Frequent Drop Research Articles

Konservierungsmittel in der Ophthalmologie

Preservatives are a legal requirement for eye drops in multidose containers. Moreover, they are necessary for stabilization and intraocular penetration for a number of ophthalmic preparations. Most preservatives act in a relatively unspecific manner as detergents or by oxidative mechanisms and thereby cause side effects at the ocular surface. They may also affect the lens, trabecular meshwork and the retina. Benzalkonium chloride is the most commonly used preservative in ophthalmology and is more toxic than other or newer preservatives, such as polyquaternium-1 (Polyquad), sodium perborate, oxychloro-complex (Purite®) and SofZia. Preservative-free topical medication is highly recommended for patients with ocular surface disease, frequent eye drop administration, proven allergy to preservatives and contact lens wear.

Net Job Creation in the U.S. Economy: Lessons from Monthly Data, 1950-2011

This paper studies the monthly net job creation (NJC) at the aggregate and the sectoral levels in the U.S. over the period 1950-2011. The paper has few important findings. First, NJC did not show a significant trend over the last six decades, which led to a fall in the NJC rate. Second, NJC was very volatile and it could change course even in the span of one month. Third, there was no clear pattern about the co-movement between NJC and the change in the unemployment rate. Fourth, the averages of total NJC and private NJC since late 2010 were significantly higher than their respective historical averages and the volatility in NJC since the end of the Great Recession was not unusual by historical standards. Fifth, while the evidence about the effects of the 2009 American Recovery and Reinvestment Act on employment is inconclusive, some sectors appeared to benefit from it. Finally, the most frequent drop in the unemployment rate was by 0.1 percent, and drops of more than 0.2 percent should not be highly expected.

Analysis of isoflavones in soy drink by capillary zone electrophoresis coupled with electrospray ionization mass spectrometry

Capillary zone electrophoresis coupled with electrospray ionization mass spectrometry (CZE–ESI-MS) has been applied for the first time for the separation and quantification of isoflavones in soy products. The proposed method was successfully applied to the determination of seven isoflavones, including aglycones and glucosides, in soy drink. The target compounds were the glucosides daidzin and genistin, and the aglycones daidzein, genistein, formononetin, biochanin A and glycitein. During CE separation in positive mode, the analytes were present as anions, and MS detection was carried out in ESI positive-ion mode. To prevent the frequent drops in current and to improve the resolution in the separation of analytes in anionic form, a programmed nebulizing gas pressure (PNP) was applied along the analysis. Extraction of isoflavones from soy drinks was carried out by liquid–liquid extraction using ethanol. The proposed extraction procedure is simple, efficient, and affords reproducible results. Quantification of the isoflavones in soy drinks using the external standard method did not produce good results; therefore, both internal standard and standard addition quantification methods were used, obtaining significantly similar results. The detection limits found were lower than 3.2 μg L −1.

Programmed Nebulizing Gas Pressure for Efficient and Stable Capillary Electrophoresis−Mass Spectrometry Analysis of Anionic Compounds in Positive Separation Mode

Here we have developed a method for the analysis of anionic compounds by capillary electrophoresis coupled to electrospray ionization-mass spectrometry (CE-ESI-MS). The strategy proposed is based on the application of programmed nebulizing gas pressure (PNP), which is applied during the different steps of analysis: sample injection, electrophoretic separation, and detection by the mass spectrometer. The proposed procedure prevents the frequent drops in current observed in the analysis of anions and allows high separation efficiency by capillary electrophoresis to be maintained because it is not necessary to employ pressured-assisted electrophoresis. Additionally, for the first time we describe the use of 100 μm capillaries in capillary electrophoresis-mass spectrometry, allowing the loading of larger samples and hence greater sensitivity, with no loss of the efficiency achieved with the 50 μm capillaries usually used.

Personality Disorder Related To an Acute Orbitofrontal Lesion in Multiple Sclerosis

Back to table of contents Previous article Next article LettersFull AccessPersonality Disorder Related To an Acute Orbitofrontal Lesion in Multiple SclerosisLorna Galleguillos, M.D., Teresa Parrao, P.S., and Carolina Delgado, M.D.Lorna GalleguillosSearch for more papers by this author, M.D., Teresa ParraoSearch for more papers by this author, P.S., and Carolina DelgadoSearch for more papers by this author, M.D.Published Online:1 Oct 2011https://doi.org/10.1176/jnp.23.4.jnpe7AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: A 19-year-old woman with relapsing–remitting multiple sclerosis experienced subacute behavioral changes, with disinhibition, impulsiveness, and conversion drop attacks, which were related to acute lesions in the right orbitofrontal cortex. Although drop attacks remitted, her poor impulse-control persisted, suggesting an organic personality disorder. Neuropsychiatric symptoms in multiple sclerosis (MS) usually form part of a chronic psychiatric disorder, but they may also have a subacute temporal course.Case ReportThe patient was a 19-year-old woman high school graduate with relapsing and remitting MS that started with symptoms at age 15. She did not have any previous history of psychiatric disease. In February of 2009 she began to show irritability and emotional fluctuations; she abandoned her university education, and started to live a libertine life that generated serious conflicts with her parents. She acted impulsively, without respect for social limits or circumstances, and had disinhibited and childish behavior. About 1 month later, her actions became increasingly bizarre, and she began to have frequent drop attacks without impairment of consciousness. These attacks were associated with intense anxious feelings that lasted a few minutes. She was hospitalized 1 month after the symptoms began. No focal signs were found in the neurological examination. Serum test and electroencephalography were normal. Brain MRI showed new hyperintense T2 lesions, one in the right orbitofrontal gyrus, with gadolinium enhancement, and a non-enhancing lesion in the left amygdala. She was treated with intravenous methylprednisolone 1 g/day for 3 days; aripiprazole 15 mg/day, and sertraline 50 mg/day for 1 month. The drop attacks remitted completely with the treatment, but her poor impulse-control and emotional instability persisted. Subsequently, she began to cut her forearms with sharp objects, without suicidal intention. A psychiatric evaluation done after the hospitalization concluded that she had an organic personality disorder.DiscussionAlthough many of the symptoms that were shown by our patient are compatible with the main features of a borderline personality disorder (impulsivity, emotional instability, dissociation, self-injuring behavior), their beginning was temporally related to new brain lesions, and had a subacute temporal course with partial remission after 2 months. Thus, these symptoms are very likely to be secondary to a relapse of multiple sclerosis. As the majority of cases reported of relapses with neuropsychiatric symptoms, the psychiatric morbidity persisted, making a great impact in the patient's social functioning.1 Using the five-factor model of personality, it had been found that personality traits in MS are correlated with executive dysfunction2 and euphoria.3 This gave rise to the theory of a frontal syndrome as the origin of personality disorders.2 This is complementary with the results of another study finding that hypometabolism in the right orbito-frontal cortex and parahippocampal gyrus were related to the “psychotic variant of personality maladaptation in MS.”4 The orbito-frontal cortex is essential for regulating social interactions, and its lesions have been significantly related to behavioral abnormalities, euphoria, and impulsiveness, constituting an “orbito-frontal syndrome,” like our patient's behavior. Lesions in the frontal and left temporal cortex had been consistently found in other cases of MS with psychiatric relapses,1,5 but, as far as we know, this is the first report of a psychiatric relapse related to a gadolinium-enhancing lesion in the orbito-frontal cortex.Departamento de Neurología y NeurocirugíaDirección de Investigación Clínica Hospital Clínico Universidad de Chile Santiago, Chilee-mail: [email protected]uchile.cl1. Lo Fermo S , Barone R , Patti F , et al.: Outcome of psychiatric symptoms presenting at onset of multiple sclerosis: a retrospective study. Mult Scler 2010; 16:742–748Crossref, Medline, Google Scholar2. Benedict RHB , Priore RL , Miller C , et al.: Personality disorder in multiple sclerosis correlates with cognitive impairment. J Neuropsychiatry Clin Neurosci 2001; 13:70–76Link, Google Scholar3. Fishman I , Benedict RHB , Bakshi R , et al.: Construct validity and frequency of euphoria sclerotica in multiple sclerosis. J Neuropsychiatry Clin Neurosci 2004; 16:350–356Link, Google Scholar4. Reznikova TN , Terent'eva IY , Kataeva GV : Variants of personality maladaptation in patients with multiple sclerosis. Neurosci Behav Physiol 2007; 37:747–754Crossref, Medline, Google Scholar5. Ashagr-Ali AA , Taber KH , Hurley RA , et al.: Pure neuropsychiatric presentation of multiple sclerosis. Am J Psychiatry 2004; 161:226–231Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByPsiquiatría Biológica, Vol. 23, No. 3 Volume 23Issue 4 Fall 2011Pages E7-E7 Metrics PDF download History Published online 1 October 2011 Published in print 1 October 2011

Refractory Noninfectious Anterior Uveitis Associated with Systemic Mastocytosis

A 10-year-old boy with biopsy-proven systemic mastocytosis presented with bilateral nongranulomatous anterior uveitis associated with high intraocular pressure. Anterior chamber paracentesis was performed for cytological evaluation, which demonstrated monocytes and macrophages but no evidence of mast cells. His uveitis was partially controlled with frequent topical steroid drops and weekly oral methotrexate therapy. The glaucoma was controlled with topical antiglaucoma medications in the right eye. Deep sclerectomy was required in the left eye to control the intraocular pressure. To the best of the authors' knowledge, this is the first report of such an association.

Intracranial Brain Abscess Preceded by Orbital Cellulitis and Sinusitis

A 17-year-old boy with pyrexia, headache, and frequent drop attacks reported an acute onset of periorbital pain and swelling 1 month previously. Coronal computed tomography (CT) identified an ethmoid sinusitis, which was treated with functional endoscopic sinus surgery and intravenous gentamicin, prostaphylline, and metronidazone. Because of persistent symptoms, the patient returned 1 month later. The CT identified accumulation of debris in both frontal sinuses and a multilobulated lesion over the right frontal lobe. Bicoronal craniotomy was performed, and a mass located in the right frontal lobe was excised; the mass comprised chronic inflammatory tissues without evidence of malignancy. A postoperative brain CT confirmed the absence of a residual mass, and no recurrence or neurologic deficits were noted during the 3-month follow-up period. Intracranial complications cannot be prevented entirely even with the judicious use of antibiotics. Early application of the appropriate imaging modality and institution of aggressive therapy in any patient, not just pediatric patients, to prevent potential long-term disabilities and death are essential.

Endoscopic choanoplasty without stenting for congenital choanal atresia repair

Objective To present our experience with an endoscopic technique for congenital choanal atresia transnasal repair without the use of intranasal stents. Methods Twenty-one patients with congenital choanal atresia (11 bilateral aged 2–27 days and 10 unilateral aged 2–16 years) were operated upon between December 2005 and January 2009, using an endoscopic choanoplasty technique in which a laterally based mucoperiosteal flap was elevated off the posterior nasal septum and atretic plate. Endoscopic resection of bony atresia including abnormally thickened vomer and pterygoid processes was done until a widely patent ‘neo-uni-choana’ was created. Two surgeons worked simultaneously using the “four-hand” technique. No stents were used. All patients received prophylactic systemic antibiotics and local steroid-antibiotic intranasal drops for 1 week postoperatively. Parents were taught to irrigate and clean both nasal cavities using frequent saline nasal drops and a portable home suction device. Results Preoperative computed tomography showed that among bilateral choanal atresia (BCA) patients, 9 (81.8%) were bony-membranous and 2 (18.2%) were pure bony atresia. All unilateral choanal atresia (UCA) cases had pure bony atresia. Two neonates with BCA had associated congenital cardiac anomalies. None had the CHARGE association. Operative time ranged from 30 to 75 min (mean 51.4 ± 13.4 min.) for BCA and 35 to 90 min (mean 57.5 ± 18 min.) for UCA repairs. Mean estimated intraoperative blood loss was 35.5 ± 15.1 cc. in BCA and 204 ± 105.6 cc. in UCA surgery. No intraoperative complications such as skull base damage or CSF leak were encountered. Patients were followed-up for periods ranging from 6 to 18 months in BCA and 12 to 24 months in UCA cases. Three BCA cases showed postoperative restenosis by granulation tissue that was successfully managed by endoscopic excision with good nasal breathing thereafter. Complications included mid-nasal synechiae, not interfering with nasal breathing, in three BCA cases and a small hard palate perforation in one UCA patient that healed conservatively, without further surgery needed. Conclusions Transnasal endoscopic choanoplasty repair for both unilateral and bilateral choanal atresia without intranasal stenting was found to be an expedient and safe procedure that affords minimal blood loss, minimal complications with a high rate of success.

Poster 214: Shy-Drager Syndrome and Ramsay Hunt Syndrome: A Case Report

Setting: Acute inpatient rehabilitation unit. Patient: A 35-year-old man with a medical history of Parkinson disease, Shy-Drager syndrome, Ramsay Hunt syndrome, and bipolar disorder, who presented to the acute inpatient rehabilitation unit after multiple falls at home. Case Description: The patient noted inability to use his wheelchair, increasing weakness on his right side, and general functional decline. On the rehabilitation unit, the patient experienced frequent drop attacks as a result of orthostatic hypotension. These drop attacks necessitated multiple interventions, including a helmet for safety, compression stockings, small but frequent meals, and increased assistance/supervision for transfers. The patient responded to physical and occupational therapy and was able to return home independently. Assessment/Results: The hallmark of Shy-Drager syndrome is progressive autonomic failure manifested primarily as orthostatic hypotension. A rehabilitation protocol for a patient with Shy-Drager syndrome, and more generally, orthostatic hypotension, should include: maintenance of adequate blood volume with fluid intake of 2 to 2.5L/d, sleeping in a semi-recumbent position, and rising slowly to standing. In addition, patients should avoid excessive warmth, do moderate rather than vigorous exercise, eat small, frequent meals, and avoid vasodilators such as alcohol and nitroglycerin. Mechanical support may be provided by Jobst's stockings in combination with abdominal binding. Drug therapy may be required when nonpharmaceutical interventions fail. Conclusions: This case describes a previously unpublished combination of Shy-Drager syndrome and Ramsay Hunt syndrome, and the unique challenges posed in the rehabilitation setting.

Cross-shift Airway Responses and Long-Term Decline in FEV1 in Cotton Textile Workers

Acute airway response, measured as cross-shift change in FEV(1), to cotton dust may lead to subsequent chronic loss of lung function in exposed workers. To explore the association between the magnitude and frequency of cross-shift change and chronic loss of FEV(1). Four hundred eight cotton workers and 417 silk workers from Shanghai textile mills were observed prospectively for 20 years, with cross-shift measurements at baseline and follow-up surveys at approximate 5-year intervals. To account for repeated measures of 5-year change, generalized estimating equations were used to estimate the relationship between the magnitude of cross-shift change in FEV(1) (DeltaFEV(1)) and subsequent 5-year annualized change. Linear regression models were used to examine the association between the number of drops in cross-shift FEV(1) (DeltaFEV(1) < 0) and annualized change over the entire study period. Exposure to cotton dust was associated with a 10 ml/year decrement in 5-year annualized FEV(1) decline. In addition, every 10 ml in DeltaFEV(1) drop was associated with an additional 1.5 ml/year loss in annualized FEV(1) decline. The association between the frequency of drops and annualized decline was stronger for cotton workers than for silk workers over the entire study period. Cotton workers had larger and more frequent drops, as well as excessive chronic declines in FEV(1), than did silk workers. The magnitude and frequency of cross-shift drops were associated with chronic loss in FEV(1) over the entire 20-year period examined.

Physical and ecological processes of internal waves on an isolated reef ecosystem in the South China Sea

Field measurements at Dongsha Atoll in the northern South China Sea showed frequent drops in daily water temperature up to 8°C during intrusions of large nonlinear internal waves. The internal waves had a period of about 4 hours and velocity amplitude of 0.3 m s−1. Large variations of dissolved oxygen were observed a week after cold‐water intrusion, which was followed in another 2 days by a significant increase of chlorophyll content. The 7–8‐day delay suggests that phytoplankton blooms occurred after the nutrients were released through microbial decomposition of organics brought up by the internal waves. This study highlights the effects of internal waves and the possible role of the microbial food web on nutrient regeneration in a tropical reef ecosystem.

Corpus callosotomy: A palliative therapeutic technique may help identify resectable epileptogenic foci

Corpus callosotomy has a long history as a palliative treatment for intractable epilepsy. Identification of a single epileptogenic zone is critical to performing successful resective surgery. We describe three patients in which corpus callosotomy allowed recognition of unapparent seizure foci, leading to subsequent successful resection. We retrospectively reviewed our epilepsy surgery database from 2003 to 2005 for children who had a prior callosotomy and were candidates for focal resection. All underwent magnetic resonance imaging and scalp video electroencephalograph monitoring, and two had magnetoencephalography, electrocorticography and/or intracranial video electroencephalograph monitoring. The children were 8 and 9 years old, and seizure onset varied from early infancy to early childhood. One child had a history of head trauma preceding seizure onset, one had a large intracerebral infarct and dysplastic cortex in the contralateral frontal lobe, and the other had an anterior temporal lobe resection without improvement in seizure frequency. After medical management failed, callosotomy was performed with the expectation of decreasing the seizure types affecting both hemispheres. Following transection of the callosal fibers, a single focus was recognized and resected, with resultant dramatic improvement in seizure control. In medically refractory epilepsy, where rapid secondary bisynchrony is suspected but the electroencephalograph is non-localizing, callosotomy should be considered as a means of treating generalized seizure types, but may also assist in identifying potentially operable seizure foci. Study limitations include its retrospective nature and cohort size. The findings, however, suggest the need for prospective, systematic, well-controlled studies of the use of corpus callostomy in this intractable patient population.

Garment Sizes Analysis on Target Ages and Body Shapes

This study was performed to narrow down the Sizing System for Female Adult's garments(KS K 0051) following age target and body shapes. The study was based on the sizing system and the anthropometric measurements, called Size-Korea, which were surveyed in the years 2003 and 2004. At first, the subjects of the survey were classified into 4 age groups, , based on the most significant differences of body sizes. Secondly, the ranges of four key dimensions - height, bust, waist and hip-of normal sizes were identified through analyzing Rohrer index and percentile. The selected sizes within the ranges were grouped by the drop which was the subtraction of bust girth from hip girth. In conclusion, there was the most frequent drop for each age group; 9cm drop for the years old group, the 6cm drop for the years old and years old and 3cm drop for years old. The upper body garment sizes of the same drop and target ages could be merged to 10 to 12 sizes, which were remarkably smaller than the Female Adult garment sizing system, and further to 2-5 sizes, considering the percentile importance. However, years old group needed to be analyzed in different ways, because the number of subjects of normal size in the age decreased rapidly, that the normal sizes for them were very limited. In addition, the reference body sizes of each garment size were apparently different when they were compared to each age groups. These basic data for garment size specification could be usefully adapted for the apparel companies' own sizing system according to their age target and body shapes, to achieve efficient production and better fit.

Simplification of eye drop regimes helps reduce involuntary non-compliance with glaucoma treatment

Dear Editor, We read with interest the article by Buller and co-workers [1] indicating that patients anticipate and experience less inconvenience from once daily (OD) eye drop regimes compared to more complicated alternatives. They suggest, therefore, that OD regimes will encourage voluntary compliance. We would propose that OD treatment regimes also reduce involuntary non-compliance and are particularly advantageous for elderly patients. We surveyed 70 consecutive glaucoma patients by means of interview administered questionnaire to determine whether the medication they were actually using was the same as that advised by the ophthalmologist at their previous clinic visit. It was found that 11/70 (16%) were not compliant with the regime recommended. Six of these 11 were using the drops at an inappropriate frequency, which was felt to be due to a failure to make the treatment regime clear during the previous consultation. The other five of the 11 non-compliant patients were using medication other than that intended. Although the initial prescription for glaucoma medication may be given by an ophthalmologist, the responsibility for ongoing prescription of treatment in many health care systems rests with the family doctor or general practitioner. The source of error in these cases, therefore, was the system of communication between specialist and general practitioner. Non-compliant patients (mean age 78.9) were significantly older than those who complied (mean age 69.9) (p=0.04). Patients using OD drop treatments were also significantly more likely to be compliant than those on more complex regimes; only 1 of 33 OD patients failed to comply, compared to 10 of 37 patients prescribed more frequent drop administration (p<0.01). The mean number of drops instilled per day was, therefore, significantly higher in the group of patients who were non-compliant compared to those who complied, being 2.8 drops per day versus 1.9 drops per day (p=0.02). Two sources of involuntary non-compliance were, therefore, identified: patients who did not understand what treatment regime to follow and family doctors who were not providing continued supply of the glaucoma medication intended by the ophthalmologist. Our survey suggests that both effects might be reduced by opting for simplified treatment regimes and making sure that the regime is understood by the patient and their family doctor. These steps are of particular importance for elderly patients who are more likely to be on numerous systemic and topical medications for other conditions and who may be more easily confused with the administration of these treatments. Where using OD therapy is no longer adequate to control intra-ocular pressure, we would encourage a reGraefe’s Arch Clin Exp Ophthalmol (2007) 245:327–328 DOI 10.1007/s00417-006-0438-8

Evaluation of Interhemispheric Time Difference by Magnetoencephalography Before and After Total Callosotomy-Two Case Reports-

Interhemispheric time difference (ITD) measured by electroencephalography (EEG) and magnetoencephalography (MEG) was compared to seizure outcome after callosotomy. Two patients with frequent drop attacks underwent simultaneous EEG and MEG before and after total callosotomy. ITDs in 30 bilateral synchronized (BS) discharges were calculated independently by EEG and MEG. As minimum transcallosal conduction time was suggested to be approximately 20 msec, BS discharges were classified into five categories according to ITD and side: left- or right-leading long (300 to 80 msec), left- or right-leading moderate (80 to 20 msec), and negligible (<20 msec). In Case 1 before callosotomy, EEG detected 77% negligible and 23% right-leading moderate BS discharges, whereas MEG detected 30% and 63%, respectively. After callosotomy, drop attacks reduced remarkably and EEG and MEG detected no BS discharges. In Case 2 before callosotomy, EEG detected 77% negligible and 23% moderate BS discharges, whereas MEG detected 80% and 20%, respectively. After callosotomy, drop attacks recurred 2 months later and EEG and MEG detected left- and right-leading long BS discharges (63% by EEG and 56% by MEG). MEG detected a large number of BS discharges with moderate ITD before surgery in Case 1, suggesting that the transcallosal pathway was the main pathway for the synchronization, whereas the negligible ITD in Case 2 excludes transcallosal propagation. BS discharges with longer ITD after surgery in Case 2 suggest a persistent poly-synaptic non-transcallosal pathway. MEG with higher spatial resolution than EEG may provide surgical indications for callosotomy.

Transcorneal and transscleral iontophoresis of dexamethasone phosphate using drug loaded hydrogel

Purpose To evaluate dexamethasone penetration to the eye after a short transcorneal and transscleral iontophoresis using a drug loaded hydrogel assembled on a portable iontophoretic device. Methods Iontophoresis of dexamethasone phosphate was studied in healthy rabbits using drug loaded disposable HEMA hydrogel sponges and portable iontophoretic device. Corneal iontophoretic administration was performed with a current intensity of 1 mA for 1 and 4 min. Transconjunctival and transscleral iontophoresis were performed twice for 2 min at two near places in the pars-plana area, on the conjunctival membrane or directly on the sclera. Dexamethasone concentrations were assayed using HPLC. Results Dexamethasone levels in the rabbit cornea after a single transcorneal iontophoresis for 1 min were up to 30 fold higher compared to those obtained after frequent eye drop instillation. Also, high drug concentrations were obtained in the retina and sclera 4 h after transscleral iontophoresis. Conclusions A short low current non-invasive iontophoretic treatment using dexamethasone-loaded hydrogels has potential clinical value in increasing drug penetration to the anterior and posterior segments of the eye.

Drip-tips do not impair the development of epiphyllous rain-forest lichen communities

Drip-tips are a common phenomenon in tropical rain forests, often believed to facilitate drainage of water from the leaf surface and, in that way, reduce epiphyll growth. Some authors suggest a function in reducing splash soil erosion, leaching of substances from the leaf, and light reflectance, while other studies did not find any such correlations. We used an experimental approach to test for the effect of drip-tips on the development of epiphyllous lichen communities. Artificial leaves with and without pronounced drip-tips were exposed in a tropical lowland rain forest at La Selva Biological Station (Costa Rica) for a period of 38 mo, and the physical behaviour of rainwater was tested. On leaves with drip-tips, the water ran off in small, frequent drops 8–30 mm3 in size. On leaves without drip-tips, the water accumulated in the apex region and dripped off periodically in large drops 50–150 mm3 in size. Nevertheless, there was no significant difference in the development of epiphyllous lichen communities on leaves with and without drip-tips, in terms of area covered, species richness and composition. However, leaves without drip-tips had more debris accumulated in the apex region and, at the same time, fewer lichen species present in this region. Thus, while drip-tips do have an influence on how water is channelled off the leaf surface, they do not impair the development of epiphyllous lichen communities, except for the apex region where the presence of drip-tips does in fact enhance, not reduce, the establishment of lichens, by preventing the accumulation of debris. We conclude that, while drip-tips may have an ecological function, this function is unrelated to the development of epiphyllous lichen communities.

Therapies for Lennox-Gastaut syndrome

The treatment of Lennox-Gastaut Syndrome (LGS) has been improved with the introduction of the new anti-epileptic drugs: lamotrigine and topiramate, the employment of a ketogenic diet, and the availability of vagal nerve stimulation. It is difficult to provide recommendations for the treatment of LGS, in the absence of comparative trials. However, suggestions can be made on the basis of the best evidence available. Treatment should commence with valproate and continue with lamotrigine or topiramate. If seizure control is not sufficient, felbamate, a ketogenic diet, and vagal nerve stimulation are recommended. A partial callosotomy may be performed for the treatment of frequent drop attacks. Other anti-epileptic drugs may be used after a risks-benefits evaluation.

Neoclassical tearing modes on ASDEX Upgrade: improved scaling laws, high confinement at high \U0001d6c3N and new stabilization experiments

In this paper, recent results on the physics of neoclassical tearing modes (NTMs) achieved on ASDEX Upgrade are reported. A scaling law for NTM decay has been found, showing that the minimum local bootstrap current density required for mode growth is proportional to the ion gyro radius. As this scaling law does not depend on the seed island size, and thus on the background MHD activity, it is more reliable than previously derived scaling laws for the NTM onset. Furthermore, the recently reported frequently interrupted regime is discussed. In this new regime (m,n) NTMs are characterized by frequent amplitude drops caused by interaction with (m+1, n+1) background MHD activity. Due to the resulting reduced time averaged island size this leads to lower confinement degradation compared to that caused by the usual NTMs. As shown here, the transition into this regime can actively be triggered by lowering the magnetic shear at the q = (m+1)/(n+1) rational surface. Further investigations regard mechanisms to increase the βN value for NTM onset such as plasma shaping, seed island size and density profile control. Using these studies, a scenario with high βN (βN = 3.5) at high density (n/nGW = 0.83) and confinement (H98(y,2) = 1.2) has been developed. Moreover, this scenario is characterized by type II ELM activity and thus by moderate heat load to the target plates. Finally, new NTM stabilization experiments are reported, demonstrating an increase in βN after NTM stabilization.

Late-onset interface keratitis after uneventful laser in situ keratomileusis

Although there have been many proposed etiologies for interface inflammation after laser in situ keratomileusis, the causative factor(s) remains an enigma. This case of late-onset interface inflammation suggests that the many previously suspected interface contaminants from the surgical environment were not involved. Transformation of a previously inert material to an inflammatory stimulus is proposed as a potential cause; however, a sample of inflammatory focus was not obtained because of the immediate and complete response to frequent topical steroid drops.