Loss Of Fixation Research Articles

The effect of pupillary dilatation on visual field testing in glaucoma

Introduction The concern on the effect of pupillary dilatation on visual field parameters in patients with glaucoma comes from the fact that patients usually seek field examination after their pupils have been dilated for fundus examination. Aim To investigate the influence of pupillary dilatation on visual field testing in patients with glaucoma, by using automated static perimetry. Patients and methods A prospective comparative noninterventional clinical study was conducted on 20 eyes (11 patients) with open-angle glaucoma. Two consecutive visual field examinations were performed on each eye of all participants. The first was done on the undilated normal pupil size, whereas the second was done after dilating the pupil to 6–8 mm. Results After pupillary dilatation, fixation losses were significantly higher. There was no significant difference in false-negative or false-positive results. There was improvement in the mean deviation with no statistical significance. Pattern standard deviation showed also improvement, which was statistically significant. Discussion and conclusion It was found that pupillary dilatation caused variability and difference in the visual field parameters, which emphasizes the importance of consistent pupillary size in performing the serial automated visual field tests, especially in patients with glaucoma to allow standardized judgment on the patient’s progression.

Enhancing growth and yield potential of paddy through potassium application in North-Eastern plains of India

Split application makes potassium available at peak crop requirement period whereas basal application appeared to accommodate maximum demand at initial growth stages resulting into fixation and other losses. To assess the most suitable and economic ways of potassium application on growth and yield of transplanted paddy in north-eastern plains of India, an experimented was conducted during 2017-18, to evaluate the performance of different levels of potassium applied at different times. The experiment was laid out in split plot design with 3 replications consisting of three levels of potassium application i.e. K1-100% RDK (40kg), K2-150% RDK (60kg) and K3-200% RDK (80kg) at four different times i.e. S1 (basal), S2 (50% basal + 50% at max. tillering), S3 (50% basal + 25% at max. tillering + 25% at PI) and S4 (75% as basal + 1% spray at maximum tillering and PI). The results revealed that with increase in the level of potassium, significant positive effects on all the growth parameters and yield attributes were observed whereas potassium application with S3 showed better crop performance. Increased level of potassium (200% RDK) recorded significantly higher grain yield (4999 kg ha-1) and straw yield (8488 kg ha-1). Thus, levels of potassium in paddy may safely be increased up to 200% for maximizing yield potential as well as net profit and it should be applied in split doses with 50% of it as basal, 25% at max. tillering and rest 25% at panicle initiation.

Implant-Related Complications Following Proximal Femoral Nail Antirotation (PFNA) in Unstable Intertrochanteric Fractures – Early Follow Up

INTRODUCTION; Intertrochanteric fractures present in a wide variety of patterns that range from simple to complex and may be minimally displaced or widely displaced. Unstable intertrochanteric fracture can fail due to mechanical problems, including loss of fixation, re-fracture, or implant failure. PURPOSE; The aim of this study was to analyse the failures in patients with unstable intertrochanteric femur fractures treated with short Proximal Femoral Nail Antirotation (Synthes) METHODS; A retrospective analysis of 97 patients with unstable intertrochanteric factures (AO : 31A2, n = 65 / 67.01 % ; 31-A3: n = 32 /32.9 %) treated with a PFNA in a self-contained district general hospital was conducted. RESULTS; The study included 25 (26%) males and 72 (74%) females with mean age of 82 years. The study period was over 12 months with mean follow up of 11 months (range 6 to 18 months). Intraoperative and postoperative radiographs showed good reduction in 80 patients, acceptable in 12 and poor in 3. Twenty patients had implant related complications, consequently ten patients (10.5 %) had to undergo revision surgery. The reasons of revision surgery were; Implant failures = 8 (8.4%), Helical Blade backing out =1( 1.05 %) and Greater trochanter splintering =1 (1.05%). CONCLUSION ; Implant related complications requiring revision occurred in 10 patients (10.5 %) in early follow up. Of those requiring revision 6 patients had highly unstable 31 A2.3 type fracture. Our study reinforces high failures in unstable intertrochantric fractures. Though Ideal implant remains elusive but Optimum intraoperative reduction and use of augments should be considered to improve outcomes.

Clinical validation trial of Glaucoma Easy Screener (GES) as a low‐cost and portable visual field screening tool

AbstractPurposeThe aim of this study is to compare the performance of Glaucoma Easy Screener (GES), as a low cost and portable visual field screening tool to the glaucoma screening test (GST) from Octopus.MethodsGES is comprised of a Moto G5 smartphone, Homido v1 virtual reality headset and a gaming joystick for user input. The screening app’s design is based on the recently introduced Octopus GST perimeter. The test contains 28 points in the central 300. Test stimuli at each location are presented at an intensity level that can be detected in 95% of the time in case of a normal visual field. The app monitors false positive errors with catch trials and fixation losses using the blind spot method. Test result is presented with a plot of seen and missed points along with other parameters including test duration and reliability indices. A normative database for the GES was constructed by testing 62 eyes of 33 normal subjects (aged 22–56, 10 male/23 female) using a threshold procedure. To evaluate agreement between Octopus GST and GES, 36 eyes of 18 subjects (among the 33 normal subjects) were tested both with GES and Octopus GST.ResultsThere is a good level of agreement between Octopus GST and GES, with 31 eyes(86%) showing above 85% agreement, based on the count of seen and missed points. There was above 85% agreement for 24 points in all eyes. The remaining 4 points had an agreement between 78 and 85%. Test duration was slightly higher for GES with an average of 2 min per eye compared to 1.1 min with Octopus GST.ConclusionsResults from this clinical trial show a good level of agreement between GES and Octopus GST. GES can serve as a low‐cost and portable visual field screening kit to complement other glaucoma tests, to make referral decisions in situations where standard equipment is not available.

Magnetic resonance imaging of the failed superior capsular reconstruction

BackgroundSuperior capsular reconstruction (SCR) of the shoulder is an increasingly common procedure in the treatment of patients with massive, irreparable rotator cuff tears lacking significant osteoarthritis. Post-operatively, the appearance of failed grafts has only been described in isolated case reports and review articles. MethodsFrom January 2016 through December 2017, surgical records at a single tertiary-care facility were queried to identify all patients undergoing SCR. Patient records were reviewed for patient demographic information, reason for post-operative MRI, and post-operative surgeon assessment. 74 patients underwent SCR, of whom 12 received a follow-up MRI post-operatively. One patient was excluded due to missing records; the remaining 11 patients comprise the study cohort. Post-operative MRIs were obtained at mean six months after surgery. ResultsOn review of post-operative MRIs, three distinct locations of failure were identified. Four patients (40%) had midsubstance failure of the allograft with all glenoid and humeral head fixation remaining intact. One patient (10%) had complete detachment of the allograft from both glenoid and humeral head fixation. Five patients (50%) had detachment of the allograft from the glenoid. ConclusionIn this series of ten failed SCRs, the most common mode of failure was loss of fixation on the glenoid, followed closely by midsubstance rupture. We found no instances of isolated fixation failure on the humeral head. This series illustrates the need for careful imaging in patients whose post-operative course suggests clinical failure. These findings suggest that strengthening glenoid fixation may provide better clinical outcomes as this procedure becomes more common.Level of evidence: III - Retrospective study.

PO 18239 - Malerba Z-type osteotomy for the treatment of adult acquired flatfoot deformity

Introduction: Adult acquired flat foot deformity (AAFD) is a condition characterized by tendon and ligament failure that leads to progressive midfoot collapse and to hindfoot valgus. Calcaneal osteotomies are among the oldest and most conventional procedures for the treatment of angular limb deformities; they aim to reestablish the alignment and the line of action vector of the triceps surae muscle. Various disadvantages of classic osteotomies have been established in recent years, such as fixation loss, insufficient correction and reduced tarsal tunnel volume. Malerba Z-type osteotomy aims to resolve possible complications resulting from the usual incisions, to enhance the procedure and to allow multiplane corrections. Objective: To describe the functional and radiographic outcomes of Malerba Z-type osteotomy in patients with AAFD subjected to reconstructive surgery. Methods: Ten patients diagnosed with AAFD, with a mean age of 45 years (35-55), were operated on from January 2017 to January 2018. All patients underwent weight-bearing radiographs and alignment measurements and functional assessment using the pain visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) scale preoperatively and at the final evaluation at a mean of 12 months (6-18 months) after surgery. Results: The 10 patients showed positive progression after the surgery, reporting no major complications. Only one case of superficial dehiscence and one case of transient sural nerve neuropraxia (in different patients) were observed. On average, the AOFAS score increased by 50 points on average (25.7 to 76.6), and the VAS score decreased by 4 points (8.3 to 3.4). The mean calcaneal pitch increased from 5.5° to 15.2°. Nine patients transitioned from valgus malalignment (hindfoot angle greater than 10°) to the physiological (5 to 10° valgus) range. Conclusion: Ankle-foot realignment is an essential condition for surgical success in AAFD; it promotes a soft-tissue healing environment while maintaining an adequate muscle line of action. Malerba Z-type osteotomy was found to be a safe technique with high potential for deformity correction, leading to functional and radiographic improvement in patients who undergo this surgery.

Engineering the transcriptional activator NifA for the construction of Rhodobacter sphaeroides strains that produce hydrogen gas constitutively.

Purple non-sulfur photosynthetic bacteria such as Rhodobacter sphaeroides and Rhodopseudomonas palustris produce hydrogen gas (H2) via proton reduction, which is catalyzed by nitrogenase. Although the expression of nitrogenase is usually repressed under nitrogen-sufficient conditions, a partial deletion of nifA, which encodes a transcriptional activator of nitrogen-fixation genes, has been reported to enable the constitutive expression of nitrogenase in R. palustris. In this study, we evaluated the effects of a similar mutation (nifA* mutation) on H2 production during the photoheterotrophic growth of R. sphaeroides, based on the notion that H2 production by nitrogenase compensates for the loss of CO2 fixation via the Calvin cycle, thereby restoring the redox balance. The chromosomal nifA* mutation resulted in the slight restoration of the photoheterotrophic growth of a mutant strain lacking ribulose-1,5-bisphosphate carboxylase/oxygenase (RubisCO), the key enzyme of the Calvin cycle, when the strain was cultured in van Niel's yeast medium. In addition, the strain with the nifA* mutation produced detectable levels of H2 during photoheterotrophic growth with acetate and ammonium; however, the H2 production was considerably lower than that observed during the photoheterotrophic growth of the strain with acetate and L-glutamate, where L-glutamate serves as a poor nitrogen source, thereby causing nitrogenase derepression. On the other hand, introduction of a multicopy plasmid harboring nifA* markedly restored the photoheterotrophic growth of the RubisCO-deletion mutant in van Niel's yeast medium and resulted in efficient H2 production during the photoheterotrophic growth with acetate and ammonium.

Complications in children's orthopaedics: avoiding late deformity in paediatric fracture surgery

Paediatric orthopaedic surgery can be an unfamiliar and challenging field with the potential for devastating consequences. This article discusses late deformity associated with humeral supracondylar fractures and slipped capital femoral epiphysis (SCFE). Common complications include loss of fixation, mal-reduction, avascular necrosis and growth disturbance. Many cases result in reoperation and revision surgery associated with significant morbidity. We discuss the risk factors, aetiology, tips to avoid them and management options based on current evidence.

Graft Collapse and Loss of Fixation in Lateral Column Lengthening

Category:AnkleIntroduction/Purpose:Lateral Column lengthening through an osteotomy of the anterior process of the calcaneus is one of the most effective procedures for restoring arch alignment in the adult acquired flatfoot, without fusing essential joints. Despite remarkable radiographic corrections, previous studies have found persistent lateral hindfoot pain remains a challenge. In this study, we reviewed a large series of patients who underwent lateral column lengthening as part of flat foot reconstructive surgery, using either autograft or allograft. Rates of graft collapse and loss of fixation were determined with two different graft sources.Methods:After Institutional Review Board approval, all patients who underwent lateral column lengthening between 2002 and 2018 were reviewed for clinical and radiographic outcomes. Variables such as age, gender, diagnosis, type of bone graft, subsequent surgery, screw/hardware breakage, length of follow-up, time until weight bearing, and length of radiographic follow-up were recorded. Approximately half the patients had iliac crest allograft for the distraction, and the others had proximal tibial structural autograft.Results:52 patients met inclusion criteria. The average age was 47±14 years (range 18-86), with 32 women (62%) and 20 men (38%). 25 (48%) patients had a second surgery, most often for hardware removal. Two patients had repair of a nonunion. Twenty- five percent of patients who had proximal tibial autograft had hardware breakage and some degree of graft collapse, whereas none had hardware breakage in the iliac crest allograft group (p<0.05). Twenty-one of the 36 patients in the proximal tibia autograft group underwent a second surgery for persistent lateral column pain, with removal of hardware and bone debridement, compared to only 4 in the allograft group (p<0.05).Conclusion:Proximal tibia autograft performed relatively poorly in this case series, with a higher rate of graft collapse and lateral column pain. The allograft group had less complications, but even in this group, the rate of revision surgery is higher than might be expected for foot surgery in general. Lateral column lengthening is a powerful procedure for restoring hindfoot alignment without sacrificing essential joints, but suffers from a relatively high rate of persistent lateral column pain (which usually is not present prior to surgery) and reoperation.

Outcomes of Defect Management at Tibiotalocalcaneal Fusion Treated with Innovative ‘Bamboo Hut’ Technique

Category:HindfootIntroduction/Purpose:Tibiotalocalcaneal (TTC) fusion is a salvage procedure for post-traumatic as well as neuropathic cases. Many of these cases are characterised by some or other form of loss of talus resulting in a defect. At TTC fusion, prevention of shortening following such a defect is a challenge. Though allografts have helped solve this issue, they may not be easily available in developing countries. A retrospective analysis of prospectively collected data of 14 cases of TTC fusion with loss of talus is presented here. Cases were managed with innovative defect bridging ‘Bamboo Hut’ technique.Methods:Cases with either preoperative or perioperative loss of talus who required bridging of defect were included in the present study. Resultant defect following excision of the talus was bridged with two or three vertically placed fibular strut grafts. Grafts were snugly tied with each other with sutures to prepare a construct like a hut supported with wooden steaks (Bamboo). Fixation was carried out with indigenous TTC nail with a built-in compression device to generate compression of grafts between tibia and calcaneus.Results:Present series comprised of 6 post-traumatic cases, 7 cases of diabetic Charcot neuroarthropathy and 1 case of neuroarthropathy following operated meningomyelocele. Cases were followed up for an average period of 36 months with the average time to union being six months. All posttraumatic cases went on to the bony union but two out of eight neuropathy cases ended up in fibrous union with collapse & loss of fixation. Wound healing issues were noticed in two cases. None of the cases required amputation.Conclusion:With non-availability of allografts, prevention of shortening at TTC fusion is a challenge. This issue can be successfully managed with innovative ‘Bamboo Hut’ grafting technique, supported with in-built compression of the fusion site with the use of an indigenous nail.

Impact of tear metrics on the reliability of perimetry in patients with dry eye.

The application of artificial tears before performing perimetry can improve the reliability and results of perimetry in patients with glaucoma and dry eye (DE). However, the effects of ocular surface and tear film conditions on perimetry measurements and reliability have not been fully characterized. This prospective, cross-sectional, multicenter study investigated tear metrics in perimetry and assessed the relationships that existed among ocular surface condition, tear condition, and perimetry reliability. Forty-three eyes (43 patients) with DE disease according to the 2016 Japanese diagnostic criteria of DE and 43 eyes (43 subjects) of age- and visual field mean deviation-matched normal control subjects were studied. Perimetry was performed using the Humphrey Field Analyzer (30-2 SITA-Standard). Schirmer's test, strip meniscometry value, blink rate, tear film break-up time (TFBUT), fluorescein staining of ocular surface, and Dry Eye-related Quality of Life Score (DEQS) were measured. Blink rate was re-measured during perimetry. TFBUT and fluorescein staining were re-evaluated after perimetry. Perimetry reliability was evaluated with fixation loss, false-positive, and false-negative rates. Blink rate during perimetry was significantly lower for both patients with DE and normal controls (both P<0.001). TFBUT after perimetry was significantly higher than before perimetry in patients with DE (P<0.001). Fluorescein staining of ocular surface was significantly increased in patients with DE and normal control subjects (P = 0.002 and P<0.001, respectively). Spearman correlation analysis revealed that blink rate during perimetry was negatively correlated with fixation-loss rate (r = -0.393, P = 0.009) in patients with DE. Performing perimetry was associated with a significant change in tear condition and ocular surface condition in both patients with DE and normal control subjects. The changes in tear condition and ocular surface condition may impact the reliability of perimetry in patients with DE.

Treatment of Distal Femur Fractures With the DePuy-Synthes Variable Angle Locking Compression Plate.

To determine the failure rate of the DePuy-Synthes variable angle locking compression curved condylar plate (VA-LCP) and quantify failure modes. Retrospective review. Level I Trauma Center. One hundred thirteen patients with 118 OTA/AO classification 33A and 33C distal femoral fractures were included in the study. Internal fixation using only the DePuy-Synthes VA-LCP plate. Primary outcomes included mechanical failure rate of the DePuy-Synthes VA-LCP plate in open and closed fractures. Secondary outcomes included overall failure rate of treatment, risk factors for mechanical failure, and the specific location of failure: loss of fixation in the proximal segment, implant failure over the working length, or failure of locking screw fixation distally. There were 11 total failures (9.3%) in 118 fractures. Failure rates for the closed and open fracture groups were 5.4% and 15.9%, respectively. Twenty patients (16.9%) required reoperation to promote union. Open fractures (P = 0.00475), the presence of medial metaphyseal comminution (P = 0.037), the length of the zone of comminution (P = 0.037), and plate length (P = 0.0096) were significantly higher in those with implant failure. Most failures (63.6%) were in the working length of the implant. The use of the Synthes VA-LCP is a viable option in distal femoral fractures and has an acceptable failure rate and reoperation to promote union rate. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Optimized Dental Implant Fixture Design for the Desirable Stress Distribution in the Surrounding Bone Region: A Biomechanical Analysis.

The initial stability of a dental implant is known to be an indicator of osseointegration at immediate loading upon insertion. Implant designs have a fundamental role in the initial stability. Although new designs with advanced surface technology have been suggested for the initial stability of implant systems, verification is not simple because of various assessment factors. Our study focused on comparing the initial stability between two different implant systems via design aspects. A simulated model corresponding to the first molar derived from the mandibular bone was constructed. Biomechanical characteristics between the two models were compared by finite element analysis (FEA). Mechanical testing was also performed to derive the maximum loads for the two implant systems. CMI IS-III active (IS-III) had a more desirable stress distribution than CMI IS-II active (IS-II) in the surrounding bone region. Moreover, IS-III decreased the stress transfer to the nerve under the axial loading direction more than IS-II. Changes of implant design did not affect the maximum load. Our analyses suggest that the optimized design (IS-III), which has a bigger bone volume without loss of initial fixation, may minimize the bone damage during fixture insertion and we expect greater effectiveness in older patients.

Complications du traitement chirurgical des fractures distales de la clavicule

IntroductionDistal clavicle fractures have low rates of union when treated with conservative measures. Operative treatment is generally recommended for Neer type II and V. Multiple fixation methods exist with no clear gold standard. The goal of the current study is to assess the outcomes and complications of distal clavicle fractures treated with one of three fixation methods: standard clavicular plate, hook plate, or suture fixation about the coracoid. MethodsThis is a retrospective cohort study of surgically treated unstable Neer type II and V distal clavicle fractures in adults. These operations were performed by multiple surgeons within a single healthcare system between January 2010 and September 2012. Patients were divided into three cohorts: pre-contoured clavicular locking plates, hook plates, and suture-only fixation methods. Univariate and mulivariate modeling analyses were performed. ResultsIn total, 74 distal clavicle fractures comprised the final cohort. Fifty-eight (77%) of these fractures were Neer type II; the remaining 16 (21.6%) were Neer type V. Median follow-up time was 12 months (range 10–28). BMI, smoking status, diabetes, and ASA class were similar among all cohorts. Twenty-one patients were treated with suture fixation alone (28.3%), 37 with a contoured clavicular plate (50%) and 16 with hook-plate fixation (21.6%). Twenty-one patients (28.4%) experienced complications, including two hardware failures requiring revision surgery. In total, 10/16 (62.5%) of patients with hook-plates required hardware removal for irritation, compared to 6/37 (16.2%) with a contoured clavicular plate (OR=8.61, p-value=0.001), and none with sutures alone. In total, 3/21 patients (14.2%) treated with suture fixation methods were diagnosed with adhesive capsulitis post-operatively; no patients in the plate fixation groups received this diagnosis. The Neer V group had a higher proportion of any complications (37.5%) compared to Neer II (25.9%), and a higher rate of stiffness (12.5% v. 1.7% in Neer II). ConclusionThis study compared the outcomes of three different fixation methods for unstable distal clavicle fractures. The overall union rate with any method of operative intervention was very high (98.6%), consistent with previous studies. Hook plates had a much higher re-operation rate, mostly owing to a higher incidence of hardware removal, an expected outcome owing to the prominence of these plates in the subacromial space. Contoured clavicular plates were associated with a lower incidence of irritation and hardware removal than hook plates, although one patient in this group experienced loss of fracture fixation and went on to asymptomatic radiographic nonunion. Suture-only fixation methods had the lowest rate of re-operation, with only one of 21 procedures resulting in failure and requiring revision. However, there was a significantly higher rate of adhesive capsulitis in the suture fixation cohort, perhaps due to the tethering effect of the clavicle to the coracoid or violation of the rotator interval. While this study supports that most distal clavicle fracture fixation methods can achieve stable union, there is a highly variable complication profile associated with each fixation method. The routine use of hook plate fixation cannot be recommended.

223. Surgery for severe pediatric spinal deformity has a significant rate of revision: a prospective multicenter cohort study

BACKGROUND CONTEXT Surgical treatment of severe pediatric deformity can be extremely challenging due to difficulties with instrumentation placement in small patients, stress on implants due to correction of severe deformities, and use of three column osteotomies. We investigated the instrumentation and fusion related complications in these complex spine deformity surgical cases. PURPOSE The purpose of this study was to evaluate the frequency and timing of revisions related to instrumentation or fusion in patients with severe pediatric deformity. STUDY DESIGN/SETTING Prospective observational multicenter cohort of severe pediatric deformity patients treated surgically. PATIENT SAMPLE Patients with a minimum spinal deformity curve of 100° or who were scheduled for a VCR procedure were prospectively enrolled at 17 sites. Patient who had reached a minimum of 2 years postoperative were included for analysis. OUTCOME MEASURES Postoperative complications associated with instrumentation and/or fusion, time of revisions and complications from index surgery METHODS Patients with severe spinal deformity (>100° or planned VCR) were included with a min. Two year f/u from 17 centers. Complications with or without revision due to pseudoarthrosis, instrumentation failure, infection requiring instrumentation removal and progression of deformity were all analyzed. RESULTS A total of 228 of 312 patients had a min of 2 yrs f/u. Of these, 29 pts (13%) had complications associated with instrumentation or fusion. A total of 22 patients (10%) had 27 revisions. The average time for all revisions was 16 mos (0-36) after index surgery; 3 patients were revised 2x and 1 pt 3x. The 27 revisions included 5 patients with loss of fixation, revised an ave. of 21 mos po (1-35). Four patients with pseudarthrosis were revised an average of 21 mos po (13-28). One patient was revised for prominent instrumentation at 27 mos po, and 5 patients for deep infection between 1-27 mos, average 15 mos. Eight patients had revisions for deformity progression at an ave of 13 mos (1-36). One patient was revised for a malpositioned screw a few days po, and 1 at 12 mos po for implant/instrumentation failure. Eight patients had complications that did not require revision. These included 1 with prominent implants, 1 with a malpositioned screw in the disc space, 3 had progressive deformity including PJK , 1 patient for implant prominence, 1 for loss of fixation, and 2 implant failures . CONCLUSIONS Pediatric patients with severe spinal deformity are at significant risk for revision surgery at a rate of 13% within 2 years. The average time for revision surgery was 16 mos po but was necessary as long 36 months after index surgery. Long term follow-up is necessary to evaluate failures in this patient population. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Update on the Use of Premium Intraocular Lenses in Glaucoma

In this report, we review the latest evidence for and against the use of premium intraocular lenses (IOL) in patients with glaucoma. Visual outcomes from clinical studies of newer Extend Depth of Focus (EDF) IOLs and low add apodized diffractive-refractive IOLs are significantly better than prior generations of multifocal (MF) IOLs. Clinical studies show that EDF and monofocal IOLs have similar contrast sensitivities in photopic conditions independent of spatial frequency. Premium IOLs restore uncorrected visual function, but intolerable visual disturbances and contrast impairment are uncommon side effects. Awareness of issues unique to glaucoma is critical for appropriate patient selection. Combined procedures with sizable shifts in IOP may have better refractive outcomes when staged. Toric and accommodating IOLs are reasonable options for most stages of glaucoma without fixation loss. EDF and newer MF IOLs can be appropriate options for stable pre-perimetric and early perimetric conditions.

The Association Between Visual Field Reliability Indices and Cognitive Impairment in Glaucoma Patients.

This prospective cross-sectional study found that patients with cognitive impairment (CI) are more likely to produce unreliable visual field (VF) tests, especially with higher false-negative (FN) responses and consequent overestimation of mean deviation (MD). Aging-associated CI can impair the ability of individuals to perform a VF test and compromise the reliability of the results. We evaluated the association between neurocognitive impairment and VF reliability indices in glaucoma patients. This prospective, cross-sectional study was conducted in the Ophthalmology Department, Hospital Kuala Pilah, Malaysia, and included 113 eyes of 60 glaucoma patients with no prior diagnosis of dementia. Patients were monitored with the Humphrey Visual Field Analyzer using a 30-2 SITA, standard protocol, and CI was assessed using the clock drawing test (CDT). The relationships between the CDT score, MD, pattern standard deviation, Visual Field Index (VFI), fixation loss (FL), false-positive values, and FN values were analyzed using the ordinal regression model. Glaucoma patients older than 65 years had a higher prevalence of CI. There was a statistically significant correlation between CDT scores and glaucoma severity, FL, FN, and VFI values (rs=-0.20, P=0.03; rs=-0.20, P=0.04; rs=-0.28, P=0.003; rs=0.21, P=0.03, respectively). In a multivariate model adjusted for age and glaucoma severity, patients with lower FN were significantly less likely to have CI (odds ratio, 0.91; 95% confidence interval, 0.89-0.93) and patients with higher MD were more likely to have CI (odds ratio, 1.10; 95% confidence interval, 1.05-1.16); false positive, FL, pattern standard deviation, and VFI showed no significant correlation. Cognitive decline is associated with reduced VF reliability, especially with higher FN rate and overestimated MD. Screening and monitoring of CI may be important in the assessment of VF progression in glaucoma patients.

Role of fixing nitrogen in common bean growth under water deficit conditions

AbstractIn common bean (Phaseolus vulgaris L), limited information is available if potential of nodulation and symbiotic nitrogen fixation is associated with the expression of traits that confer better adaptation to drought conditions. Adaptive traits were therefore measured in N‐fixing bean lines BAT 477, DOR 364, and PAN 185 and in nonnodulating lines BAT 477‐NN and DOR 364‐NN. Drought affected growth in all bean lines and decreased chlorophyll content but more in DOR 364‐NN and BAT 477‐NN, and also reduced nodule size with highest reduction in DOR 364 (21.6%). Loss of nitrogen fixation under drought conditions was further associated with lower water use efficiency, measured as carbon isotope ratio of 13C/12C, and lower %N in shoots when compared to capability to fix nitrogen. Loss of symbiotic nitrogen fixation in mutant bean lines DOR 364‐NN and BAT 477‐NN negatively affected root architectural traits under drought. Under drought conditions, line BAT 477‐NN had about 50% lower values for all root architectural traits, such as root angle, strongly emphasizing an association of capability to fix nitrogen with root development. An association between capability to fix nitrogen and maintaining a better harvest index and seed yield was also found in the study. Under well‐watered conditions, all N‐fixing lines had a higher harvest index and seed yield (2.6–2.8 t of seed yield/ha) in comparison with the two nonfixing bean lines (1.4 t/ha). Although the harvest index and seed yield declined due to drought in all tested lines, this decline was only significant for line DOR 364‐NN (harvest index) and lines DOR 364‐NN and BAT 477‐NN (seed yield). Our study has overall demonstrated an important association between the capability of maintaining atmospheric N‐fixation and expression of traits conferring better adaptation to drought conditions with any change in nitrogen fixation affecting these traits.

Early Changes in Cement-Bone Fixation Using a Novel Rat Knee Replacement Model.

Trabecular resorption from interdigitated regions between cement and bone has been found in postmortem-retrieved knee replacements, but the viability of interdigitated bone, and the mechanism responsible for this bone loss is not known. In this work, a Sprague-Dawley (age 12 weeks) rat knee replacement model with an interdigitated cement-bone interface was developed. Morphological and cellular changes in the interdigitated region of the knee replacement over time (0, 2, 6, or 12 weeks) were determined for ovariectomy (OVX) and Sham OVX treatment groups. Interdigitated bone volume fraction (BV/TV) increased with time for Sham OVX (0.022 BV/TV/wk) and OVX (0.015 BV/TV/wk) group, but the rate of increase was greater for the Sham OVX group (p = 0.0064). Tissue mineral density followed a similar increase with time in the interdigitated regions. Trabecular resorption, when it did occur, started at the cement border with medullary-adjacent bone in the presence of osteoclasts. There was substantial loss of viable bone (~80% empty osteocyte lacunae) in the interdigitated regions. Pre-surgical fluorochrome labels remained in the interdigitated regions, and did not diminish with time, indicating that the bone was not remodeling. There was also some evidence of continued surface mineralization in the interdigitated region after cementing of the knee, but this diminished over time. Statement of clinical significance: Interdigitated bone with cement provides mechanical stability for success of knee replacements. Improved understanding of the fate of the interdigitated bone over time could lead to a better understanding of the loosening process and interventions to prevent loss of fixation. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2163-2171, 2019.

A study on functional outcome of surgically stabilised ankle fracture between diabetics and non diabetics in a tertiary care center

Background: Retrospective observational study of Ankle fracture fixation at Department of orthopedics at Railway hospital, Chennai, Tamil Nadu during the period 2006-2012. Methods: Subjects are matched for age, sex, social factors and grouped into cases and controls based on diabetes. Out of total 74 traceable case details, 49 patients were studied in two groups as 27 non Diabetics and 22 diabetics. 1 patient in both the study groups was deceased and rest were lost to follow up or did not meet the inclusion criteria. Subjects were assessed clinically with Olerud Moleander score and complications were studied.Results: In the study population, the diabetics had lower objective functional score - Olerud Moleander score (p=0.046), but similar subjective functional score (P=0.17), elder mean age (P=0.004), similar sex distribution (P=0.38), similar distribution of fracture pattern (P=0.95), similar time delay to surgery (P=0.12), similar follow up duration (P=0.38), similar incidence of complications (P= 0.15) compared to non-Diabetics. Association of time delay to surgery and complications could not be established.Conclusion: In Patients with uncomplicated diabetes, following ankle fracture fixation, incidence of complications like arthritis & loss of fixation are marginally higher but not significant. (P=0.15). Regular follow up and screening for diabetes, reduce the incidence of complications among diabetics following ankle fracture fixation. Although the objective functional Olerud Moleander score was marginally less among diabetics (P=0.046), the subjective score was similar (P=0.17) in both groups.