Prospective, randomized study of one, two, or three trabecular bypass stents in open-angle glaucoma subjects on topical hypotensive medication

PURPOSE: To assess the safety and efficacy of one, two, or three trabecular microbypass stents in eyes with primary open-angle glaucoma (OAG) not controlled on ocular hypotensive medication. A total of 119 subjects were followed for 18 months postoperatively. MATERIALS AND METHODS: Subjects with medicated intraocular pressure (IOP) 18–30 mmHg and postmedication-washout baseline IOP 22–38 mmHg were randomized to implantation of one, two, or three stents. Ocular hypotensive medication was to be used if postoperative IOP exceeded 18 mmHg. RESULTS: A total of 38 subjects were implanted with one stent, 41 subjects with two stents, and 40 subjects with three stents. Both month 12 IOP reduction ≥20% without ocular hypotensive medication vs baseline unmedicated IOP and month 12 unmedicated IOP ≤18 mmHg were achieved by 89.2%, 90.2%, and 92.1% of one-, two-, and three-stent eyes, respectively. Furthermore, 64.9%, 85.4%, and 92.1% of the three respective groups achieved unmedicated IOP ≤15 mmHg. Over the 18-month follow-up period, medication was required in seven one-stent subjects, four two-stent subjects, and three three-stent subjects. At 18 months, mean unmedicated IOP was 15.9±0.9 mmHg in one-stent subjects, 14.1±1.0 mmHg in two-stent subjects, and 12.2±1.1 mmHg in three-stent subjects. Month 18 IOP reduction was significantly greater (P<0.001) with implantation of each additional stent, with mean differences in reduction of 1.84 mmHg (95% confidence interval 0.96–2.73) for three-stent vs two-stent groups and 1.73 mmHg (95% confidence interval 0.83–2.64) for two-stent vs one-stent groups. Adverse events through 18 months were limited to cataract progression with best-corrected visual acuity loss and subsequent cataract surgery. CONCLUSION: In this series, implantation of each additional stent resulted in significantly greater IOP reduction with reduced medication use. Titratability of stents as a sole procedure was shown to be effective and safe, with sustained effect through 18 months postoperatively in OAG not controlled with medication

Surface modifications of AISI 420 stainless steel by low energy Yttrium ions

In this work, we study surface modifications of AISI 420 stainless steel specimens in order to improve their surface properties. Oxidation resistance and surface micro-hardness were analyzed. Using an ion beam delivered by a Laser Ion Source (LIS) coupled to an electrostatic accelerator, we performed implantation of low energy yttrium ions on the samples. The ions experienced an acceleration passing through a gap whose ends had a potential difference of 60 kV. The gap was placed immediately before the samples surface. The LIS produced high ions fluxes per laser pulse, up to 3x1011 ions/cm2, resulting in a total implanted flux of 7x1015 ions/cm2. The samples were characterized before and after ion implantation using two analytical techniques. They were also thermally treated to investigate the oxide scale. The crystal phases were identified by an X-ray diffractometer, while the micro-hardness was assayed using the scratch test and a profilometer. The first analysis was applied to blank, implanted and thermally treated sample surface, while the latter was applied only to blank and implanted sample surfaces. We found a slight increase in the hardness values and an increase to oxygen resistance. The implantation technique we used has the advantages, with respect to conventional methods, to modify the samples at low temperature avoiding stray diffusion of ions inside the substrate bulk

Pseudo-ductility and reduced notch sensitivity in multi-directional all-carbon/epoxy thin-ply hybrid composites

© 2017 The Author(s) Un-notched and notched tensile response and damage accumulation of quasi-isotropic carbon/epoxy hybrid laminates made of ultra-high modulus and intermediate modulus carbon fibre/epoxy thin-ply prepregs were studied. It was confirmed that the ply fragmentation demonstrated previously in unidirectional hybrids as a successful pseudo-ductility mechanism can be transferred to multi-directional laminates. Furthermore, reduced notch sensitivity was demonstrated in quasi-isotropic specimens for both open holes and sharp notches as a result of local ply fragmentation around the notch

Comparative genomic analyses identify common molecular pathways modulated upon exposure to low doses of arsenic and cadmium

<p>Abstract</p> <p>Background</p> <p>Exposure to the toxic metals arsenic and cadmium is associated with detrimental health effects including cancers of various organs. While arsenic and cadmium are well known to cause adverse health effects at high doses, the molecular impact resulting from exposure to environmentally relevant doses of these metals remains largely unexplored.</p> <p>Results</p> <p>In this study, we examined the effects of <it>in vitro </it>exposure to either arsenic or cadmium in human TK6 lymphoblastoid cells using genomics and systems level pathway mapping approaches. A total of 167 genes with differential expression were identified following exposure to either metal with surprisingly no overlap between the two. Real-time PCR was used to confirm target gene expression changes. The gene sets were overlaid onto protein-protein interaction maps to identify metal-induced transcriptional networks. Interestingly, both metal-induced networks were significantly enriched for proteins involved in common biological processes such as tumorigenesis, inflammation, and cell signaling. These findings were further supported by gene set enrichment analysis.</p> <p>Conclusions</p> <p>This study is the first to compare the transcriptional responses induced by low dose exposure to cadmium and arsenic in human lymphoblastoid cells. These results highlight that even at low levels of exposure both metals can dramatically influence the expression of important cellular pathways.</p

Assessment of the genetic risks of a metallic alloy used in medical implants

The use of artificial implants provides a palliative or permanent solution for individuals who have lost some bodily function through disease, an accident or natural wear. This functional loss can be compensated for by the use of medical devices produced from special biomaterials. Titanium alloy (Ti-6Al-4V) is a well-established primary metallic biomaterial for orthopedic implants, but the toxicity of the chemical components of this alloy has become an issue of concern. In this work, we used the MTT assay and micronucleus assay to examine the cytotoxicity and genotoxicity, respectively, of an extract obtained from this alloy. The MTT assay indicated that the mitochondrial activity and cell viability of CHO-K1 cells were unaffected by exposure to the extract. However, the micronucleus assay revealed DNA damage and an increase in micronucleus frequency at all of the concentrations tested. These results show that ions released from Ti-6Al-4V alloy can cause DNA and nuclear damage and reinforce the importance of assessing the safety of metallic medical devices constructed from biomaterials

TOWARD A COVID-19 SCORE-RISK ASSESSMENTS AND REGISTRY

ABSTRACTImportanceCritical care resources like ventilators, used to manage the current COVID-19 pandemic, are potentially inadequate. Established triage standards and guidelines may not contain the most appropriate severity assessment and outcome prediction models.ObjectivesDevelop a draft pandemic specific triage assessment score for the current COVID-19 pandemic. Design a website where initial Toward a COVID-19 Scores (TACS) can be quickly calculated and used to compare various treatment strategies. Create a TACS Registry where data and outcomes for suspected and confirmed COVID-19 patients can be recorded. Use the TACS Registry to develop an influenza epidemic specific database and score for use in future respiratory based epidemics.Design, Setting, ParticipantsRetrospective analysis of 3,301 ICU admissions with respiratory failure admitted to 41 U.S. Intensive Care Units from 2015-19. Independent external validation on 1,175 similar ICU Admissions using identical entry criteria from Barnes Jewish Hospital (BJH), Washington University from 2016-2019.Main OutcomesTACS was created with 16 readily available predictive variables for risk assessment of hospital mortality 24 hours after ICU Admission and the need for prolonged assisted mechanical ventilation (PAMV) (&gt; 96 hours) at 24- and 48-hours post ICU admission.ResultsTACS achieved an Area Under the Curve (AUC) for hospital mortality after 24 hours of 0.80 in the development dataset; 0.81 in the internal validation dataset. At a probability of 50% hospital mortality, positive predictive value (PPV) was 0.55, negative predictive value (NPV) 0.89; sensitivity 22%, specificity 97%.For PAMV after 24 hours, the AUC was 0.84 in the development dataset, 0.81 in the validation dataset. For PAMV after 48 hours, the AUC was 0.82 in the development dataset, 0.78 in the validation dataset.In the external validation the AUC for TACS was 0.76 +/- 0.024. We launched a website that is scaled for mobile device use (https://covid19score.azurewebsites.net/) that provides open access to a user-friendly TACS Calculator for all predictions. We also designed a voluntary TACS Registry for collection of data and outcomes on ICU Admissions with COVID-19.Conclusions and RelevanceToward a COVID-19 score is a starting point for an epidemic specific triage assessment that could be used to evaluate various approaches to treatment. The TACS Registry provides the ability to establish a respiratory specific outcomes database that can be used to create a triage approach for future such pandemics.Key PointsQuestionCan a rapid epidemic specific risk assessment severity score and data and outcome repository be constructed in the midst of a pandemic.FindingsUsing development and validation datasets with ICU admissions similar to those developing COVID-19, developed an initial Toward a COVID-19 Score that could be used to compare various treatment approaches. Also launched an online facilitated data collection and outcome assessment registry for collection of a pandemic specific database so a new triage score could be created for use in the next pandemic.MeaningIn the midst of a pandemic rapid development of an epidemic specific triage score and a data registry for the creation of a new score for use in future pandemics appears feasible.</jats:sec

Chronic obstructive pulmonary disease phenotypes using cluster analysis of electronic medical records

Chronic obstructive pulmonary disease is a heterogeneous disease. In this retrospective study, we hypothesize that it is possible to identify clinically relevant phenotypes by applying clustering methods to electronic medical records. We included all the patients &gt;40 years with a diagnosis of chronic obstructive pulmonary disease admitted to the University of New Mexico Hospital between 1 January 2011 and 1 May 2014. We collected admissions, demographics, comorbidities, severity markers and treatments. A total of 3144 patients met the inclusion criteria: 46 percent were &gt;65 years and 52 percent were males. The median Charlson score was 2 (interquartile range: 1–4) and the most frequent comorbidities were depression (36%), congestive heart failure (25%), obesity (19%), cancer (19%) and mild liver disease (18%). Using the sphere exclusion method, nine clusters were obtained: depression–chronic obstructive pulmonary disease, coronary artery disease–chronic obstructive pulmonary disease, cerebrovascular disease–chronic obstructive pulmonary disease, malignancy–chronic obstructive pulmonary disease, advanced malignancy–chronic obstructive pulmonary disease, diabetes mellitus–chronic kidney disease–chronic obstructive pulmonary disease, young age–few comorbidities–high readmission rates–chronic obstructive pulmonary disease, atopy–chronic obstructive pulmonary disease, and advanced disease–chronic obstructive pulmonary disease. These clusters will need to be validated prospectively. </jats:p