Drop In Number Research Articles

Electronic Infusion Flow Regulator with Occlusion Detection

Infusion is one medical equipment that provides several fluids into the body through a needle into a vein to replace fluids or food substances lost from the body. The use of manual infusion to determine the number of drops given to the patient and the calculation manually. The purpose of this research is to design an automatic infusion flow control device equipped with occlusion detection. This module consists of an Arduino Mega 2560, DC motor (stepper NEMA 17), optocoupler module, 4x4 keypad, and TFT. Infusion drops are detected by the optocoupler sensor. The microcontroller will process the detection results and send a DC motor command to move according to the settings entered. The unit of flow rate used in the module is ml/min. After measuring using an IDA calibration device with the Fluke brand type IDA 4 plus on the occlusion parameter, the average time is 41 seconds and the results of the flow rate have the largest deviation of 0.15 ml/min at the time setting of 6 hours and the volume of 500. While the smallest deviation is 0.12 ml /min on setting time 4 hours and volume 500 ml. From the results of measurements that have been carried out, this module is expected to help nurses regulate the infusion. The results in the future this module can be developed again with the appearance of the flow rate results can be directly displayed without having to wait for the drops to stabilize.

Evaluation for the performance of heat transfer process in a double pipe heat exchanger using nanofluids

This research investigates the effects of employing nanofluids in a tubular heat exchanger on the heat transfer process. The performance of employing water as a base fluid and multi-wall carbon nanotubes (MWCNTs) with a varying concentration nanofluid as operational fluids was investigated in an experimental investigation. The current study makes use of an Armfield Heat Exchanger (HT31) and an Armfield heat exchange service unit (HT30X). Five volumetric concentrations of nanomaterials were used to make nanofluids (0.22%, 0.33%, 0.66%, 1.1%, 1.53%). The Reynolds number of the flow inside the tube ranged from 1598 to 8000. By measuring the variables, the overall heat transfer coefficient, pressure drop, friction factor, and mean Nusselt number are computed. The overall heat transfer coefficient increases as the concentration of MWCNTS and the mass of flow increase, according to the experimental data. In comparison to distilled water, the Nusselt number value has increased by 68%, this increase is due to the nanoparticles’ volume concentration. Pressure drop values increase significantly when nanofluids are used. The friction factor increases as the volume concentration of nanoparticles increases. A relationship between Reynolds number and MWCNT volume concentration is proposed for computing the Nusselt number. An acceptable agreement may be found by comparing the results of the current investigation to the literature.

Development of resilience indicator traits based on daily step count data for dairy cattle breeding

BackgroundResilient animals are minimally affected by disturbances, such as diseases and heat stress, and quickly recover. Daily activity data can potentially indicate resilience, because resilient animals likely keep variations due to disturbances that threat animal homeostasis at a low magnitude. We used daily step count of cows to define resilience indicators based on theory, exploratory analysis and literature, and then investigated if they can be used to genetically improve resilience by estimating heritability and repeatability, and genetic associations with other resilience-related traits, i.e. health traits, longevity, fertility, and body condition score (BCS).ResultsTwo groups of resilience indicators were defined: indicators describing (1) mean step count at different lactation stages for individual cows, and (2) fluctuations in step count from individual step count curves. Heritability estimates were highest for resilience indicators describing mean step count, from 0.22 for the 2-week period pre-partum to 0.45 for the whole lactation. High mean step count was consistently, but weakly, genetically correlated with good health, fertility, and longevity, and high BCS. Heritability estimates of resilience indicators describing fluctuations ranged from 0.01 for number of step count drops to 0.15 for the mean of negative residuals from individual curves. Genetic correlations with health traits, longevity, fertility, and BCS were mostly weak, but were moderate and favorable for autocorrelation of residuals (− 0.33 to − 0.44) and number of step count drops (− 0.44 to − 0.56) with hoof health, fertility, and BCS. Resilience indicators describing variability of residuals and mean of negative residuals showed strong genetic correlations with mean step count (0.86 to 0.95, absolute), which suggests that adjustment for step count level is needed. After adjustment, ‘mean of negative residuals’ was highly genetically correlated with hoof health, fertility, and BCS.ConclusionsMean step count, autocorrelation and mean of negative residuals showed most potential as resilience indicators based on resilience theory, heritability, and genetic associations with health, fertility, and body condition score. Other resilience indicators were heritable, but had unfavorable genetic correlations with several health traits. This study is an important first step in the exploration of the use of activity data to breed more resilient livestock.

Analysis of iron ore pellets properties concerning raw material mineralogy for effective utilization of mining waste

The value addition in iron ore mining waste generated from washing or beneficiation plants is a challenging task. The iron ore slimes, which contain low iron content with high gangue minerals like kaolinite, gibbsite, and quartzite, cannot be used directly for iron production. The present study focuses on utilization of iron ore slimes without beneficiation by blending with high-grade fines for making iron ore pellets. The pellets were prepared by adding slimes in different weight proportions (0, 10, 20, 30, 40, and 50%) with high-grade iron ore fines. The high-grade iron ore fines contain 64% Fe, 2.25% LOI, and Blaine number 2975 cm2/g, whereas iron ore slimes contain 52.45% Fe, 5.60% LOI, and Blaine number 7046 cm2/g. Pellets were produced without using bentonite as the binder. The pellet properties, such as drop number, green and dry compressive strength and moisture content of green pellet, cold compressive strength, porosity, swelling index, reduction degradation index, and reducibility index of fired pellet, have been investigated. The pellet mineralogy was analyzed using x-ray diffraction and optical microscope. The empirical correlation has been developed incorporating feed mineralogical data based on kaolinite and goethite to predict the physical and metallurgical properties of pellet.

Surgical Outcomes of the Ahmed Valve Implantation Following Trans-scleral Cyclophotocoagulation

Purpose: To determine the intraocular pressure (IOP) lowering effect and complications of Ahmed valve implantation (AGV) in patients who underwent cyclophotocoagulation (CPC).Methods: Patients who underwent AGV after CPC in group 1, those who underwent CPC after AGV in group 2, and patients who underwent repeated CPC in group 3 were included in this retrospective observational study. Changes in IOP, number of glaucoma eye drops, and best corrected visual acuity (BCVA) were analyzed before and 1 week, 1 month, 3 months, 6 months, and 12 months after surgery, and postoperative complications were analyzed.Results: Eight patients in group 1, 10 patients in group 2, and seven patients in group 3 were included in the analysis. Preoperative IOP was 45.6 ± 15.5, 29.3 ± 5.6, and 43.4 ± 14.4 mmHg in the three groups, respectively, and the number of glaucoma eye drops was 3.8 ± 0.7, 3.9 ± 0.3, and 3.7 ± 1.0 in the three groups, respectively. At 12 months postoperatively, IOP decreased significantly in all three groups compared to preoperatively (all <i>p</i> < 0.05), and the number of glaucoma eye drops was also significantly reduced (all <i>p</i> < 0.05). Among patients with preoperative BCVA of 0.02 decimal or higher, postoperative BCVA decreased in two patients in group 2 and one in group 3 (<i>p</i> = 0.380). Hypotony occurred in one patient in group 1 and two patients in group 3 (<i>p</i> = 0.383), and among them, one patient in group 1 and one patient in group 3 progressed to the phthisis (<i>p</i> = 0.940).Conclusions: In patients whose IOP cannot be controlled after CPC, AGV is expected to be used as a relatively safe and effective treatment method for lowering IOP.

Evaluation Criterion of Proton Exchange Membrane (ECPEM) fuel cells considering inserted porous media inside the gas flow channel

• Electrochemical and heat transfer analyses of proton exchange membrane fuel cell. • Introducing a new design using porous media inside the gas flow channel. • Evaluating the power density, voltage, pressure drop and Nu as the outputs. • Define a new parameter “Evaluation Criterion of Proton Exchange Membrane (ECPEM)”. • Training an ANN model to calculate the optimum value of ECPEM to be 78.88. The focus of this study is to evaluate the effects of porous media inside the gas flow channel of Proton Exchange Membrane Fuel Cells (PEMFC) on four different output parameters of voltage, power density, pressure drop, and Nusselt number (Nu) considering the impacts of its thickness, viscous resistance, and current density. Although it is proved that the new design will improve the convective heat transfer, there have not been studies to evaluate the effects of this porous layer on the electrochemical performance and heat transfer simultaneously. The results showed that viscous resistance has by far the highest impact on the power densities in high current densities while thicker inserted porous layer improves the performance. Results also demonstrate that a parameter is needed to consider all these output parameters at the same time, hence the Evaluation Criterion of Proton Exchange Membrane (ECPEM) is defined using artificial neural network (ANN) modeling. Single-objective optimization of the ECPEM is developed using the ANN models to produce 250,000 data. The optimum value of ECPEM was obtained 78.88 in the thickness of 500 μ m and the viscous resistance of 2,111,000 ( 1 m 2 ) while the current density is equal to 0.65 ( A / c m 2 ).

The black hole of the transition process: dropout of care before transition age in adolescents

Recent evidence confirms the risks of discontinuity of care when young people make a transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS), although robust data are still sparse. We aimed to identify when and how patients get lost to care during transition by tracking care pathways and identifying factors which influence dropping out of care during transition. This is a retrospective observational study of 760 patients who reached the transition age boundary within 12 months before transition time and being treated at CAMHS for at least during preceding 18 months. Data were collected at two time points: last visit to CAHMS and first visit to AHMS. Socio-demographic, clinical and service utilization variables on CAMHS treatment were collected. In the 12 months leading up to the transition boundary, 46.8% of subjects (n = 356) withdrew from CAHMS without further contact with AHMS, 9.3% withdrew from CAHMS but were referred to AHMS by other services, 29% were transferred from CAHMS to AHMS, 10% remained at CAHMS and 5% patients were transferred to alternative services. Fifty-six percent of subjects experience cessation of care before the transition age. The risk of dropout increases with shorter contact time in CAMHS, is greater in subjects without pharmacological treatment, and decreases in subjects with psychosis, bipolar disorder, eating disorders, mental retardation, and neurodevelopmental disorders. This study confirms that a large number of people drop out of care as they approach the CAMHS transition and experience discontinuity of care during this critical period.

Hydrodynamic Studies during Gas‐Solid Conveying in a Vertically Upward Converging Riser Tube‡

AbstractExperimental and theoretical investigations on hydrodynamics for gas‐solid particles flow were carried out in a vertical upward converging pneumatic conveying system. One‐dimensional mathematical modeling and simulation were done using the FORTRAN‐95 program. The influence of convergence geometry on the hydrodynamic parameters like particle velocity, gas‐particle slip velocity, pressure drop, and particle Reynolds number (Rep) along the riser were studied. Experiments were conducted using the dilute phase mode with three types of granular cereal seeds of different sizes. Some significant differences in all hydrodynamic parameter profiles along the riser were observed between converging and uniform risers. Enhancement of Rep in the converging riser implies a higher gas‐solid transfer coefficient.

The use of topical nalbuphine in different concentrations to control pain after photorefractive keratectomy.

This is a randomized controlled study aiming to evaluate the safety and efficacy of two different concentrations of topical nalbuphine hydrochloride, when used to relieve pain in the first days following photorefractive keratectomy (PRK). This is a prospective double blinded randomized clinical trial that included 189 patients who had PRK for correction of low and moderate refractive errors. Patients were randomly assigned to three groups according to the eye drops given to relieve pain in the first three postoperative days; the first group received topical nalbuphine with a concentration of 2mg/ml (Group A = 64 patients), the second group received topical nalbuphine in a concentration of 1mg/ml (Group B = 69 patients) and the third group received topical artificial tears only (Group C = 56 patients).The patients were asked to rate their pain daily using a numeric rating scale and to record the number of drops instillation times/day. The time needed for complete epithelial healing, best-corrected visual acuity (BCVA) and spherical equivalent after three months were recorded in each group. In the first three days, there was a statistically significant difference in pain score among the three groups with lower values in the two topical nalbuphine groups when compared with the control group receiving artificial tears. Moreover, the higher concentration group showed significantly lower pain score and less number of drops used /day in comparison with the lower concentration group.There were no statistically significant differences in epithelial healing time, BCVA and spherical equivalent after three months among the three groups. The use of topical nalbuphine is effective in relieving pain in the first few days following PRK and this pain relief is not associated with any compromise regarding epithelial healing nor refractive outcome. The pain control with 2mg/ml concentration is significantly higher than that with 1mg/ml concentration of nalbuphine. Trial registration numberISRCTN21394752 https://doi.org/10.1186/ISRCTN21394752 The trial is retrospectively registered in ISRCTN registry at March 08, 2021.

Пшенично-ржаные хлебобулочные изделия c добавлением соевой окары

The enrichment of mass-produced varieties of bakery products, such as wheat and rye, is an urgent task at the present time. The use of soy okara for this purpose is due to its rich chemical composition and high ability to swell and bind moisture. The purpose of the research was to determine the effect of replacing dry soy okara flour on the properties of semi-finished products and the quality of wheat-rye bakery products. The technological properties of okara, flour and their mixtures were determined by the indicators of water binding capacity, the degree of swelling, the quantity and quality of gluten and the number of drops. Soy okara was added in an amount of 3–12% in increments of 3% instead of flour. Okara was not added to the control sample. In the test, the acidity was determined by titration, the maximum shear stress and adhesion on the device Structurometer ST-1. The quality of the finished bread was evaluated according to the indicators of the mass fraction of moisture, porosity, specific volume, organoleptic indicators by standard and generally accepted methods. The preservation of the freshness of bakery products was assessed by the change in the moisture content of the crumb and its swelling during storage. It was found that in soy okara, the water binding capacity and the degree of swelling are higher than in flour by 2,45–2,8 times and 20–25%, respectively. The introduction of soy okara helps to reduce the amount of raw gluten by 0,45–1,8%, the IDC­index by 2–8 units of the device, and also reduces the number of drops by 8–35 seconds compared to the control. As a result of the conducted studies, it was found that the moisture, acidity, viscosity increases in the experimental samples of the test with soy okara and the adhesion decreases accordingly by 1,8–5,2%, 0,1–0,7%, 7,2–28,8%, 2,3–11,2%. The introduction of 9% soy okara instead of flour does not reduce the quality of finished products. At the same time, the yield increases by 13,7%, the freshness retention period by 24 hours, the calcium and fiber content increases by 20,3% and 4 times, respectively, the biological value increases by 3%, and the energy value decreases by 10% compared to the control.

Quantifying the Impacts of COVID-19 on US Aviation Economy

The spread of COVID-19 pandemic at the end of 2019 has resulted the severe loss on US economy. The paper uses time series analysis based on the aviation data from February 2020 to September 2021 and other related information, the relationship of key factors is examined. The results turn out: (1) the causality relationship between passengers and aviation economy exists. (2) the unemployment rate has negatively affected the numbers of passengers. (3) the rate of IPI decreases by 1% in response to the increase of unemployment rate by 0.14%, whereas the numbers of passengers drop by 2.7% due to the same influence.

НОВЫЕ СОРТА ОЗИМОЙ ТРИТИКАЛЕ СЕЛЕКЦИИ САМАРСКОГО НИИСХ

The evaluation of new zoned varieties of selection of the Samara Research Institute in the region for possible use in various fields of agriculture was carried out in 2018-2022 in the laboratory of breeding and genetics of soft wheat, triticale sector in the fields of the Samara Research Institute, located in the chernozem steppe of the Middle Volga region. The object of study was four varieties of winter triticale included in the register of the Russian Federation. Based on the conducted studies, it was found that, on average, the Capella, Spica and Arcturus varieties exceeded the Crumb standard by 0.03-0.44 t/ha. The highest yield is established on the Spica variety – 4.86 t/ ha. The new varieties significantly exceeded the Crumb variety by the weight of 1000 grains by 5.60-8.10g, by the weight of grain from the ear by 0.26-0.40 pcs. In terms of the number of drops, the Arcturus and Spica varieties significantly exceeded the standard by 62.6-122.8 C. The dependence of grain productivity, green mass, ear on climatic conditions is analyzed. Correlation analysis at the phenotypic and genotypic level is given. As a result of many years of purposeful breeding work, three new triticale varieties of different uses have been bred, which surpass the Crumb variety in yield and quality, which gives farmers a choice and will allow them to sell triticale grain grown at the price of valuable wheat.

Drop-Weight Impact Resistance of Ultrahigh-Performance Concrete and the Corresponding Statistical Analysis

An experimental and statistical study on the impact resistance of ultrahigh-performance concrete (UHPC) is presented. The impact resistance was evaluated by conducting the drop-weight impact test with a hammer of 10 kg following ACI Committee 544 (ACI 544.9R-17). Three mixture types, namely ordinary concrete, nonfibrous UHPC matrix, and UHPC were designed, and each type was prepared with 40 cylindrical specimens with dimensions of Φ150×63.5 mm for impact test. The commonly used distribution functions for material properties (normal distribution and Weibull distribution) were selected to examine the test data, and the goodness of fit of these two distributions was evaluated using a Anderson-Darling test. Results indicate that the designed UHPC endured an average of 623 drops of impact weight before the first crack, while the ordinary concrete and nonfibrous UHPC matrix showed the first crack only after 26 drops and 17 drops, respectively. The higher-strength nonfibrous UHPC matrix broke with a fewer number of drops under impact load than the ordinary concrete (with coarse aggregate) due to the greater brittleness of the UHPC matrix. Both the normal and Weibull distribution can describe the impact resistance of ordinary concrete, while the nonfibrous UHPC matrix and UHPC showed poor fitness to either the normal or Weibull distribution. Statistical analysis results indicate large scatters in the impact resistance of UHPC, and tests with small sample size may result in unreliable judgment. In this paper a baseline of UHPC drop-impact resistance to inspire proper qualification of UHPC members designed to withstand impact loading is provided.

Numerical study of oil–water emulsion formation in stirred vessels: effect of impeller speed

The mixing of immiscible oil and water by a pitched blade turbine in a cylindrical vessel is studied numerically. Three-dimensional simulations combined with a hybrid front-tracking/level-set method are employed to capture the complex flow and interfacial dynamics. A large eddy simulation approach, with a Lilly–Smagorinsky model, is employed to simulate the turbulent two-phase dynamics at large Reynolds numbers $Re=1802{-}18\ 026$ . The numerical predictions are validated against previous experimental work involving single-drop breakup in a stirred vessel. For small $Re$ , the interface is deformed but does not reach the impeller hub, assuming instead the shape of a Newton's Bucket. As the rotating speed increases, the deforming interface attaches to the impeller hub which leads to the formation of long ligaments that subsequently break up into small droplets. For the largest $Re$ studied, the system dynamics becomes extremely complex wherein the creation of ligaments, their breakup and the coalescence of drops occur simultaneously. The simulation outcomes are presented in terms of spatio-temporal evolution of the interface shape and vortical structures. The results of a drop size analysis in terms of the evolution of the number of drops, and their size distribution, is also presented as a parametric function of $Re$ .

Application of the Dynamic Compaction Method for Ground Improvement of Collapsible Loess in Qinhai

The collapsibility of loess has a great influence on subgrade construction in Qinghai, China, so laboratory tests are utilized to evaluate the collapsibility influencing factors, which illustrates that the collapsibility of this region is not dominated by soluble salts but an alkaline environment, high porosity and a low water content. The in situ self-weight submerging test reveals the settlement regularities, with a maximum settlement of 22.4 cm, which suggests that the soil in the test region is self-weight collapsible loess. In consideration of the economy and applicability, dynamic compaction was chosen as the ground improvement method. The optimal number of drops (N) for an energy level of 1000 kN·m is 6, and for the energy levels of 1500 kN·m and 2000 kN·m, N is 8. Besides the maximum effective depth for 1000 kN·m is 5 – 6 m, and it is 6 – 7 m for 1500 kN·m and 2000 kN·m.

Pembuatan Alat Monitoring Infus Berbasis NodeMCU ESP8266

The problem of late replacement of infusion mattresses for patients in a medical institution is still common today. It still helps him closely with the nurses' negligence in monitoring the patient's infusion condition. This condition is very dangerous for the patient's health. Therefore the making of infusion monitoring equipment based on NodeMCU esp8266. This tool works by relying on the results of sensor readings that are inserted into the microcontroller which will be processed by NodeMCU. The sensor used in making this system is the sensor module, the sensor reading sensor is the intended emission sensor - in this case, means the drip drops, the sensor will count the number of drops. From the number of drops, it can be used to count the drip infusion. In this study, it can be concluded that the NodeMCU ESP 8266-based infusion monitoring tool using the IR Obstacle sensor component has been successfully made through the functionality test process.

Submicron drops from flapping bursting bubbles

Tiny water drops produced from bubble bursting play a critical role in forming clouds, scattering sunlight, and transporting pathogens from water to the air. Bubbles burst by nucleating a hole at their cap foot and may produce jets or film drops. The latter originate from the fragmentation of liquid ligaments formed by the centripetal destabilization of the opening hole rim. They constitute a major fraction of the aerosols produced from bubbles with cap radius of curvature (R) > ∼0.4 × capillary length (a). However, our present understanding of the corresponding mechanisms does not explain the production of most submicron film drops, which represent the main number fraction of sea spray aerosols. In this study, we report observations showing that bursting bubbles with R < ∼0.4a are actually mainly responsible for submicron film drop production, through a mechanism involving the flapping shear instability of the cap with the outer environment. With this proposed pathway, the complex relations between bubble size and number of drops produced per bubble can be better explained, providing a fundamental framework for understanding the production flux of aerosols and the transfer of substances mediated by bubble bursting through the air-water interface and the sensitivity of the process to the nature of the environment.

МОРФОЛОГИЧЕСКИЙ МОНИТОРИНГ ЭКСПЕРИМЕНТАЛЬНОГО ФИБРОЗА ПЕЧЕНИ У КРЫС

Background. Though thioacetamide (TAA)-induced liver fibrosis (LF) is recognized as a classical model of toxic liver damage, there is no literature data on the description of its successive stages of histological and ultrastructural changes in various cell populations involved in fibrosis. Objective. To conduct morphological monitoring of fibrosis formation in the liver of rats using the TAA model of LF based on histological and ultrastructural changes in hepatocytes and perisinusoidal lipocytes (HSC). Material and methods. The experiment was carried out on 18 sexually mature male rats. LF was modeled by intraperitoneal injection of 2% TAA solution at a dose of 10 ml / kg every other day. Light microscopy of semi-thin sections of the liver was performed, as well as electron microscopy of ultrathin sections. Results. The study of semi-thin sections of rat liver tissue from the control group showed a normal architecture of the parenchyma, a large number of HSCs containing large lipid droplets ("resting" phenotype), a very small amount of cytoplasmic matrix poor in membrane organelles. In the animals that were receiving TAA for 4 weeks, a mesenchymalepithelial transition of HSCs from the "resting" type to a fibrogenic state (fibrogenic phenotype) was recorded, that was accompanied by a gradual decrease in the number of retinol-containing drops and the appearance of fibroblastlike cells (FLC) in HSCs. In the animals, that were receiving TAA for 12 weeks, the pool of fibrogenic cells in the liver increased, a mesothelial-mesenchymal transition occurred, characterized by the mesothelial cell migration deeper into the parenchyma and their acquisition of a mesenchymal phenotype. Lipid containing activated FLC were also found in fibrous tissue around the central vein. Foci of hepatic tissue destruction caused by necrosis and apoptosis of hepatocytes were much more common. Conclusions. Administration of TAA induces liver fibrosis while histological and ultrastructural monitoring of the state of hepatocytes and HSCs allows to monitor all stages of fibrosis, clarifying the mechanisms of damage to intracellular organelles and variants of hepatocyte death. This model of LF in rats can be used to test new antifibrotic drugs.

Efficacy and safety of Ab interno XEN gel implant after a failed filtering surgery.

Purpose: To evaluate the efficacy and safety of Ab interno XEN gel stent in patients with open angle glaucoma who underwent a previous failed filtering surgery. Methods: A retrospective, observational, multi-centered and descriptive cohort study was conducted from January 2019 to February 2020 on patients with primary open angle glaucoma (POAG) who underwent XEN gel stent implant after a failed filtering surgical procedure. Main parameters evaluated were: changes in IOP measured with Goldmann applanation tonometer, number of anti-glaucomatous eye drops, postoperative complications, and necessity of further surgical procedures. The quantification of quality of life was obtained from the VFQ-25 questionnaire. A descriptive analysis based on pre- post- and intra-operative data was carried out.Results: In all patients included in the study (6 patients for a total of 7 eyes), IOP dropped during the follow up time. We found a mean percentage reduction of -41.5% at 9 months compared to the preoperative data (baseline). IOP lowered from 21.71 ± 4.64 mmHg to 9 ± 3,21 mmHg 1 day after the operation, 11 ± 3.21 at 1 week, 11.42 ± 1.81 mmHg at 1 month, 12.42 ± 3.10 mmHg at 3 months, 13.57 ± 3.45 at 6 months, 12.71 ± 1.79 at 9 months. In 71.4%, the procedure turned out to be complication free and only one case required needling of the bleb in order to achieve optimal intraocular pressure control. A total of 71.4% patients reached a medication free regimen with a percentage of reduction in the mean number of drugs needed of -88.9%.Conclusion: In our experience, XEN gel stent implant performed in Caucasian patients with POAG and a history of failed filtrating surgery, showed to be an effective and safe procedure.

Evaluation of Adverse Effects of Topical Glaucoma Medications on Trabeculectomy Outcomes Using the Glaucoma Medications Intensity Index.

IntroductionTrabeculectomy is commonly performed for glaucoma when medications are unable to control disease progression or have intolerable adverse effects. Previous studies have suggested that a higher number of and/or longer treatment duration with preoperative topical glaucoma medications are associated with a higher risk of trabeculectomy failure, but most of these studies lack quantification of exposure. The aim of this study was to investigate the relationship between preoperative exposure to topical glaucoma medications and trabeculectomy outcome, using a new method for quantifying accumulated exposure.MethodsConsecutive patients with primary open-angle glaucoma (POAG) or normal-tension glaucoma (NTG) who underwent primary trabeculectomy between 2013 and 2017 were retrospectively reviewed. The Glaucoma Medications Intensity Index (GMII) was calculated for each eye by multiplying the number of drops per week by duration of use (in years). The relationship between the GMII and postoperative outcome in terms of 1- and 2-year success rates and survival time was analyzed.ResultsA total of 55 eyes from 40 subjects were analyzed, all with follow-up > 6 months (mean 2.72 ± 1.46 years). The GMII for eyes with successful (n = 41) and failed (n = 14) outcome at last visit was 111.71 ± 78.59 and 167.41 ± 85.04, respectively, and significantly higher in failed eyes (P = 0.03). Univariate regression analysis of age, gender, cup–disc ratio, previous phacoemulsification, diabetes, hypertension, dyslipidemia, preoperative number of glaucoma medications/treatment duration/intraocular pressure (IOP), and GMII showed age and GMII to be possible predictors of treatment failure. On subsequent multivariate analysis, only GMII was correlated with failure (odds ratio 1.021, 95% confidence interval 1.00–1.05; P = 0.05). When GMII ≥ 80, the postoperative survival time was shorter (P = 0.02), the 1-year IOP, number of glaucoma medications, and number of needlings performed were higher (P = 0.03, P < 0.01, P < 0.03, respectively), and reduction in glaucoma medication was less (P = 0.02).ConclusionThe GMII can be used to predict eyes at higher risk for trabeculectomy that may benefit from additional perioperative intervention or treatment. It can also help the surgeon time the surgery before the GMII becomes too high, thereby optimizing the patient’s postoperative outcome.