, we hypothesize a potential interplay between retinal dystrophies and toxic maculopathy induced by CQ, and the influence of each of them in the evolution and prognosis of the other.

Clinical experience of tooth replantation

Relevance. Modern dental practice strives, above all, to preserve teeth. A variety of operations aimed at this include dental replantation. Replantation is used in cases where there are difficulties with the root canals, such as their pathological bending or previous treatment with the resorcinol-formalin method, and also when root resection is impossible due to the risk of damage to surrounding structures, for example, the maxillary sinus or the inferior alveolar nerve.The purpose of this study was to study the osseointegration of a replanted tooth subjected to coronoradicular separation. Materials and methods. Thirty-one-year-old patient K. came to the dental clinic with the problem of pain in the projection of tooth 4.6, which occurs during chewing. A detailed examination revealed that the crown of tooth 4.6 had previously undergone restoration using a filling material that had defects. It was decided that tooth 4.6 should be removed and subsequently replanted. The tooth was extracted according to established procedures, while maximally preserving the surrounding periodontal and periosteal tissues. To preserve periodontal tissues, alveolar curettage was carefully performed. During the extraction of the tooth, it was longitudinally divided into two parts – the medial and distal roots. After this, the root canals were treated using extraoral therapy. The roots of tooth 4.6, treated with an antiseptic, were returned to their anatomical positions in the alveolus. The final stage was the creation of a control x-ray to verify the correctness of the replantation. Conclusions. After two years of observation of tooth 4.6, which was subjected to replantation, no pathological changes in root stability were detected. It was reported that the soft tissue surrounding the roots of the tooth formed a structure similar to the periodontal sulcus, which facilitated the use of retraction cord during tooth preparation.

Ultrasound Findings After Breast Cancer Radiation Therapy: Cutaneous, Pleural, Pulmonary, and Cardiac Changes.

External beam radiation therapy (RT) can induce toxicity in patients surgically treated for breast cancer. Modern irradiation techniques have lowered the incidence and severity of radiation-induced injuries; however, their side effects on normal tissues remain challenging. This review illustrates early and late changes observed using ultrasound (US) imaging, including echocardiography, at the skin, muscle, pleura, lungs, and heart levels. The US findings and the potential role of this technique in detecting and grading early and late complications of RT are highlighted in this article. US has proven useful in the differential diagnosis of post-RT complications, including but not limited to cancer recurrence and toxicity from other sources, such as anticancer drugs. Additionally, considering the progressive nature of RT-induced injury, early detection of toxicity may be helpful in the individual stratification of damage risk and serve as a tool for patient screening and management. In these cases, US can be used as a radiation-free biomarker of RT side effects at the subclinical stage.

Is Remission Now an Achievable Goal for More Patients with Systemic Lupus Erythematosus?

More than 3.4 million people worldwide are affected by systemic lupus erythematosus (SLE), a chronic, complex, and unpredictable autoimmune condition that can take years to diagnose. SLE, the most common form of lupus, frequently has a profoundly negative impact on the quality of life for patients, with many reporting chronic fatigue, anxiety, and pain as symptoms. Inadequate disease control, and associated side effects of current treatment for people with SLE, lead to recurrent flares in symptoms and high risk of organ damage. Fifty percent of people with SLE have irreversible organ damage within 5 years of diagnosis due to long-term oral glucocorticoid (GC) use, disease flares, and persistent disease activity. SLE mortality remains unacceptably high and is one of the top 10 causes of death in young women in the USA. Although the speed of innovation has accelerated in recent years, there is still a great need beyond symptom management to tackle the underlying cause of the disease and achieve clinical remission for patients. In 2023, the European Alliance of Associations for Rheumatology (EULAR) updated its recommendations for SLE management, elevating the importance of treating to target remission or low disease activity with elimination of steroids, where possible, to reduce the risk of organ damage and adverse outcomes in patients. EULAR defines remission in SLE, according to the Definition of Remission in SLE (DORIS) criteria, as having no disease activity while receiving treatment, but GC ≤5 mg/day. Two leading SLE experts, Ian Bruce, Queen’s University Belfast, UK, and Julia Weinmann-Menke, Medical Center of the Johannes Gutenberg University, Mainz, Germany, discuss why remission is now a realistic goal in SLE, and how aiming for early and sustained remission can help to improve patient outcomes and address urgent unmet medical needs.

026. Utilizing Pre-Existing Lacerations for Frontal Bone Fracture Management: A Case Report

Background: Patients with fractures of the frontal bone use the coronal incision approach to expose the anterior cranial vault, including the forehead. The flap allows for widespread exposure of the fractures, facilitating access for the removal of segmental fractures and hematoma evacuation. Maintaining sufficient pedicle width is crucial to reduce the risk of unintentional arterial damage and to ensure proper venous drainage. The objective of this study was to document the surgical approach for segmental fracture removal under a forehead pedicle flap. Case: This case presents a 22-year-old male with moderate traumatic brain injury, who had two lacerations on his forehead and showed an open depressed fracture of the frontal bone after a motor vehicle collision. The patient experienced loss of consciousness and a history of vomiting. Imaging revealed intracerebral hemorrhage in the frontal region and a depressed fracture of the frontal bone. Intraoperative findings revealed the fracture site through the previous laceration incision. The fracture was clearly evaluated by the surgeon using tools to lift the skin between the two incisions. Conclusion: Despite the access for segment fracture removal being conducted through a pre-existing laceration, the patient outcomes were favorable, and no complications were reported.

Alfacalcidol-Induced Kidney Injury in Patients with Severe Motor and Intellectual Disabilities.

Patients with severe motor and intellectual disabilities (SMID) often experience insufficient physical activity, leading to osteoporosis. The active form of vitamin D is commonly prescribed for the prevention or treatment of osteoporosis. We observed four cases of kidney injury believed to be associated with the administration of 1α-OH vitamin D (alfacalcidol) preparations. This study employed a case series design to investigate change in kidney function in SMID patients following administration or discontinuation of alfacalcidol. We retrospectively analyzed data of 23 SMID patients (sex: 10 males, 13 females; age range: 27 to 74 y), and assessed kidney function, serum calcium, and albumin levels. Data was grouped into A: 16 cases collected both before starting alfacalcidol administration and during alfacalcidol administration; and into B: 11 cases collected during alfacalcidol administration and after discontinuation of alfacalcidol administration. Of the 23 patients, four were assigned into both group A and group B. Of the 16 cases in group A, six showed ≥30% decreased kidney function. Of the 11 cases in group B, the median values of modified Cr-eGFR were 43.0 and 65.1 mL/min/1.73 m2, respectively (p=0.008), indicating a significant improvement in kidney function. It is essential for practitioners to understand that osteoporosis may ordinarily occur in SMID patients due to reduced bone stimulation. Thus caution must be exercised when administering active vitamin D preparations to this population, as they carry a risk of kidney organ damage despite having no direct effect on bone health.

Heart Rate and Rhythm Changes in Dogs Treated in a Hyperbaric Oxygen Chamber

In veterinary medicine, hyperbaric oxygen chamber treatment (HBOT) is gaining popularity. Therefore, an increasing number of patients referred for this therapy are being recorded, mainly due to ischemic events, wound healing support, and a high risk of reperfusion damage. During the HBOT procedure, several changes occur in the body’s micro- and macroenvironments. This study involved 34 dogs of various ages and health statuses. The atmospheric conditions in the test hyperbaric chamber included a pressure of 1.5 atmosphere absolute (ATA) at 100% oxygenation. The individuals were divided into three groups: (1) individuals with degenerative mitral valve disease (DMVD), (2) individuals with diseases other than cardiac issues, and (3) healthy individuals who qualified for the HBOT procedure. The period of measurement using the Holter apparatus was divided into four stages: 30 min before the subject’s placement in the hyperbaric chamber; a 4-min compression period (setting chamber conditions); a 90 min HBOT period; and a 1 min decompression period of the hyperbaric chamber. During the HBOT, there was a statistically significant decrease in heart rate in groups 2 and 3 compared to group 1. The heart rate in group 1 remained unchanged through every period of the study. In addition, some of the dogs developed respiratory arrhythmia; in two dogs, premature ventricle beats occurred. The changes observed during the ventricular period indicate that the HBOT procedure causes a significant change in heart rate in dogs without cardiac diseases.

Shear Bond Strength of Ceramic Brackets on Enamel Conditioned With CO2 Laser.

Objective This study evaluated the shear bond strength of ceramic brackets on enamel conditioned using three methods: CO2 laser, 37% phosphoric acid, and a combination of both, and analyzed the adhesive remnant index (ARI) to determine the amount of residual adhesive after bracket removal. Material and methods A total of 120 human premolars were stored in 0.2% thymol (Wt/vol) and divided into four groups (n=30/group): Group I was enamel conditioned with 37% phosphoric acid; Group II was irradiated with a CO2 laser at 0.5W power; Groups III and IV, 37% phosphoric acid; and CO2 laser wascombined at powers of 0.5W and 3W, respectively. Brackets were bonded using Transbond Plus CC resin. Samples were light-cured for 15 seconds and stored (37°C, 24 h). ARI assessment: The amount of adhesive remaining on the enamel surface was determined using a scale of 0 to 3. The analysis of shear bond strength and ARI was performed using the Kruskal-Wallis Test. Results Statistical analysis revealed significant differences between some groups. Group III, which combined acid etching and CO2 laser conditioning, showed lower bond strength than the control group, although not significantly. On the other hand, Group II (CO2laser only) showed the lowest bond strength and significant differences compared to the different groups, indicating that the exclusive use of laser is ineffective for conditioning. Significant differences were also observed between Groups III and IV, with Group IV exhibiting higher bond strength. However, the average value (GIII: 10.59±5.66 and GIV: 18.01±8.95 MPa) exceeded the recommended range (5.9 - 7.8 MPa). Regarding the ARI, Group II showed the lowest value, with significant differences compared to the other groups. Although Group IV had a higher ARI value than Group III, this difference was not statistically significant. Conclusions The combined use of phosphoric acid and CO2 laser provides adequate bond strength for ceramic brackets, with a lower amount of residual adhesive, which facilitates their removal and reduces the risk of damage to the enamel. Although laser irradiation alone does not provide sufficient bond strength, its use in combination with 37% phosphoric acid optimizes retention and minimizes the negative effects associated with conventional acid etching.

Drought and heat stress interactions: Unveiling the molecular and physiological responses of Persian walnut

While numerous studies explored the response of walnut plants to drought stress (DS), there remains a significant gap in the knowledge regarding the impact of heat stress (HS) and the combined effects of DS and HS on the recovery capacity of walnut trees. This study aimed to investigate the mechanism of Persian walnut (cv. Chandler) response to the combined DS and HS, focusing on various aspects including photosynthesis, water relations, and osmotic regulation. The treatments involved subjecting plants to DS (through a withholding method for 24 d), HS (gradually up to 40 °C for 8 d), and a combined DS and HS, which were compared to a control group (no stress) during the stress and recovery phases. The results showed that DS had significantly more negative effects on chlorophyll content, relative water content (RWC), leaf water potential (WP), osmotic potential (OP) compared to HS. Involvement of osmoregulation mechanism was detected more in DS and HS plants through the accumulation of proline, glycine Betaine and total soluble carbohydrates. The functionality of photosynthesis was significantly impacted by both HS and DS, respectively. While the HS accelerated the change of the abovementioned physiological processes in drought-stressed seedlings. Consistently, more pronounced damage was found in leaves under the combined stress, alongside the decrease RWC, chlorophyll content and fluorescence ratios. Based on the analysis of the linear mixed-effect model, the effects of combined stress and HS on photosynthesis parameters were detected in the early stages of stress compared to DS. Within a range of stresses, the abovementioned physiological processes of individual and combined-stressed plants recovered to levels comparable to those of the control. Our results also showed a substantial reduction in the expression of the photosynthetic genes (Fd, Cyt b6f, and PsbB) in Persian walnut saplings under abiotic stress conditions indicating significant damage to their photosynthetic apparatus. This study highlights that, under scenarios of aggravating drought occurring with heat, walnut seedlings could face a high risk of damage to physiological structures in relation to the synergistically increased hydraulic and thermal impairments.

A Review of Intelligent Depth Distance Perception Research for Power Transmission Line Corridor Scenarios

Transmission lines are essential carriers for the transmission of electrical energy, and their safe operation is fundamental to ensuring reliable power supply. However, the environment of transmission line corridors is complex and variable, posing numerous risks of external damage. With the development of smart power systems, information technologies such as video monitoring provide effective means for monitoring and managing external damage to transmission lines. Nonetheless, the current technology for identifying external damage and safe distances for transmission lines is weak, leading to frequent false alarms and low efficiency in practical applications. To address this issue, this paper systematically reviews and summarizes the progress of distance recognition technology in power systems. First, it outlines the spatial distance perception performance requirements for models in transmission line corridor scenarios and summarizes the spatial distance data characteristics of these corridors. Second, the paper categorizes existing common safety distance recognition methods from the perspectives of active and passive ranging, analyzing their advantages and disadvantages in the context of transmission line corridors. Finally, this paper summarizes the types and performance characteristics of current deep learning-based distance recognition methods and proposes a potential application framework for these methods in transmission line corridor scenarios. It also discusses the future application prospects and challenges faced by this framework.

Vitreous Hydro-dissection with a Flute Needle for Inducing Posterior Vitreous Detachment in Pediatric Retinopathies.

To present a novel intraoperative technique using a flute needle to induce posterior vitreous detachment (PVD) in pediatric retinal cases. Following 23-gauge pars plana vitrectomy in pediatric eyes with complex vitreoretinal disease, triamcinolone is applied for staining, and vitreous hydro-dissection is performed. A flute needle containing basic salt solution (BSS) is introduced to separate the thin residual posterior vitreous cortex from the retina near the vascular arcades. Gentle taps allow balanced salt solution (BSS) to enter the vitreous crevice, with controlled oscillation facilitating separation. PVD is then induced, and the vitrector is used to lift and complete the detachment. Vitreous hydro-dissection with a flute needle was effective in inducing PVD in pediatric eyes with complex vitreoretinal disease. We report no intraoperative or postoperative complications. This adjuvant vitreous hydro-dissection technique facilitates PVD induction and may reduce the associated risk of iatrogenic retinal damage.

Autoinjector optimization through cavitation response and severity minimization

Abrupt acceleration of the syringe of an autoinjector (AI) upon rod-plunger impact may induce undesired severe cavitation events and impose extraneous stresses upon the device, leading to device failure. Cavitation results from a rapid and significant pressure drop in a liquid, leading to the formation and growth of small vapor-filled cavities. Upon collapse, these cavities generate an intense shock wave that may lead to protein aggregation and device container damage and shatter. Since the maximum acceleration of the syringe depends upon the operating conditions of the AI, the severity of cavitation will likewise depend on the operating conditions of the AI. Likewise, injection time and ensuring proper needle displacement before drug release also depend on operating conditions, making optimization of the autoinjector a multiobjective optimization problem.Therefore, in this study, optimization of an autoinjector to limit cavitation severity is pursued via an experimentally validated computational model for cavitation in spring-driven autoinjectors. Our goal is to locate AI design configurations that balance maximizing device performance and patient comfort and minimizing the risks of device damage and severe cavitation upon actuation.Relevant parameters of interest are the drive spring force, air gap height, solution viscosity, friction between the rod and spring, frictional force on the plunger, rates of change of frictional force on the plunger, elasticity of plunger, viscosity of the plunger, and initial displacement between the plunger and the driving rod. The kinematics of the syringe barrel, needle displacement (travel distance) at the start of drug delivery, and injection time are gathered using an experimentally validated autoinjector kinematics model. At the same time, cavitation bubble dynamics are resolved using an experimentally validated cavitation model that takes the temporal displacement of the syringe and temporal air gap pressure as inputs.We use our experimentally validated models to explore the parameter space and understand the driving factors of our desired outcomes. Subsequently, we pose the design problem as a multi-objective optimization problem and develop a deep neural network surrogate model supplemented with iterative learning to speed up optimization. A variance-based sensitivity analysis was performed to determine the sensitivity and influence of design parameters on the outcomes, and the main contributors to the outcomes of interest were isolated. Using a multi-objective optimization framework, we located 300 + successful candidates and evaluated them through uncertainty analysis to identify three promising candidates that meet all criteria for drug viscosities of interest. Finally, we show that this methodology can be used to conduct hypothesis testing, leading to novel design configurations.

Multi-objective optimal control of a hybrid offshore wind turbine platform integrated with multi-float wave energy converters

Offshore floating wind turbines will play a pivotal role in achieving net-zero emissions. This study explores a hybrid platform combining an offshore floating wind turbine with wave energy converters (WECs) from an active control perspective to mitigate turbine damage risk while maximizing wave energy conversion. Initially, the control-oriented state-space modelling of the hybrid platform and the validation of the time-domain Cummins-type models of different orders are performed by the Eulerian-Lagrangian method with model linearization and downscaling. Then, a multi-objective non-causal optimal controller is introduced, balancing wave energy capture and penalizing the nacelle acceleration. When wave energy capture maximization is set as the control target, the proposed optimal controller can improve energy output by 184% as compared against a well-tuned passive damper across all peak periods tested. However this causes peak hub acceleration to increase marginally beyond the desirable limits of 3–4 m/s2 for wind turbine operation. When hub acceleration is penalized, the multi-objective optimal controller can reduce peak values below limits by between 40% and 61% with trivial loss of wave energy capture.