Early Detachment Research Articles

Early Flap Detachment of Heterodigital Island Flaps

Early Flap Detachment of Heterodigital Island Flaps

Accelerated podocyte detachment early after kidney transplantation is related to long-term allograft loss of function.

Kidney allograft half-life has not improved despite excellent short-term survival. Recent long-term surveillance biopsy studies identify accumulating glomerulosclerosis (GS) to be associated with late allograft loss. While podocyte depletion is well known to drive proteinuria and GS in animal models and human glomerular diseases, its role in renal allograft loss of function is generally not recognized. To address these questions, we collected urine from 125 kidney allograft recipients in the first posttransplant year for urine pellet messenger RNA (mRNA) and protein analysis, with a median follow up of 4.5years. Using multivariable linear models adjusted for proteinuria, transplant, recipient and donor factors, we observed that the average urine pellet podocin mRNA normalized to urine creatinine (UPodCR) in the first posttransplant year was significantly associated with an estimated glomerular filtration rate (eGFR) decline (P = 0.001). The relationship between UPodCR and eGFR decline persisted even among recipients who were nonproteinuric and who had no recurrent or de novo glomerular disease identified on 1-year protocol biopsy. Finally, we identified recipient, donor and recipient:donor body surface area mismatch ratio to be independently associated with UPodCR early after transplantation. A larger donor was protective, while a larger recipient and increased recipient:donor size mismatch ratio were associated with increased UPodCR. These findings support the concept that in kidney allografts, accelerated podocyte loss precedes proteinuria and is associated with inferior long-term allograft outcomes as measured by eGFR decline and may be initiated by recipient:donor size mismatch. Modulating factors driving early podocyte detachment after kidney transplantation may help improve long-term outcomes.

Petrogenesis and tectonic implications of Early Cretaceous andesitic–dacitic rocks, western Qinling (Central China): Geochronological and geochemical constraints

40Ar/39Ar and zircon U–Pb geochronological and whole-rock geochemical analyses for the Laozanggou intermediate-acidic volcanic rocks from the western Qinling orogenic belt, Central China, constrain their petrogenesis and the nature of the Late Mesozoic lithospheric mantle. These volcanic rocks yield hornblende or whole-rock 40Ar/39Ar plateau ages of 128.3–129.7 Ma and zircon U–Pb age of 131.3 ± 1.3 Ma. They exhibit SiO2 of 56.86–66.86 wt.%, K2O of 0.99–2.46 wt.% and MgO of 1.03–4.47 wt.%, with Mg# of 42–56. They are characterized by arc-like geochemical signatures with significant enrichment in LILE and LREE and depletion in HFSE. All the samples have enriched Sr–Nd isotopic compositions with initial 87Sr/86Sr ratios ranging from 0.7112 to 0.7149 and ɛNd(t) values from −10.2 to −6.3. Such geochemical signatures suggest that these volcanic rocks were derived from enriched lithosphere-derived magma followed by the assimilation and fractional crystallization (AFC) process. The generation of the enriched lithospheric mantle is likely related to the modification of sediment-derived fluid in response to the Triassic subduction/collision event in Qinling orogenic belt. The early Cretaceous detachment of the lithospheric root provides a reasonable mechanism for understanding the petrogenesis of the Laozanggou volcanic sequence in the western Qinling orogenic belt.

Mutant p53R248Q downregulates oxidative phosphorylation and upregulates glycolysis under normoxia and hypoxia in human cervix cancer cells.

Mutations in p53 are strongly associated with several highly malignant cancer phenotypes but its role in regulating energy metabolism has not been completely elucidated. The effect on glycolysis and oxidative phosphorylation (OxPhos) of mutant p53R248Q overexpression in HeLa cells (HeLa-M) was analyzed and compared with cells overexpressing wild-type p53 (HeLa-H) and nontransfected cells containing negligible p53 levels (HeLa-L). p53 R248Q overexpression induced early cell detachment during in vitro growth; however, detached HeLa-M cells showed high viability, shorter generation time and significant diminution in the adhesion proteins E-cadherin and β-catenin versus HeLa-H and HeLa-L cells. Under normoxia, a lower growth rate of attached HeLa-M cells correlated with decreased levels of proliferating cell nuclear antigen (PCNA), peroxisome proliferator-activated receptor gamma coactivator 1-α (PGC-1α), adenosine monophosphate-activated protein kinase (AMPK), mitochondrial proteins (20-80%) and OxPhos flux (69 ± 12%). On the contrary, HeLa-M also showed increased contents of CDKN1A, nuclear factor κB (NF-κB), c-MYC, hypoxia-inducible factor 1-α (HIF-1α; 1-4 times), glycolytic HIF-1α targets (2-4 times), and glycolysis flux (2-fold) versus HeLa-H. In consequence, glycolysis provided ~70% of the cellular adenosine triphosphate (ATP) in HeLa-M cells under normoxia whereas, OxPhos predominated (65-82%) in HeLa-H and HeLa-L cells. Pifithrin-α, a specific p53 inhibitor, did not alter the p53 R248Q target protein contents and OxPhos and glycolytic fluxes, and a poor HIF-1α-p53 R248Q interaction was attained, in HeLa-M cells. These observations suggested that p53 R248Q deficiently interacted with pifithrin-α and HIF-1α. Therefore, lower mitochondrial biogenesis, deficient HIF-1α/mutant p53 interaction, and development of a pseudohypoxic state under normoxia were the apparent biochemical mechanisms underlying glycolysis activation and OxPhos downregulation in HeLa-M cells.

Effect of discontinued oral antithrombotics during perioperative period of retinal detachment surgery

Objective To observe the effect of discontinued oral antithrombotics during perioperative period of retinal detachment surgery on the efficacy and cardio-cerebral-vascular system. Methods The data of 46 eyes of 46 cases of early retinal detachment, who sustained oral prophylactic antithrombotics were analyzed retrospectively.All cases were divided into 2 groups randomly: group A, the total of 25 eyes suspended oral antithrombotics at 7 days before vitrectomy and continued oral antithrombotics at 7 days after vitrectomy. The group B, the total of 21 eyes did not suspend oral administration of antithrombotic agents before vitrectomy. All cases of two groups underwent vitrectomy under non-contact wild-angle viewing system and chandelier. The visual recovery, postoperative hemorrhage and effect on cardio-cerebral-vascular system were analyzed. Results BCVA of two groups were improved after vitrectomy (P=0.001, 0.000). The difference of intra- and post-operative hemorrhage was not significant between the two groups (P=0.410, 0.940). No cardiovascular or cerebrovascular event occurred during perioperative period. The waiting time for vitrectomy of group A was longer than that of group B (P=0.000), and the rate of silicone oil tamponade of group A was higher than that of group B (P=0.023). At the last follow-up, the visual acuity of group B was significantly better than that of group A (P=0.000). Conclusion The oral antithrombotics could not be suspended during perioperation of vitrectomy. Key words: Detachment, retinal; Vitrectomy; Antithrombotics; Hemorrhage; Visual acuity

Preliminary results of the placental decorin profile in bovine pregnancy and parturition

Decorin is a small leucine-rich proteoglycan which is involved in multiple biological functions mainly as a structural and signaling molecule. Due to its biological properties in connective tissue, decorin may participate in remodeling of ECM during attachment and detachment of placenta within the course of pregnancy and at parturition in cows. The aim of the study was to detect the presence of decorin protein in bovine placental tissues and to evaluate its profile during pregnancy and at parturition. Placental tissues from healthy pregnant cows (2–5 month) were collected in abattoir (n = 10), while parturient tissues were obtained during caesarian section at physiological term (n = 6). Maternal and fetal parts were separated manually and subjected to homogenization and to quantitative ELISA and verification by Western blotting with anti-decorin antibodies. ELISA test showed that the concentration of decorin during pregnancy was higher in the fetal part of placenta compared with the maternal part (p < 0.001). Similar pattern was noted regarding to maternal and fetal samples derived from parturient cows. Our preliminary results demonstrate that the concentration of decorin is gestation time-dependent in healthy bovine placenta. Possible confirmation of the involvement of decorin in early pregnancy attachment and detachment of the placenta during parturition requires further research.

A Study of the Flow Patterns Between Two Corrugated Plates With an Egg-Carton Configuration

Enhancing mixing in heat exchangers for low Re regimes is vital. A better mixing may be achieved by using corrugated plates. In this work, the flow patterns between corrugated plates with a novel egg-carton geometry were studied. Three-dimensional (3D) numerical models were developed for the steady laminar flow between two corrugated plates having 180 deg or 0 deg phase angles. The Reynolds number (Re ≤ 600) was defined as a function of the average distance between the corrugated plates. The numerical models were strictly developed and corroborated to achieve global convergence, local convergence, and grid-size independence. For both phase angles, it was determined that “close recirculations” decrease in size downstream and finally disappear becoming “open recirculations” due to the flow developing characteristics; the secondary flow regions were found to grow downstream; interestingly, increments on the Reynolds number favor recirculation growth and early flow detachment; the behavior and geometry of the recirculation were in line with previous flow visualization results. The recirculations were determined to be z-symmetric with respect to the channel center only for the 180 deg model. The recirculations in the 0 deg model were smaller and became “open recirculations” earlier than in the 180 deg model. Convex geometries on the transversal direction were found to favor detachment, while concave geometries inhibit it. The capability of the numerical methods to track flow paths in any direction showed a complex three-dimensional flow causing 3D-interaction among secondary flows and the main flow not reported before for these channels and just hinted by previous flow visualization studies.

Monitoring Unfolding of Titin I27 Single and Bi Domain with High-Pressure NMR Spectroscopy

A complete description of the pathways and mechanisms of protein folding requires a detailed structural and energetic characterization of the folding energy landscape. Simulations, when corroborated by experimental data yielding global information on the folding process, can provide this level of insight. Molecular dynamics (MD) has often been combined with force spectroscopy experiments to decipher the unfolding mechanism of titin immunoglobulin-like single or multidomain, the giant multimodular protein from sarcomeres, yielding information on the sequential events during titin unfolding under stretching. Here, we used high-pressure NMR to monitor the unfolding of titin I27 Ig-like single domain and tandem. Because this method brings residue-specific information on the folding process, it can provide quasiatomic details on this process without the help of MD simulations. Globally, the results of our high-pressure analysis are in agreement with previous results obtained by the combination of experimental measurements and MD simulation and/or protein engineering, although the intermediate folding state caused by the early detachment of the AB β-sheet, often reported in previous works based on MD or force spectroscopy, cannot be detected. On the other hand, the A′G parallel β-sheet of the β-sandwich has been confirmed as the Achilles heel of the three-dimensional scaffold: its disruption yields complete unfolding with very similar characteristics (free energy, unfolding volume, kinetics rate constants) for the two constructs.

Evaluation of the FreeStyle® Libre Flash Glucose Monitoring System in Children and Adolescents with Type 1 Diabetes

Background/Aims: The FreeStyle® Libre Flash Glucose Monitoring System (FGM, Abbott) measures glucose concentrations in the interstitial fluid for up to 14 days. It has been approved for use in children aged > 4 years in January 2016. Experience in children is still limited. We evaluated the accuracy and usability of the FGM in children with type 1 diabetes mellitus (DM). Methods: 67 children with type 1 DM (35 girls), aged 4–18 years, were included. Subjects wore a sensor on the back of their upper arm. For the first 14 days, they regularly measured capillary blood glucose (BG) with their usual BG meter (Accu-Chek® Mobile [ACM], Roche [n = 24]; Contour® Next Link [CNL], Bayer [n = 26]; OneTouch® Verio® IQ [OTV], LifeScan [n = 17]) followed by a sensor glucose (SG) scanning. SG readings were compared to BG measurements by consensus error grid (CEG) analysis; the mean difference (MD), the mean relative difference (MRD), the mean absolute difference (MAD), and the mean absolute relative difference (MARD) were calculated. After 14 days, subjects were asked to fill in a questionnaire on the usability of the FGM. Results: 2,626 SG readings were paired with BG results. FGM readings were highly correlated with BG (r = 0.926, p < 0.001). 80.3% of the data pairs were in zone A (= no effect on clinical action) and 18.4% were in zone B (= altered clinical action with little or no effect on the clinical outcome) of the CEG. Overall MD was +7.5 mg/dL; MD varied with the BG meter: ACM +10.4 mg/dL, CNL +14.2 mg/dL, OTV –3.6 mg/dL (p < 0.001). Overall, MARD was 16.7%. We observed a large interindividual variability in the accuracy parameters. MD and MRD were inversely related to BMI (r = –0.261 [p < 0.05]; r = –0.266 [p < 0.05], respectively). MARD was inversely related to age (r = –0.266 [p < 0.05]). Twenty-nine patients (43.3%) reported sensor problems, mainly early detachment of the sensor. Nonetheless, the usability questionnaire indicated high levels of satisfaction. Conclusions: Our results showed a reasonable agreement between the FGM SG readings and capillary BG measurements in children. There was, however, a large interindividual variability. The wearing of the sensor requires special attention. Further studies in children are imperative in order to document the accuracy and safety of the FGM in the paediatric population.

Factors Associated With Early Graft Detachment in Primary Descemet Membrane Endothelial Keratoplasty

To evaluate the risk factors for early graft detachment in Descemet membrane endothelial keratoplasty (DMEK). Case-control study. Participants: A total of 173 donor corneas and 173 eyes of the patients following DMEK or DMEK in combination with phacoemulsification and intraocular lens implantation were included. Pre-stripped DMEK grafts were transplanted using pull-through technique. At the end of surgery, the anterior chamber was filled with air, which was removed 3 hours later only if pupillary block was suspected. Rebubbling was performed in all cases with graft detachment, independently of its extension, as documented by means of anterior segment optical coherence tomography. The donor characteristics were collected from the eye bank database and matched with the recipient database. Donor and recipient characteristics affecting graft detachment using univariate and multivariate analysis. The combination of DMEK with cataract removal and IOL implantation (odds ratio [OR]= 5.31, 95% confidence interval [CI] 2.03-13.86, P < .002) and air fill of ≤75% of anterior chamber height at 2-3 hours postoperatively (OR= 2.66, 95% CI 1.12-6.34, P= .027) were found to be independent risk factors for postoperative graft detachment. Cataract removal at the time of DMEK is a risk factor for early graft detachment and therefore sequential surgery may be preferred over combined surgery in an attempt at minimizing rebubbling. Air level in the anterior chamber should be monitored and maintained above 75% in the early hours following surgery.

Stability of the anterior arm of three different Hyrax hybrid expanders: an in vitro study.

ABSTRACTIntroduction: The force applied to the teeth by fixed orthopaedic expanders has previously been studied, but not the force applied to the orthodontic mini-implant (OMI) used to expand the maxilla with Hyrax hybrid expanders (HHE). Objective: The aim of this article was to evaluate the clinical safety of the components (OMI, abutment and double wire arms) of three different force-transmitting systems (FTS) for conducting orthopaedic maxillary expansion: Jeil Medical & Tiger Dental™, Microdent™ and Ortholox™. Methods: For the realization of this in vitro study of the resistance to mechanical load, three different abutment types (bonded, screwed on, and coupling) and three different OMIs’ diameters (Jeil™ 2.5 mm, Microdent™ 1.6 mm and Ortholox™ 2.2 mm) were used. Ten tests for each of these three FTS were carried out in a static lateral load in artificial bone blocks (Sawbones™) by a Galdabini universal testing machine, then comparing its performance. Comparisons of loads, deformations and fractures were carried out by means of radiographs of FTS components in each case. Results: At 1- mm load and within the elastic deformation, FTS values ranged from 67 ± 13 N to 183 ± 48 N. Under great deformations, Jeil & Tiger™ was the one who withstood the greatest loads, with an average 378 ± 22 N; followed by Microdent™, with 201 ± 18 N, and Ortholox™, with 103 ± 10 N. At 3 mm load, the OMIs shaft bends and deforms when the diameter is smaller than 2.5 mm. The abutment fixation is crucial to transmit forces and moments. Conclusions: The present study shows the importance of a rigid design of the different components of HHEs, and also that HHEs would be suitable for maxillary expansion in adolescents and young adults, since its mean expansion forces exceed 120N. Furthermore, early abutment detachment or smaller mini-implants diameter would only be appropriate for children.

Évaluation pratique de la prise en charge par DSAEK des décompensations endothéliales après kératoplasties transfixiantes

To report our anatomical and functional results as well as possible complications of the first six Descemet's stripping endothelial keratoplasties (DSAEK) performed in our department for endothelial decompensation after penetrating keratoplasty (PK) METHODS: This was a retrospective and observational monocentric study of six patients with DSAEK after prior PK between January 2015and July 2016. The data collected were: demographic characteristics (age, sex), ophthalmological comorbidities, initial indication for PK, delay between PK and DSAEK. Best corrected visual acuity (BCVA) preoperatively and at 1, 3and 6months postoperatively were collected in Monoyer's and Parinaud scale and converted to log MAR for statistical analysis. The central cornea and graft thickness measured on OCT as well as postoperative complications were also collected. Mean follow-up duration was 7.2months [3-10]. The average time after PK was 7.7years. The mean age of the patients was 67.5years [32-87]. The initial indication for PK was Fuchs dystrophy (3/6), pseudophakic bullous keratopathy (1/6), corneal laceration (1/6) and other corneal dystrophy (1/6). The authors report one case a combined phaco-DSAEK surgery. The complications observed were: an early graft detachment treated by an additional air bubble injection (1/6) and cystoid macular edema in one other case. The average central corneal thickness decreased from 780μm at day7postoperatively to 656μm at 6months. The average thickness of the graft decreased from 154μm at day7to 122μm at 6months. The mean preoperative BCVA was 1.52log MAR [1.0-1.7], compared to the mean postoperative BCVA which was 1.5log MAR [1.1-2.3] at 1month, 1.15log MAR [0.5-1.7] at 3months and 1.1log MAR [0.7-1.7] at 6months (data available for 4patients at 6months). The recovery of visual acuity was limited in 2cases, despite corneal clarity restored in all our patients. Our results can be compared to those described in literature. As more penetrating keratoplasty grafts reach the end of their lives, this will allow for more powerful studies. DSAEK on eyes previously treated with PK is a good alternative to a new PK in the case of endothelial decompensation of the graft. The possibility of a posterior lamellar graft allows for faster visual recovery, with preservation of the anterior corneal power and a lower rate of complications.

Heat Transfer Improvement in Automotive Brake Disks Via Shape Optimization of Cooling Vanes Using Improved TPSO Algorithm Coupled With Artificial Neural Network

One important safety issue in automotive industry is the efficient cooling of brake system. This research work aims to introduce an optimized cooling vane geometry to enhance heat removal performance of ventilated brake disks. The novel idea of using airfoil vanes is followed as the basis of this investigation (Nejat et al., 2011, “Heat Transfer Enhancement in Ventilated Brake Disk Using Double Airfoil Vanes,” ASME J. Therm. Sci. Eng. Appl., 3(4), p. 045001). In order to perform the optimization technique efficiently, an integrated shape optimization process is designed. According to the aerodynamic and heat transfer considerations, first an appropriate airfoil is selected as the base profile to be optimized. For the shape modification purpose, a curve parameterization method named class shape transformation (CST) is utilized. The control parameters defined in CST method are then established as the geometrical design variables of an improved territorial particle swarm optimization (TPSO) algorithm. In order to overcome the potential bottleneck of high computational cost associated with the required computational fluid dynamics (CFD)-based function evaluations, TPSO algorithm is coupled with a predictive artificial neural networks (ANN), well trained with an input dataset designed based on the Taguchi method. The obtained profile shows an evident convective heat dissipation improvement accomplished mainly via airflow acceleration over the vanes, avoiding early flow detachment and adjusting the flow separation region at the rear part of the suction sides. The results also reveal the approaches by which such a superior performance is achieved by means of the modified surface curvatures.

Atomistic investigation on the detachment of oil molecules from defective alumina surface

The mechanism of oil detachment from defective alumina surface in aqueous solution was investigated via atomistic molecular dynamics (MD) simulations. Special attention was focused on the effect of surface defect on the oil detachment. Our simulation results suggest that compared with perfect Al2O3 surface, defective substrate surface provides much more sites for the adsorption of oil molecules, thus it has higher oil adsorption energy. However, higher oil-solid adsorption energy does not mean that oil contaminants are much more difficult to be detached. It is found that surface defect could induce the spontaneous imbibition of water molecules, effectively promoting the detachment of oil molecules. Thus, compared with perfect alumina surface, the detachment of oil molecules from defective alumina surface tends to be much easier. Moreover, surface defect could lead to the oil residues inside surface defect. In water solution, the entire detachment process of oil molecules on defective surface consists of following stages, including the early detachment of oil molecules inside surface defect induced by capillary-driven spontaneous imbibition of water molecules, the following conformational change of oil molecules on topmost surface and the final migration of detached oil molecules from solid surface. These findings may help to sufficiently enrich the removal mechanism of oil molecules adhered onto defective solid surface.

Graft detachment and rebubbling rate in Descemet membrane endothelial keratoplasty

Descemet membrane endothelial keratoplasty (DMEK) is a selective replacement of dysfunctional endothelium with healthy donor Descemet membrane and endothelium. Although the donor preparation and surgical methods still remain a challenge, DMEK is gaining popularity in terms of early rehabilitation and visual outcomes. New and improved donor preparation techniques like prestripped DMEK tissues are being taken up rapidly because of less manipulation that is required in the surgical theatre. Donor graft delivery in the recipient eye has also been improved because of new products like prestripped and preloaded membranes. As DMEK is at its budding stage, only early outcomes have been known so far. Early graft detachment, rebubbling rates, and primary failures are still being studied in DMEK. As there are different techniques that are currently used for preparation and injection of the graft, it becomes difficult to judge the results based on specific inclusion and exclusion criteria. Graft detachment and rebubbling rates have been a huge challenge both during the surgery and also while reporting postoperative data. We highlight the importance of defining graft detachment and rebubbling rates and their surgical relevance, which may also have an impact on graft preparation and insertion techniques.

Effect of 3D magnetic perturbations on divertor conditions and detachment in tokamak and stellarator

Enhanced perpendicular heat and momentum transport induces parallel pressure loss leading to divertor detachment, which can be produced by the increase of density in 2D tokamaks. However, in the 3D configurations such as tokamaks with 3D fields and stellarators, the fraction of perpendicular transport can be higher even in a lower density regime, which could lead to the early transition to detachment without passing through the high-recycling regime. 3D fields applied to the limiter tokamak plasmas produce edge stochastic layers close to the last closed flux surface (LCFS), which can allow for enhanced perpendicular transport and indeed the absence of high recycling regime and early detachment have been observed in TEXTOR and Tore Supra. However, in the X-point divertor tokamaks with the applied 3D fields, the parallel transport is still dominant and the detachment facilitation has not been observed yet. Rather, 3D fields affected detachment adversely under certain conditions, either by preventing detachment onset as seen in DIII-D or by re-attaching the existing detached plasma as shown in NSTX. The possible way for strong 3D effects to induce access to the early detachment in divertor tokamaks appears to be via significant perpendicular loss of parallel momentum by frictional force for the counter-streaming flows between neighboring flow channels in the divertor. In principle, the adjacent lobes in the 3D divertor tokamak may generate the counter-streaming flow channels. However, an EMC3-EIRENE simulation for ITER H-mode plasmas demonstrated that screened RMP leads to significantly reduced counter-flows near the divertor target, therefore the momentum loss effect leading to detachment facilitation is expected to be small. This is consistent with the observation in LHD, which showed screening (amplification) of RMP fields in the attachment (stable detachment) case. Work for optimal parameter window for best divertor operation scenario is needed particularly for the 3D divertor tokamak configuration.

Complications of Tibial Tuberosity Osteotomy.

It is important to understand potential complications of tibial tuberosity osteotomies (TTOs) and how to avoid them. TTO is associated with a 1% to 3% rate of tibial fracture and 1% rate of nonunion. Early weight-bearing and complete detachment of the distal tuberosity may increase these risks. Painful screws requiring removal occur in 3% to 77% of cases. Use of small (3.5- mm diameter), countersunk screws reduces this risk. Recurrent instability occurs in ∼5% of cases at 5 years. The risk of deep-vein thrombosis (4%) after TTO is higher than that associated with other sports surgeries (1% to 2%). The risk of wound complications is ∼1% and can be reduced with meticulous handling of soft tissues and avoidance of large medial incisions. The risk of deep infection is <1%. Severe complications such as compartment syndrome and pulmonary embolism are rare.

Late Cretaceous extension and exhumation of the Stong and Taku magmatic and metamorphic complexes, NE Peninsular Malaysia

Fragmentation of large continental areas by post-orogenic extension requires favourable geodynamic conditions and frequently occurs along pre-existing suture zones or nappe contacts, as exemplified by the Stong and Taku magmatic and metamorphic complexes of northern Peninsular Malaysia. For this case, we have employed a field and microstructural kinematic study combined with low temperature thermo-chronology to analyse the tectonic and exhumation history. The results show that the Late Palaeozoic - Triassic Indosinian orogeny created successive phases of burial related metamorphism, shearing and contractional deformation. This orogenic structure was subsequently dismembered during a Cretaceous thermal event that culminated in the formation of a large scale Late Santonian - Early Maastrichtian extensional detachment, genetically associated with crustal melting, the emplacement of syn-kinematic plutons and widespread migmatisation. The emplacement of these magmatic rocks led to an array of simultaneously formed structures that document deformation conditions over a wide temperature range, represented by amphibolite- and greenschist- facies mylonites and as well as brittle structures, such as cataclastic zones and normal faults that formed during exhumation in the footwall of the detachment. The formation of this detachment and a first phase of Late Cretaceous cooling was followed by renewed Eocene - Oligocene exhumation, as evidenced from our fission track ages. We infer that an initial Cretaceous thermal anomaly was responsible for the formation of an extensional gneiss dome associated with simple shear and rotation of normal faults. These Cretaceous processes played a critical role in the establishment of the presently observed crustal structure of Peninsular Malaysia.

Surgical Management and Outcome of Open Globe Injuries with Posterior Segment Complications: A 10-Year Review

ABSTRACTPurpose: To describe the characteristics, management, and outcomes of open globe injured (OGI) eyes that underwent pars plana vitrectomy (PPV) for posterior segment complications. Methods: Retrospective chart review of cases that underwent PPV for posterior segment complications associated with OGI between 2003-2012 at University Hospital, Newark, NJ. Results: 120 eyes were identified and classified as follows: “early retinal detachment (RD)” (within 30 days of OGI), 64 (53%) eyes; “delayed RD” (≥30 days after OGI), 30 (25%) eyes; and “no RD,” 26 (22%) eyes. Injuries included penetrating (39 (33%) eyes), rupture (60 (50%) eyes), and penetrating wounds with retained intraocular foreign body (21 (17%) eyes). Injuries in Zones I, II, and III were seen in 40 (35%) eyes), 38 (34%) eyes, and 35 (31%) eyes, respectively, with statistically different ocular trauma scores (p<0.01) associated with each zone of injury. Mean presenting and final logMAR VA were 2.20± 0.63 and 1.87 ±0.60, respectively (p<0.01), with a mean follow-up of 3.2 years. Final overall anatomic success after surgeries was 98% for early RD and 95% for delayed RD. Conclusion: Despite a high anatomic success rate, the overall functional success rate for eyes with posterior segment trauma that undergo PPV is poor and comparable to other studies.

Toxicity of Intracameral Injection of Fourth-Generation Fluoroquinolones on the Corneal Endothelium.

The aim of this study was to compare the cellular susceptibility patterns and morphologic changes in the corneal endothelium associated with the use of fourth-generation fluoroquinolones. Endothelial susceptibility was assessed through intracameral injection of besifloxacin, gatifloxacin, and moxifloxacin. Human umbilical vein endothelial cells (HUVECs) were used as the standard cellular lineage to assess the quantitative toxicity of each antibiotic solution. Qualitative changes in the morphologic character of the corneal structure and the endothelial layer were generated using a combination of ex vivo and in vivo assays. Experimental assays were conducted in triplicate, and the results were statistically analyzed. At 1 hour of exposure, all HUVECs exposed to antibiotics showed viability above 85%, after 3 hours of exposure to besifloxacin, gatifloxacin, and moxifloxacin, the percentages of viable cells were 68.3 ± 4.0 (P < 0.001), 90.7 ± 4.2 (P < 0.05), and 93.3 ± 1.5 (P > 0.05), respectively. All fluoroquinolones tested showed toxicity to HUVECs, resulting in significant (P < 0.001) loss of cellular viability after 24 hours of drug exposure. Giant endothelial cells were observed in animals treated with the 3 fluoroquinolones in contrast to the absence of these abnormal cells in the untreated group. Early cellular detachment was seen in the endothelial layer after exposure to gatifloxacin and moxifloxacin. We concluded that injection of fourth-generation fluoroquinolones in the aqueous humor did not adversely affect the corneal endothelium. However, these results suggested that prophylactic intracameral injection of besifloxacin, gatifloxacin, or moxifloxacin, if needed, should be administered as a last therapeutic resource in clinical practice, with careful and constant monitoring of corneal endothelium.