Temporal Side Research Articles

Optimal spatial and temporal demand side management in a power system comprising renewable energy sources

The increase in installed capacity of renewable energy sources (RES) has a positive effect on the development of smart grids and demand side management (DSM). The reason for this is the intermittent nature of renewable energy, which is directly related to the problem of balancing the production and consumption of power within the power system. By using the DSM, the power consumption in the system comprising RES can be easier adjusted to the power production. The paper proposes an improved concept of DSM through the spatial and temporal DSM. The optimal spatial and temporal DSM aims at determining the power diagram of each individual load bus in order to achieve the optimal state in the whole system. The optimal state of the system can be quantified through the minimum daily energy losses or minimum daily operating costs. A mathematical definition of the optimal spatial and temporal DSM problem is presented as well as the algorithm for its solution. The proposed methodology has been tested by three test networks. The results confirm the overall system performance improvements that include: reduction of energy losses in the system, reduction of the operating costs and the increase of the voltage quality within the system.

Optical Coherence Tomography Observation of Gonio Structures during Microhook Ab Interno Trabeculotomy.

Introduction Intraoperative observation of ocular structures using microscope-integrated optical coherence tomography (iOCT) has been adopted recently. I report my initial feasibility assessment of iOCT for the incised trabecular meshwork observation during microhook ab interno trabeculotomy. Case Series Both the nasal and temporal sides or either side of the trabecular meshwork/inner wall of Schlemm's canal was incised more than 3 clock hours. After then, under observation using a Swan-Jacob gonioprism lens with the real-time 5-line scan mode, OCT images of the area were successfully acquired in 10 (83%) of 12 sides in nine eyes. Based on the appearance of the acquired images of the 10 sides, the trabeculotomy cleft could be classified into three incisional patterns, that is, six (60%) anterior-opening patterns (posterior-based flap), three (30%) middle-opening patterns (posterior- and anterior-based flaps), and one (10%) posterior-opening pattern (anterior-based flap), according to the predominant locations of the trabecular meshwork flaps. Conclusion Intraoperative observation of the gonio structures including the trabeculotomy cleft was feasible using the RESCAN 700 in combination with a gonioprism.

Relationship between Metabolic Syndrome and Ocular Microcirculation Shown by Laser Speckle Flowgraphy in a Hospital Setting Devoted to Sleep Apnea Syndrome Diagnostics

Purpose To clarify whether the incidence of metabolic syndrome (MetS) and the overlap of MetS components are affecting the ocular circulation shown by laser speckle flowgraphy (LSFG). Materials and Methods We studied 76 consistent patients. Blowout score (BOS) and blowout time (BOT), which are the pulse waveform analysis parameters, and mean blur rate (MBR) using LSFG in the optic nerve head (ONH) and choroid were evaluated. Throughout, the ONH was separated out from the vessels and tissue for analysis and MBRs in the ONH were divided into four sections (superior, temporal, inferior, and nasal). Results Thirty-two patients were diagnosed having Mets. MBR-Tissue (P = 0.003), MBR-All (P = 0.01), MBR-Choroid (P = 0.04), and BOS-Choroid (P = 0.03) were significantly lower in patients with MetS than in the patients without MetS. Multiple-regression analysis revealed the temporal side of MBR-Tissue and BOS-Choroid which were identified as factors contributing independently to the overlap of the MetS components. Multiple-regression analysis also revealed that the MetS components were identified to be factors independently contributing to the BOS-Choroid and temporal side of MBR-Tissue. Conclusion Our study clarified that the incidence of MetS and the overlap of the MetS components are significantly affecting the ONH and choroidal microcirculation.

Neuropsychologic Testing in Chiasmal Patients Exhibiting Inattention in the Temporal Visual Space during Monocular Visual Testing

Objective: By means of neuropsychologic tests, to further analyse a specific chiasmal monocular visual testing behaviour, here labelled temporal blocking because of the elective ignorance of optotypes on the temporal side of the chart. Often it is combined with impairment of reading and other cognitive impairments. Methods: Eighteen patients with lesions to the chiasm and some degree of temporal blocking aged 24 - 76 years underwent: 1) tests for visual neglect (Gothenburg test; behavioural inattention tests: star cancellation; line bisection); 2) visuo-perceptual tests; and 3) a test involving reading a crowded ten-letter and cipher bar. Results: The temporal blocking in two patients recovered after emergency neurosurgery and their results were normal when subsequently tested. Of the 16 patients with deficiencies, 14 had a poorer left eye (p Conclusions: The best neuropsychologic tests appeared to be those for visual neglect and the crowded bar test. In most cases, the right cerebral hemisphere’s lack of some crossed information from the left eye, usually needed for normative saccades and adjustment to visual space, may be a factor underlying the specific visual behaviour.

소프트 콘택트렌즈 착용자의 피팅 상태에 따른 각막 이심률과 곡률반경과의 상관관계

Purpose. Because of a recent increase in use of soft contact lens at younger ages, in the present study, the correlation between corneal eccentricity and radius of curvature and fitting types of contact lens was investigated. Methods. The study evaluated the fitting status of targets through lens centration, push-up test, dynamic lag test and static lag test of lenses usually worn by 49 men and women (98eyes) in their 20s to 30s who put on soft contact lenses. After evaluation, the subjects were classified into 3 categories by fitting status(steep, aligment and flat). The radius of corneal curvature in the naked eyes was measured by using keratometer. Moreover the corneal eccentricity in the nasal side, temporal side, superior side and inferior side was measured by using the device capable of measuring the corneal eccentricity. Results. The radius of corneal curvature and corneal eccentricity of soft lenses worn by subjects were higher in the order of steep fitting and flat fitting, and the higher average corneal curvature radius and corneal eccentricity is intend to be more steep fitting(p=0.051, p=0.052). The corneal eccentricity showed a tendency to nasal fitting type at the higher eccentricity and temporal fitting type at the smaller eccentricity, statistically significant difference was observed(p<0.05). The study showed there were low correlation that nasal and temporal side at steep fitting, superior side at normal fitting and 4side(nasal, temporal, superior, inferior) at flat fitting, therefore when the corneal eccentricity changed the radius of corneal curvature also changed. The corneal eccentricity and the radius of corneal curvature showed statistically significant difference at 4side and each fitting types(p<0.05). Conclusions. The results of this study, the fitting status, of wearer are based on radius of corneal curvature and corneal eccentricity, and if lens fitting would be done considering that, it seems to be useful in a soft contact lens prescription.

Spatio-temporal reconstruction of brain dynamics from EEG with a Markov prior

Electroencephalography (EEG) can capture brain dynamics in high temporal resolution. By projecting the scalp EEG signal back to its origin in the brain also high spatial resolution can be achieved. Source localized EEG therefore has potential to be a very powerful tool for understanding the functional dynamics of the brain. Solving the inverse problem of EEG is however highly ill-posed as there are many more potential locations of the EEG generators than EEG measurement points. Several well-known properties of brain dynamics can be exploited to alleviate this problem. More short ranging connections exist in the brain than long ranging, arguing for spatially focal sources. Additionally, recent work (Delorme et al., 2012) argues that EEG can be decomposed into components having sparse source distributions. On the temporal side both short and long term stationarity of brain activation are seen. We summarize these insights in an inverse solver, the so-called “Variational Garrote” (Kappen and Gómez, 2013). Using a Markov prior we can incorporate flexible degrees of temporal stationarity. Through spatial basis functions spatially smooth distributions are obtained. Sparsity of these are inherent to the Variational Garrote solver. We name our method the MarkoVG and demonstrate its ability to adapt to the temporal smoothness and spatial sparsity in simulated EEG data. Finally a benchmark EEG dataset is used to demonstrate MarkoVG's ability to recover non-stationary brain dynamics.

LONG-TERM OUTCOMES OF RADIAL OPTIC NEUROTOMY FOR MANAGEMENT OF OPTIC DISK PIT MACULOPATHY.

To evaluate the long-term outcomes of radial optic neurotomy (RON) in patients with optic disk pit maculopathy and to compare the functional and anatomical outcomes of pars plana vitrectomy (PPV) with temporal side single RON versus PPV without RON. This retrospective study included 15 eyes of 15 consecutive patients who had surgery for optic disk pit maculopathy. Patients were followed for 12 to 115 months after surgery. Anatomical and functional results were evaluated with optical coherence tomography, MP-1 microperimetry in the central 20°, and measurement of best-corrected visual acuity. Descriptive statistical methods, Friedman chi-square test, post hoc Dunn test, Mann-Whitney test, Wilcoxon signed-rank test, and Fisher's exact test were used to determine the best-corrected visual acuity and MP-1 microperimetry differences between time points and to compare the results between the two treatment groups. Two male and 5 female patients with a mean age 23.3 ± 8.7 (±standard error) years at presentation had PPV and silicone oil or gas tamponade with RON. Best-corrected visual acuity did not deteriorate after the operation in any of the eyes, and improved in 6 (86%) eyes (3 ± 2 lines). After surgery, complete resolution of fluid in the central macula was observed in 6 (86%) eyes. Five male and 3 female patients with a mean age 28.2 ± 8.2 years at presentation had PPV, posterior vitreous detachment, with or without juxtapapillary laser treatment, and silicone oil or gas tamponade. Best-corrected visual acuity did not deteriorate after the operation in any of the eyes, and improved in 5 (62.5%) eyes (2 ± 0.7 lines). After surgery, fluid in the central macula resolved completely in 4 (50%) eyes. Pars plana vitrectomy with temporal side, single RON seems to be an effective method of managing optic disk pit maculopathy. The anatomical and functional improvements, without additional treatment or complication during the follow-up period, indicate that RON might be an alternative treatment approach to PPV alone for optic disk pit maculopathy.

Infrared thermography in the evaluation of meibomian gland dysfunction.

To evaluate meibomian gland dysfunction (MGD) by infrared thermography. An observational study was conducted at the Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan. Participants included 89 MGD patients (30 in Grade 1, 49 in Grade 2, and 10 in Grade 3) and 65 controls. The close-eye thermographic images of the eyelid were obtained noninvasively by infrared thermography. Temperatures at 8 regions of interest (ROIs) of the eyelid margin and a reference temperature at the center of the upper eyelid were measured. The temperature ratio was defined as the temperature of ROI divided by the reference temperature. Eyelid margin temperature measured by infrared thermography increased from temporal side (ROI 1) to the nasal side (ROI 8) of the eye in both MGD patients and control groups. The temperature ratios were significantly higher in MGD participants than in controls, especially at ROI 8. The eyelid margin temperature measured by infrared thermography was higher in MGD participants. Further development of this infrared thermography system may become a rapid and non-invasive tool for MGD screening.

Effect of location of opening incision on astigmatic correction after small-incision lenticule extraction

We compared the visual and refractive outcomes between 2 different incisional sites in small incision lenticule extraction (SMILE) for low myopic astigmatism. This was a contralateral eye study. Consecutive cases that underwent bilateral SMILE surgery were included. Procedures for both eyes were identical apart from the location of opening incision. The incision was set on the temporal side for the right eye (Group 1), while a superior incision was set for the left eye (Group 2). Twenty-nine patients with a mean age of 35.0 ± 9.6 years were included. Preoperative visual and refractive parameters were comparable between the 2 groups (p > 0.250). At 3 months, the logMAR uncorrected distance visual acuity was 0.074 ± 0.090 in Group 1 and 0.084 ± 0.130 in Group 2 (p = 0.861). No difference was found in the postoperative manifest spherical equivalent (p = 0.501) and manifest cylinder (p = 0.178) between the 2 groups. The efficacy index was 0.85 ± 0.16 in Group 1 and 0.85 ± 0.20 in Group 2 (p = 0.828). Astigmatic correction was not significantly affected by the location of opening incisions using vector analysis. Our study did not find significant differences in visual and refractive outcomes with temporal or superior opening incision during SMILE surgery.

Clinical and pathologic observation of uveal metastatic carcinoma

Objective: To observe the clinical and pathological features of uveal metastatic carcinoma. Methods: It was a retrospective case series study. The clinical manifestation, growth pattern, tumor types and relative pathological features of 13 patients visiting from January 1980 to December 2014 with uveal metastatic carcinoma in Tianjin Eye Hospital were analyzed retrospectively. Results: There were 13 cases, 6 cases of male and 7 of female. Age was from 37.0 to 66.0 years old. The mean age was 52.1 years old. all cases were monocular. There were 5 cases with right eye and 8 cases with left eye. Among 13 cases, 10 tumors were in posterior choroid, one tumor was in anterior choroid and ciliary body, 2 tumors were in the iris. There were 5 patients with lung cancer, 4 patients with breast cancer, 1 patient with prostate cancer, 1 patient with thyroid cancer and 1 patient with esophageal cancer. The primary tumor wasn't found in 1 patient. The rapid decrease of visual acuity showed in 10 patients with posterior choroidal metastatic carcinoma, 8 of them accompanied with extensive retinal detachment and 6 of them had secondary glaucoma. The multiple gray-white nodule or pink cauliflower mass on the papillary margin of iris were showed respectively in 2 patients with iris metastatic carcinoma. The pathological examination found that posterior choroidal metastatic carcinoma mainly located in temporal or nasal side choroids in 10 cases, among them, local or diffuse flat choroidal masses showed in 6cases, extensive mass involving choroid and ciliary body showed in 1 case, large nodular or globular choroidal mass showed in 2 cases, choroidal mass surrounded the optic disc in 1 case, optic nerve invasion showed in 3 cases and extraocular or orbital invasion showed in 3 cases. The scleral and subconjunctival invasion showed in 1 case of anterior choroid and ciliary body metastatic carcinoma. Conclusions: Uveal metastatic carcinoma manifested various growth pattern, the rapid decrease of visual acuity, flat or nodular choroidal solid mass, secondary retinal detachment and glaucoma were common clinical features. Some cases might invade extraocular or orbital tissue. (Chin J Ophthalmol, 2016, 52: 769-774).

Results of scalp cooling during anthracycline containing chemotherapy depend on scalp skin temperature

ObjectivesThe success of scalp cooling in preventing or reducing chemotherapy induced alopecia (CIA) is highly variable between patients undergoing similar chemotherapy regimens. A decrease of the scalp skin temperature seems to be an important factor, but data on the optimum temperature reached by scalp cooling to prevent CIA are lacking. This study investigated the relation between scalp skin temperature and its efficacy to prevent CIA. Materials and methodsIn this explorative study, scalp skin temperature was measured during scalp cooling in 62 breast cancer patients undergoing up to six cycles of anthracycline containing chemotherapy. Scalp skin temperature was measured by using two thermocouples at both temporal sides of the head. The primary end-point was the need for a wig or other head covering. ResultsMaximal cooling was reached after 45 min and was continued for 90 min after chemotherapy infusion. The scalp skin temperature after 45 min cooling varied from 10 °C to 31 °C, resulting in a mean scalp skin temperature of 19 °C (SEM: 0,4). Intrapersonal scalp skin temperatures during cooling were consistent for each chemotherapy cycle (ANOVA: P = 0,855). Thirteen out of 62 patients (21%) did not require a wig or other head covering. They appeared to have a significantly lower mean scalp skin temperature (18 °C; SEM: 0,7) compared to patients with alopecia (20 °C; SEM: 0,5) (P = 0,01). ConclusionThe efficacy of scalp cooling during chemotherapy is temperature dependent. A precise cut-off point could not be detected, but the best results seem to be obtained when the scalp temperature decreases below 18 °C. Trialregister.nl NTR number3082

Gaze Evoked Deformations of the Peripapillary Retina in Papilledema and Ischemic Optic Neuropathy.

To examine the effects of horizontal eye movements on the shape of the peripapillary basement membrane layer (ppBM layer) in patients with papilledema, anterior ischemic optic neuropathy (AION) and normal eyes. Spectral-domain optical coherence tomography (SD-OCT) axial rasters of the optic nerve were used to analyze the shape of the ppBM layer. We compared registered images in two eye positions: 10° to 15° of adduction and 30° to 40° of abduction from 80 patients (45 with papilledema, 15 with AION, and 20 normal eyes). Horizontal eye movements induce a relative "seesaw-like" shape deformation of the ppBM layer in patients with papilledema. On adduction, there is a relative posterior displacement temporal to the basement membrane opening (BMO) and an anterior displacement nasally (P = 0.001). The pattern reverses in abduction. Normal eyes and AION display similar but smaller changes in shape predominantly affecting the temporal side on adduction. The shape difference was significantly different for normal eyes (P = 0.03) and for AION (P = 0.01). Horizontal eye movements affect the shape of the ppBM layer. The deformation in normals and AION, in adduction, causes posterior displacement temporal to the BMO. In contrast, the deformations in papilledema are larger, involving temporal and nasal sides, presumably because of shifts in cerebrospinal fluid pressure against the scleral flange and hydraulic stiffening of the optic nerve sheath. The clinical importance of gaze-induced deformations is unknown but repetitive motion may be a factor in the genesis or progression of a variety of optic neuropathies.

Switching of an inhibitor of vascular endothelial growth factor in the treatment of resistant to ranibizumab neovascular form of age-related macular degeneration. Case study

Aim: To analyze the spontaneous reattachment of retinal pigment epithelium (RPE) after replacing the anti-VEGF drug - ranibizumab, with aflibercept in the treatment of neovascular AMD based on the example given in our clinical study. Material and methods. We carried out a retrospective analysis of the patient’s history with exudative detachment of RPE due to choroidal neovascularization in age-related macular degeneration. This patient was treated with anti-angiogenic treatment in the form of monthly IVI ranibizumab. At the time of treatment, the visual acuity of the left eye was 0.3 with sph + 1,5D = 0,5, in the fundus of the eye there was a high exudative detachment of RPE in the macular region common to the vascular arcades. The edges were determined by the detachment of the neuroepithelium and abundance of hard drusen. Using optical coherence tomography, (OCT) we saw that the center of the macula of the left eye had a high detachment of RPE, local detachment of the neuroepithelium at the edge of the RPE detachment and an abundance of hard drusen. The foveola was flattened, and beneath it, the RPE was detached in the center - thickness of 247 microns (m). After the seventh injection of ranibizumab, we used OCT to assess the condition of the retina. The retinas condition was almost the same as before. The thickness in the central zone was 251 m, detachment of neuroepithelium was not seen, the dome of the RPE detachment circuit was unchanged and visual acuity improved to 0.7 with a maximum correction. We then replaced ranibizumab with another anti-angiogenic drug - aflibercept. Results and discussion. Two weeks on from our control examination, we noticed there was a smooth bubble detachment of the RPE and a retinal prominence over the choroidal neovascular membrane area (CNM). The OCT scan indicated minimal RPE detachment, resorption of the exudate, presence of subretinal spindle - shaped formation near the temporal side (CNM? Scar?). Retinal thickness was 178 m at the fixation point. Intravitreal injections were stopped. Visual acuity increased to 0.8 and remained stable for 5 months, but there were signs of renewed activity of choroidal neovascularization. According to OCT, the thickness in the central parts of the retina increased to 230 m, there were intraretinal cysts and increased spindle - shaped formation under the RPE. After 10 months of IVI aflibercept, acute vision decreased to 0.5, the thickness at the point of fixing increased to 250 m, subretinal formation increased and oozing of fluid was observed mainly parafoveal, which explains the high visual acuity. We then administered IVI ranibizumab. Two weeks later, the retinal thickness was 169 m, visual acuity improved to 0.8, but 1 month later we found that the retinal thickness had increased once more and decreased to 0.7. After 3 months after IVI ranibizumab, retinal thickness at the fixation point reached 286 m and visual acuity dropped to 0.5. Conclusion. In our practice, we face patients with neovascular AMD, who respond badly to ranibizumab. For such patients, it is important to replace ranibizumab with a better, more therapeutically effective anti-VEGF drug with anti-vaso proliferative properties. Aflibercept is an effective substitute for ranibizumab which was shown in this clinical case.

Angular Relations of Upper Corneal Coverage by Upper Lid Margin in Relation to Central Corneal Reflex in Normal Subjects of Shimla Hills

Aim: To study relations of Upper Lid Margin in relation to Central Corneal Reflex (CCR) in normal healthy subjects of Shimla Hills. Design: Comparative Case series involving 800 eyes of 400 subjects attending the OPD, were divided into four equal groups, males <18 years, females <18 years, males =18 years but <35 years and females =18 years but <35 years into group A, B, C and D respectively. The angular relations of upper lid (UL) in relation to CCR were calculated in computer using Goniometer, after magnifying images taken from Sony Super Steady Shot 8 megapixel Digital Camera. Three reference points on UL were taken from the spots where the UL touches the nasal side of corneal limbus (N), on temporal side of corneal limbus (T) and the midpoint of UL (point M). Then a point was taken from CCR (R). Angles thus formed on joining the above points i.e. NRT, MRT and NRM were measured using Goniometer. Results: Angle NRM values had an overall mean of 69.87o+5.75o Angle MRT values had overall mean of 58.41o+5.59o Angle NRT values had an overall mean of 128.13o+10.49o. Conclusion: 1)Angle MRT is more or less constant in all ages and in both sexes 2)Angle NRM variations are seen with advancing age especially among females. 3)Angle NRT which is constituted by angles MRT and NRM, varies with advancing age and especially in females. These findings may be taken into account in preoperative assessment and while planning postoperative outcome in all surgical procedures of eyelid, like ptosis correction.

In Vivo Identification of the Posttrabecular Aqueous Outflow Pathway Using Swept-Source Optical Coherence Tomography.

The purpose of this study was to investigate a novel imaging technique to identify the continuous posttrabecular aqueous outflow pathway from a single B-scan, using swept-source optical coherence tomography (SS-OCT). Three-dimensional volume scans of the temporal or nasal side of the anterior segment area at the limbus were acquired from 11 eyes of 11 healthy subjects, using SS-OCT. The aqueous outflow pathway was identified using an en face OCT image and reconstructed images of the vasculature (vasculature map). Delineation of the whole aqueous outflow pathway in a single B-scan was accomplished by reslicing the volume scan. The posttrabecular aqueous outflow pathway was successfully identified in 10 eyes (90.9%). Combined with a flattening technique, the en face video and vasculature map showed a clear blood stream that could not be observed on a sequential stack of B-scans. In the en face images, the vessels were widely branched in the episclera venous plexus, perpendicularly penetrating the scleral stroma. Vessels running parallel to Schlemm's canal and the collector channels were observed in the deeper region of the sclera. The average longitudinal diameter of the vessel was 29.7 ± 6.6 μm at the episcleral venous plexus, and it was significantly larger than that in the deep scleral aqueous plexus (22.0 ± 4.8 μm; P = 0.0002). The continuous posttrabecular aqueous outflow pathway could be identified from a single B-scan and quantitatively analyzed using SS-OCT with en face imaging and volume scan reslicing.

A Novel Method of Quantitative Anterior Chamber Depth Estimation Using Temporal Perpendicular Digital Photography.

PurposeWe hypothesize that: (1) Anterior chamber depth (ACD) is correlated with the relative anteroposterior position of the pupillary image, as viewed from the temporal side. (2) Such a correlation may be used as a simple quantitative tool for estimation of ACD.MethodsTwo hundred sixty-six phakic eyes had lateral digital photographs taken from the temporal side, perpendicular to the visual axis, and underwent optical biometry (Nidek AL scanner). The relative anteroposterior position of the pupillary image was expressed using the ratio between: (1) lateral photographic temporal limbus to pupil distance (“E”) and (2) lateral photographic temporal limbus to cornea distance (“Z”). In the first chronological half of patients (Correlation Series), E:Z ratio (EZR) was correlated with optical biometric ACD. The correlation equation was then used to predict ACD in the second half of patients (Prediction Series) and compared to their biometric ACD for agreement analysis.ResultsA strong linear correlation was found between EZR and ACD, R = −0.91, R2 = 0.81. Bland-Altman analysis showed good agreement between predicted ACD using this method and the optical biometric ACD. The mean error was −0.013 mm (range −0.377 to 0.336 mm), standard deviation 0.166 mm. The 95% limits of agreement were ±0.33 mm.ConclusionsLateral digital photography and EZR calculation is a novel method to quantitatively estimate ACD, requiring minimal equipment and training.Translational RelevanceEZ ratio may be employed in screening for angle closure glaucoma. It may also be helpful in outpatient medical clinic settings, where doctors need to judge the safety of topical or systemic pupil-dilating medications versus their risk of triggering acute angle closure glaucoma. Similarly, non ophthalmologists may use it to estimate the likelihood of acute angle closure glaucoma in emergency presentations.

Altered GABAA receptor density and unaltered blood–brain barrier [11C]flumazenil transport in drug-resistant epilepsy patients with mesial temporal sclerosis

Studies in rodents suggest that flumazenil is a P-glycoprotein substrate at the blood–brain barrier. This study aimed to assess whether [11C]flumazenil is a P-glycoprotein substrate in humans and to what extent increased P-glycoprotein function in epilepsy may confound interpretation of clinical [11C]flumazenil studies used to assess gamma-aminobutyric acid A receptors. Nine drug-resistant patients with epilepsy and mesial temporal sclerosis were scanned twice using [11C]flumazenil before and after partial P-glycoprotein blockade with tariquidar. Volume of distribution, nondisplaceable binding potential, and the ratio of rate constants of [11C]flumazenil transport across the blood–brain barrier (K1/k2) were derived for whole brain and several regions. All parameters were compared between pre- and post-tariquidar scans. Regional results were compared between mesial temporal sclerosis and contralateral sides. Tariquidar significantly increased global K1/k2 (+23%) and volume of distribution (+10%), but not nondisplaceable binding potential. At the mesial temporal sclerosis side volume of distribution and nondisplaceable binding potential were lower in hippocampus (both ∼−19%) and amygdala (both ∼−16%), but K1/k2 did not differ, suggesting that only regional gamma-aminobutyric acid A receptor density is altered in epilepsy. In conclusion, although [11C]flumazenil appears to be a (weak) P-glycoprotein substrate in humans, this does not seem to affect its role as a tracer for assessing gamma-aminobutyric acid A receptor density.

Surgical approach affects intraocular lens decentration.

This study aims to quantify and identify risk factors for intraocular lens (IOL) tilt and decentration early after surgery using Scheimpflug imaging. We prospectively included 268 eyes of 253 patients who underwent uneventful cataract surgery and one-piece IOL implantation using a superior or temporal approach. Scheimpflug imaging was used to evaluate the tilt and decentration of IOLs at 1week, 1month, and 3months postoperatively. Differences in IOL tilt and decentration between the approaches were examined. Correlations of age and axial length with the magnitudes of IOL decentration and tilt were also examined. In total, 139 right and 129 left eyes were included. IOL displacement averaged 150μm upward and 150μm to the nasal side of the pupil. Over 50% of the eyes were tilted upward and approximately 90% to the temporal side. The surgical approach was significantly associated with horizontal decentration in both eyes, but significantly associated with only vertical decentration in the right eye 1week postoperatively. In the left eyes, IOLs were shifted to the nasal side in 57.1% and 36.8% of the eyes that received the temporal and the superior approach, respectively, compared with 75.8% and 50% in the right eyes. The differences were significant only at 1-week follow-up (p=0.035 and p=0.003, respectively). Age or axial length was not associated with IOL tilt or decentration in either eye. Scheimpflug imaging can be used as a quantitative tool to evaluate IOL position. The incision site affected the IOL position, this finding was significant at 1week postoperatively only.

An algorithm for using expanded cervical flaps to resurface facial defects based on five different methods

BackgroundFor patients with healthy skin in the cervical region, the expanded cervical flap method is highly recommended for resurfacing facial skin defects. Many methods exist that use an expanded cervical flap. However, a gold standard for selecting the appropriate method for each patient is lacking. Here, we introduce 5 basic principles for how to use an expanded cervical flap and an algorithm for selecting the appropriate method. MethodsThe authors reviewed the medical records for all patients treated with an expanded cervical flap to restore a facial skin lesion in Shanghai's Ninth People's Hospital between 2010 and 2015. ResultsWe summarized the 5 techniques according to different types of facial deformities: (1) an advancement of the expanded cervical flap; (2) an expanded cervical flap that is rotated toward the temporal side (the rotation pivot is located in the angle of the mandible); (3) an expanded cervical flap that is rotated toward the nasal side (the rotation pivot is located in the mentum; (4) an expanded cervical flap that is rotated cephalically along the midline toward the lower third of the face (the rotation pivot is located in the bilateral angle of the mandible); and (5) a prefabricated cervical flap that is used with superficial temporal vessels. ConclusionBy using this algorithm and following five basic principles, all facial defects except for those on the nose and forehead can be resurfaced using an expanded cervical skin flap.

Прогнозирование синдрома атоничной радужки у больных с возрастной катарактой и доброкачественной гиперплазией предстательной железы

Purpose. To determine prognostic criteria of clinically significant intra-operative floppy iris syndrome (IFIS) in patients receiving α1-blockers. Material and methods. Using the optical coherence tomography of the anterior segment of the eye (AS-OCT) we examined 60 patients (60 eyes) with cataract and benign prostatic hyperplasia treated with tamsulosin or silodosin, and 33 men with cataract (33 eyes), who had no indication for α1-blockers treatment. All patients underwent phacoemulsification of the age-related cataract. Possible prognostic parameters of clinically significant (moderate and severe) IFIS development were evaluated using ROC-analysis. Results. The clinically significant IFIS developed in 14 patients treated with α1-blockers. According to the AS-OCT these patients had more pronounced narrowing of the pupil and iris thinning in the region of the pupil dilator on the temporal side. Dilated pupil diameter and the duration of α1-blockers treatment were the most informative predictors of clinically significant IFIS. With the threshold values corresponding to the 95% specificity (≤4.5mm and >45 months), these parameters provided the clinically significant IFIS prediction with sensitivity of 85.4% and 71.4%, respectively. The following simple predictive rule was suggested. Development of clinically significant IFIS could be expected if at least one of the following two conditions is met: 1.The diameter of the dilated pupil is not more than 4.6mm; 2. Duration of α1-blockers treatment is over 3.5 year s. Conclusion. The proposed prognostic criteria and the simple prognostic rule provide the most complete and timely identification of patients with the clinically significant IFIS, promoting its proper prevention.