Peeling Procedure Research Articles

Content‐based MPEG‐4 video stream retrieval for video‐guided eye surgery

AbstractPurpose This work introduces ongoing research on computer‐aided retinal surgery. A content‐based video retrieval system is presented: given a video stream captured by a digital camera monitoring the current surgery, the system retrieves similar videos in video archives. These informations could guide the surgery steps or generate surgical alerts if the current surgery shares complications with archived videos.Methods We propose to use data compression to extract video features. 1: motion vectors are derived from MPEG‐4 stream. 2: image sequence segmentation is performed by a k‐means clustering. 3: we used Kalman filter to track region displacements between consecutive frames and therefore characterize region trajectories. Finally, we combined this motion information with residual consisting of the difference between original input images and predicted images. To compare videos, we adopted an extension of fast dynamic time warping.Results The system was applied to a small dataset of 24 video‐recorded retinal surgeries (621s +‐ 299s). Images have a definition of 720x576 pixels. An ophthalmic surgeon has divided each video into three new videos, each corresponding to one step of the membrane peeling procedure: Injection, Coat, Vitrectomy. The effectiveness of the proposed method, measured by ROC curve, is interesting (Az ≅ 0.73).Conclusion A novel CBVR system, allowing retrieval of medical video, has been presented. Experiments on the dataset of retinal surgery steps validate the semantic relevance of retrieved results in ophthalmic applications.

Clinical efficacy comparison of retinol versus retinoic acid as the final step of a chemical peel procedure

Clinical efficacy comparison of retinol versus retinoic acid as the final step of a chemical peel procedure

Guidelines for chemical peeling in Japan (3rd edition)

Chemical peeling may be defined as the therapies, procedures and techniques used for the treatment of certain cutaneous diseases or conditions, and for aesthetic improvement. The procedures include the application of one or more chemical agents to the skin. Chemical peeling has been very popular in both medical and aesthetic fields. Because neither its scientific background is well understood nor a systematic approach established, medical and social problems have taken place. This prompted us to establish and distribute a standard guideline of care for chemical peeling. Previous guidelines such as the 2001 and 2004 versions included minimum standards of care such as indications, chemicals, applications, and any associated precautions, including post-peeling care. The principles in this updated version of chemical peeling are as follows: (i) chemical peeling should be performed under the strict technical control and responsibility of a physician; (ii) the physician should have sufficient knowledge of the structure and physiology of the skin and subcutaneous tissues, and understand the mechanisms of wound-healing induced by chemical peeling; (iii) the physician should be board-certified in an appropriate specialty such as dermatology; and (iv) the ultimate judgment regarding the appropriateness of any specific chemical peeling procedure must be made by the physician while considering all standard therapeutic protocols, which should be presented to each individual patient. Keeping these concepts in mind, this new version of the guidelines includes a more scientific and detailed approach from the viewpoint of evidence-based medicine.

On the peeling procedure applied to a Poisson point process

In this paper we focus on the asymptotic properties of the sequence of convex hulls which arise as a result of a peeling procedure applied to the convex hull generated by a Poisson point process. Processes of the considered type are tightly connected with empirical point processes and stable random vectors. Results are given about the limit shape of the convex hulls in the case of a discrete spectral measure. We give some numerical experiments to illustrate the peeling procedure for a larger class of Poisson point processes.

On the peeling procedure applied to a Poisson point process

In this paper we focus on the asymptotic properties of the sequence of convex hulls which arise as a result of a peeling procedure applied to the convex hull generated by a Poisson point process. Processes of the considered type are tightly connected with empirical point processes and stable random vectors. Results are given about the limit shape of the convex hulls in the case of a discrete spectral measure. We give some numerical experiments to illustrate the peeling procedure for a larger class of Poisson point processes.

Chemical peels in aesthetic dermatology: an update 2009

Peelings are among the oldest and most widespread aesthetic procedures used in aesthetic dermatology worldwide. More than 50 commercial peelings are currently available on the European market. In the present review, we summarise the current knowledge on chemical peels. A state-of-the-art peeling procedure will take into account the depth of the targeted structure and the skin condition of the patient to choose carefully among the variables such as chemical class of the peeling agent, concentration, frequency and pressure of the application. The usual classification of chemical peels comprises superficial, medium and deep peels. For superficial peels alpha-hydroxy-acids and most recently lipo-hydroxy acid are used to induce an exfoliation of the epidermis. Medium-depth agents such as trichloroacetic acid (<50%) cause an epidermal to papillary dermal peel and regeneration. Deep peels using trichloroacetic acid (>50%) or phenol based formulations reach the reticular dermis to induce dermal regeneration. The success of any peel is crucially dependent on the physicians understanding of the chemical and biological processes, as well as of indications, clinical effectiveness and side effects of the procedures.

Combination Jessner’s Solution and Trichloroacetic Acid Chemical Peel: Technique and Outcomes

Trichloroacetic acid is a commonly utilized agent for chemical resurfacing of the face. Jessner's solution in combination with trichloroacetic acid has been previously described for the treatment of facial rhytids in the dermatology literature. The purpose of this study was to describe the application technique and examine the clinical results of Jessner's solution in combination with trichloroacetic acid in a diverse plastic surgery patient population. A retrospective chart evaluation of 105 patients undergoing combination Jessner's and 35% trichloroacetic acid facial peel procedures by the senior author was performed. Patient demographics, anatomic location of peel, concomitant surgical procedures, and postoperative complications were noted. Technique and endpoints are described. Between January of 2000 and April of 2007, 115 chemical peels were performed by the senior author. All patients were female, ranging in age from 32 to 83 years (mean, 54 years). Of the 115 chemical peels performed, 104 were done with concomitant procedures. Eleven peels were performed alone. The most significant complications related to the combination peel were fungal infections (7.8 percent overall rate). In addition, the senior author performed 27 face/neck lifts with superficial musculoaponeurotic system (SMAS)-ectomy or SMAS plication along with full face combination peel, with minimal postoperative complications and no evidence of hypertrophic scarring. The combination of Jessner's solution and 35% trichloroacetic acid is an effective, safe resurfacing tool that can treat superficial to moderate rhytids. Despite the apparent simplicity of the procedure, there is a significant learning curve to understand the intricacies of chemical penetration in the skin. Consistency in results is achieved with experience and proper preoperative patient evaluation and selection.

Blood-Assisted Internal Limiting Membrane Peeling for Macular Hole Repair

To evaluate the efficacy of autologous heparinized whole blood in assisting internal limiting membrane (ILM) peeling by coating the ILM for macular hole (MH) repair. Prospective, interventional case series. Twenty-nine patients (32 eyes) who underwent blood-assisted ILM peeling for MH repair. Patients in whom stage 2-4 idiopathic MHs had developed and who desired surgery were enrolled in this study. After core vitrectomy, autologous heparinized whole blood was applied to cover the macula and to coat the surface of the macular area in the fluid-filled vitreous cavity. The redundant blood was removed and only a very thin film of blood was left on the macular area. The blood-coated ILM was removed by forceps in a circular fashion. To confirm the removed membrane was the ILM, the first 10 specimens were examined by electron microscopy (EM). The MH closure rate, the interval mean visual acuity (before and after surgery), retinal changes, and the EM results of the ILM specimens. All 32 eyes in 29 patients completed 12 months of follow-up. The ILM were coated by autologous heparinized whole blood, removed without difficulty, and confirmed by EM. The whole blood highlighted the contrast of the coated and noncoated areas during the ILM peeling procedure. The MHs were closed in all surgical eyes with a single surgery (100%). Compared with study entry, the mean logMAR best-corrected visual acuity 12 months after surgery improved significantly (1.02 and 0.53, respectively; P<0.001). At 12 months of follow-up, 31 eyes (96.9%) had stable or improved vision. No toxic fundus changes were observed during follow-up. Autologous heparinized whole blood coated the ILM and facilitated visibility during ILM peeling. Autologous heparinized whole blood is a cost-effective and useful tool for assisting MH surgery.

Double Staining with Brilliant Blue G and Double Peeling for Epiretinal Membranes

To compare methods of removing epiretinal membranes (ERM) and evaluate the usefulness of the double brilliant blue G (BBG) staining and double-peeling method. Prospective, interventional case series. We followed 246 consecutive patients who underwent pars plana vitrectomy to remove ERM and for > or =12 months. Of the 246 eyes, 104 underwent single ERM peeling using indocyanine green staining, and 142 underwent ERM peeling by 1 of the 3 following methods: without staining in 46 eyes, triamcinolone acetonide staining in 42, and BBG staining in 54. Peeling of residual internal limiting membrane (ILM) was then conducted using BBG. In the latter group, the ILM that remained after the initial peeling procedure was evaluated macroscopically with BBG staining and also histopathologically. In 6 eyes requiring reoperation owing to ERM recurrence, the peeled ERM was examined histopathologically. Postoperative visual acuity and recurrence of ERM. The ERM recurrence rate was 16.3% (17 eyes) and the reoperation rate was 5.8% (6 eyes) among the 104 eyes that underwent single ERM peeling, compared with 0% in 142 eyes with double ERM and ILM peeling. Although the ERM recurrence rate was significantly lower with double peeling, postoperative visual acuity did not differ between the 2 methods. The 3 ERM peeling methods differed in the rate and extent of residual ILM, and the lowest rate (21/54 eyes; 39%) was achieved with BBG staining (P<0.0001). Histopathologic examination of the ILM remaining after ERM peeling detected remnant ERM cells on the ILM. Histopathologic examination of the peeled ERM in 6 eyes with ERM recurrence showed residual ILM to serve as a scaffold for cell proliferation. This study verified that ERM recurrence arises from remnant ERM components on the ILM, which proliferate using the ILM as a scaffold, and that complete ILM removal seems to reduce the risk of recurrence. Brilliant blue G with good affinity for the ILM facilitates simultaneous ERM and ILM peeling in many cases, and BBG contact with the retina in the second staining has no apparent effect on visual acuity. Double BBG staining and double peeling is useful for ERM treatment.

Experimentally guided modelling of dendritic excitability in rat neocortical pyramidal neurones.

Constructing physiologically relevant compartmental models of neurones is critical for understanding neuronal activity and function. We recently suggested that measurements from multiple locations along the soma, dendrites and axon are necessary as a data set when using a genetic optimization algorithm to constrain the parameters of a compartmental model of an entire neurone. However, recordings from L5 pyramidal neurones can routinely be performed simultaneously from only two locations. Now we show that a data set recorded from the soma and apical dendrite combined with a parameter peeling procedure is sufficient to constrain a compartmental model for the apical dendrite of L5 pyramidal neurones. The peeling procedure was tested on several compartmental models showing that it avoids local minima in parameter space. Based on the requirements of this analysis procedure, we designed and performed simultaneous whole-cell recordings from the soma and apical dendrite of rat L5 pyramidal neurones. The data set obtained from these recordings allowed constraining a simplified compartmental model for the apical dendrite of L5 pyramidal neurones containing four voltage-gated conductances. In agreement with experimental findings, the optimized model predicts that the conductance density gradients of voltage-gated K(+) conductances taper rapidly proximal to the soma, while the density gradient of the voltage-gated Na(+) conductance tapers slowly along the apical dendrite. The model reproduced the back-propagation of the action potential and the modulation of the resting membrane potential along the apical dendrite. Furthermore, the optimized model provided a mechanistic explanation for the back-propagation of the action potential into the apical dendrite and the generation of dendritic Na(+) spikes.

Biomechanical Comparison of the Banana Peel to a Tibial Tubercle Osteotomy for Knee Exposure

The ‘banana peel’ is a novel extensile exposure for complex primary and revision knee replacement. The tensile strength of the patellar tendon after the peel procedure is unknown. We chose to compare the banana peel exposure to a tibial tubercle osteotomy, because the osteotomy has been shown to withstand early rehabilitation protocols. Our null hypothesis was that the strength post banana peel was no different than that of the tibial tubercle osteotomy when tested for load to failure in a cadaveric knee.

Optimal peeling order for pedigrees with incomplete genotypic information

The likelihood approach is common in linkage analysis of large extended pedigrees. Various peeling procedures, based on the conditional independence of separate parts of a pedigree, are typically used for likelihood calculations. A peeling order may significantly affect the complexity of such calculations, particularly for pedigrees with loops or when many pedigrees members have unknown genotypes. Several algorithms have been proposed to address this problem for pedigrees with loops. However, the problem has not been solved for pedigrees without loops until now. In this paper, we suggest a new graph theoretic algorithm for optimal selection of peeling order in zero-loop pedigrees with incomplete genotypic information. It is especially useful when multiple likelihood calculation is needed, for example, when genetic parameters are estimated or linkage with multiple marker loci is tested. The algorithm can be easily introduced into the existing software packages for linkage analysis based on the Elston–Stewart algorithm for likelihood calculation. The algorithm was implemented in a software package PedPeel, which is freely available at http://mga.bionet.nsc.ru/nlru/.

Cardiac Complications in Deep Chemical Peels

Deep chemical peels have been used in dermatology for more than a century. The main indications for this procedure include photoaging, perioral wrinkling, acne scars, and precancerous skin lesions. The most important potential complication of deep peels is cardiotoxicity. The objective was to estimate incidence of cardiac complications during full-face deep chemical peel and to suggest the methods to reduce the rate of this potential complication. Clinical data on the patients being treated by full-face deep chemical peel between December 1, 2004, and November 30, 2005, were recorded. Full cardiomonitoring was performed during the peeling procedure. Any arrhythmia or medical intervention was recorded. A total of 181 patients have been treated during the study period. All the patients were female; the mean age was 56 years (range, 30-77 years). In 12 patients (6.6%), cardiac arrhythmia has been recorded during the procedure. Cardiac arrhythmia was more common in patients with diabetes, hypertension, and depression. In 4 patients the arrhythmia was self-limited and did not require any intervention. In the other 8 patients, 100 mg of lidocaine was given intravenously to control the arrhythmia. The incidence of cardiac complications in appropriately performed deep chemical peeling is lower than previously appreciated.

Dilute triamcinolone-assisted peeling of the internal limiting membrane in cases of diffuse diabetic macular oedema

In this study we evaluated the efficiency of diluted triamcinolone particles in peeling of the internal limiting membrane (ILM) in cases of diffuse diabetic macular oedema. A prospective observational study of thirteen consecutive patients with diffuse diabetic macular oedema who had undergone ILM peeling aided by use of a diluted (1 mg mL(-1)) suspension of triamcinolone particles (0.05 mg). The results were assessed by measurement of visual acuity and intraocular pressure, by ophthalmoscopy, and by fluorescein angiography. ILM peeling in all eyes could be performed easily and completely with the aid of triamcinolone particles homogeneously dispersed over the macular ILM. During the peeling procedure, triamcinolone particles resulted in clear contrast between the peeled and unpeeled ILM thus enabling us to easily find the edge of the ILM and to be able to continue peeling at further attempts. In twelve of the thirteen eyes the macular oedema was completely resolved or reduced. Visual acuity improved by at least two lines in nine eyes (70%). The intraocular pressure increase did not exceed 21 mmHg in any of the patients. The diluted triamcinolone suspension enables good visualisation of the ILM during the ILM peeling procedure in cases of diffuse diabetic macular oedema. Use of a diluted suspension may reduce the risk of intraocular pressure increase and the potential toxicity of triamcinolone.

Superficial chemical peels

Superficial chemical peeling (SCP) involves the application of a peeling agent to the skin, resulting in destruction of part or all of the epidermis. SCP is mainly recommended for facial rejuvenation, photoaging and superficial rhytides, pigmentary dyschromias and acne. It can be used on all Fitzpatrick skin types, no sedation is needed, and the desquamation is usually well accepted. Overpeel and complications are very rare. The most commonly used SCP agents are glycolic acid 20-70%, trichloroacetic acid 10-35%, Jessner's solution, salicylic acid, pyruvic acid, resorcinol 30-50% preparations, and solid carbon dioxide. The careful selection of patients is critical for the outcome of a SCP and contraindications must be seriously considered. The peel procedure is generally common for all SCP agents but a good knowledge of the specific characters of each agent is of great importance in order to decide which to use for each individual patient.

The Blue Peel: How to Do It Less Expensively and Faster

One well accepted and popular method worldwide for trichloroacetic acid peels is the Obagi Blue Peel technique (Obagi Medical Products, Long Beach, CA). The peel solution is prepared by mixing a fixed volume of 30% trichloroacetic acid with the commercially available Blue Peel base. The authors suggest modifications for performing the peeling faster and less expensively: 1) preparing a larger volume of peel solution from each tube of Blue Peel base; 2) using higher concentrations of peel solution to reduce the number of coats necessary for reaching the desired depth of peel; and 3) storing the solution, as there is no need to adhere to the manufacturer's instructions to prepare the solution immediately before conducting the peel procedure to ensure homogeneity of the solution. The prepared solution can be stored at least 1 year.

Intraoperative Breakage of 20-Gauge Tano Forceps

To report three cases with breakage of a 20-gauge kryptonite forceps during vitreoretinal surgery. Interventional case report. Pars plana vitrectomy that included a membrane peeling was performed in three patients through standard ports with 20-gauge vitrectomy systems. The peeling procedure was attempted with the end-gripping kryptonite forceps. Intraoperatively, the branch/tip broke and dropped onto the posterior pole. Removal of the broken part was uncomplicated, and the subsequent clinical course was unremarkable. In one case, the handle and branch/tip part were exchanged inadvertently. In the other two cases, neither an exchange nor a maladaptation of the parts was noted. An exchange of the hand piece and gripping end may increase the risk of breakage and retinal damage. The delicate gripping tips, however, may break because of inadequate maintenance and/or aging of the material. Intraoperative visual and functional examination is recommended before intraocular use.

Epoxy polymer surface modification through wet-chemical organic surface synthesis for adhesion improvement in microelectronics

Wet-chemical surface synthesis reactions were performed on thin epoxy layers for usage as a build-up layer in microelectronics. The synthesis reactions, based on heterocyclic organic coupling agents, were used to imprint iminodiacetic acid and imidazole groups at the surface of the epoxy polymer, based on nucleofilic substitution reactions. The synthesized surfaces are examined by means of XPS and ATR-IR measurements. XPS measurements illustrate that the identity of the chemical groups near the interface (top 10 nm of the polymer surface) has been altered by the procedure. After the synthesizing procedure, copper was electrochemically deposited using an electroless/electroplating scheme. The type of groups located at the surface of the polymer has a pronounced influence on the adhesion strength of electrochemically deposited copper. Hence the interface between the copper and epoxy determines the adhesion properties between both. The surfaces of the peeled polymer layers and the backs of the copper strips were examined by XPS after the peeling procedure in order to determine the interface failure mechanism.

A Haplotype Similarity Based Transmission/Disequilibrium Test under Founder Heterogeneity

Taking advantage of increasingly available high-density single nucleotide polymorphisms (SNP) markers across the genome, various types of transmission/disequilibrium tests (TDT) using haplotype information have been developed. A practical challenge arising in such studies is the possibility that transmitted haplotypes have inherited disease-causing mutations from different ancestral chromosomes, or do not bear any disease-causing mutations (founder heterogeneity). To reduce the loss of signal strength due to founder heterogeneity, we propose an SP-TDT test that combines a sequential peeling procedure with the haplotype similarity based TDT method. The proposed SP-TDT method is applicable to any size of nuclear family with or without ambiguous phase information. Simulation studies suggest that the SP-TDT method has the correct type I error rate in stratified populations, and enhanced power compared with some existing haplotype similarity based TDT methods. Finally, we apply the proposed method to study the association of the leptin gene with obesity from the National Heart, Lung, and Blood Institute Family Heart Study.

Reasons and procedure of peeling attached to operation soiling of aircraft engine elements

Booth, the peeling procedure and devises, using electro – impulse vacuum – pneumo hydro cleaning methode to remove solid substances formation from aircraft gas - turbine engine elements after some periode of operation.