Agreement of angle closure assessments between gonioscopy, anterior segment optical coherence tomography and spectral domain optical coherence tomography.

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Tay, Elton Lik Tong; Yong, Vernon Khet Yau; Lim, Boon Ang; Sia, Stelson; Wong, Elizabeth Poh Ying; Yip, Leonard Wei Leon

2015-01-01

To determine angle closure agreements between gonioscopy and anterior segment optical coherence tomography (AS-OCT), as well as gonioscopy and spectral domain OCT (SD-OCT). A secondary objective was to quantify inter-observer agreements of AS-OCT and SD-OCT assessments. Seventeen consecutive subjects (33 eyes) were recruited from the study hospital's Glaucoma clinic. Gonioscopy was performed by a glaucomatologist masked to OCT results. OCT images were read independently by 2 other glaucomatologists masked to gonioscopy findings as well as each other's analyses of OCT images. Totally 84.8% and 45.5% of scleral spurs were visualized in AS-OCT and SD-OCT images respectively (Pgonioscopy was fair at k=0.31 (95% confidence interval, CI: 0.03-0.59) and k=0.35 (95% CI: 0.07-0.63) for reader 1 and 2 respectively. The agreement for angle closure between SD-OCT and gonioscopy was fair at k=0.21 (95% CI: 0.07-0.49) and slight at k=0.17 (95% CI: 0.08-0.42) for reader 1 and 2 respectively. The inter-reader agreement for angle closure in AS-OCT images was moderate at 0.51 (95% CI: 0.13-0.88). The inter-reader agreement for angle closure in SD-OCT images was slight at 0.18 (95% CI: 0.08-0.45). Significant proportion of scleral spurs were not visualised with SD-OCT imaging resulting in weaker inter-reader agreements. Identifying other angle landmarks in SD-OCT images will allow more consistent angle closure assessments. Gonioscopy and OCT imaging do not always agree in angle closure assessments but have their own advantages, and should be used together and not exclusively.

CORNEAL ENDOTHELIAL CELL DENSITY IN ACUTE ANGLE CLOSURE GLAUCOMA

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Nishat Sultana K

2016-09-01

Full Text Available BACKGROUND Angle closure is characterised by apposition of the peripheral iris against the trabecular meshwork resulting in obstruction of aqueous outflow. Acute angle-closure glaucoma is characterised by pain, redness and blurred vision. The pain is typically a severe deep ache that follows the trigeminal distribution and maybe associated with nausea, vomiting, bradycardia and profuse sweating. The blurred vision, which is typically marked maybe caused by stretching of the corneal lamellae initially and later oedema of the cornea as well as a direct effect of the IOP on the optic nerve head. The modifications in corneal endothelial cell density after a crisis of angle-closure glaucoma is being evaluated. AIMS AND OBJECTIVES The objective of the study is to assess the corneal endothelial cell count (density by specular microscopy in patients presenting with acute angle-closure glaucoma. METHODS Corneal endothelial cell counts of 20 eyes of patients with PACG with an earlier documented symptomatic acute attack unilaterally were compared with 20 fellow eyes. Evaluation of patient included visual acuity, intraocular pressure, gonioscopy, disc findings and specular microscopy. RESULTS The mean endothelial cell density was 2104 cells/mm2 in the eye with acute attack and 2615 cells/mm2 in the fellow eye. The average endothelial cell count when the duration of attack lasted more than 72 hours was 1861 cells/mm2 . CONCLUSION Corneal endothelial cell density was found to be significantly reduced in eyes following an acute attack of primary angle closure glaucoma.

Non-pupillary block angle-closure mechanisms: a comprehensive analysis of their prevalence and treatment outcomes

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Daniela L. M. Junqueira

2014-12-01

Full Text Available Purpose: To assess the prevalence and treatment outcomes of angle-closure mechanisms other than pupillary block in a population of Brazilian patients. Methods: A retrospective chart review was conducted to evaluate patients who had undergone laser peripheral iridotomy (LPI due to occludable angles at a single institution between July 2009 and April 2012. An occludable angle was defined as an eye in which the posterior trabecular meshwork was not visible for ≥180° on dark-room gonioscopy. Key exclusion criteria were any form of secondary glaucoma and the presence of >90° of peripheral anterior synechiae. Collected data were age, race, gender, angle-closure mechanism (based on indentation goniocopy and ultrasound biomicroscopy, intraocular pressure (IOP, number of antiglaucoma medications and subsequent management during follow-up. If both eyes were eligible, the right eye was arbitrarily selected for analysis. Results: A total of 196 eyes of 196 consecutive patients (mean age 58.3 ± 11.6 years who underwent LPI were included. In most of the patients [86% (169 patients; 133 women and 36 men], LPI sucessfully opened the angle. Mean IOP was reduced from 18.3 ± 6.4 mmHg to 15.4 ± 4.5 mmHg after LPI (p<0.01. Among the 27 patients with persistent occludable angles, the most common underlying mechanisms were plateau iris (56% and lens-induced component (34%. Most of these patients (85% were treated with argon laser peripheral iridoplasty (ALPI; approximately 90% showed non-occludable angles following the laser procedure (mean IOP reduction of 18.9%, with no significant differences between patients with plateau iris and lens-induced components (p=0.34; mean follow-up of 11.4 ± 3.6 months. Conclusion: Our findings suggest that, in this population of Brazilian patients, several eyes with angle closure were not completely treated with LPI. In the present large case series involving middle-age patients, plateau iris was the leading cause of

Argon laser peripheral iridoplasty for angle-closure glaucoma in sibilings with weill-marchesani syndrome.

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Ritch, R; Solomon, L D

1992-01-01

A patient with Weill-Marchesani syndrome and angle-closure glaucoma had persistent appositional closure after laser iridotomy that was unrelieved by topical application of either miotic or cycloplegic agents. Argon laser peripheral iridoplasty successfully opened the angle. The patient's sister also had Weill-Marchesani syndrome and angle closure unrelieved by laser iridotomy. Angle closure in Weill-Marchesani syndrome and the response to laser iridotomy and treatment with either miotic or cycloplegic agents may be complex and depends on the relative proportion of pupillary block as a mechanism underlying the angle closure, the functional status of the zonular apparatus, and the degree of angle crowding by the peripheral iris in the presence or absence of peripheral anterior synechiae.

Bilateral Acute Angle-Closure Glaucoma Induced By Escitalopram

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Dilbade Yıldız Ekinci

2014-10-01

Full Text Available Escitalopram is an antidepressant of the selective serotonin reuptake inhibitor(SSRI class. In this manuscript, we report the case of a female patient who developed bilateral acute angle-closure glaucoma induced by escitalopram. A 46-year-old female patient was admitted to our ophthalmology clinic with complaints of severe pain around the both eyes, headache, nausea, and vomiting for two days. In her past medical history, she was using escitalopram for depression for two years. Visual acuity was at hand movement level in both eyes. Anterior segment examination showed bilateral diffuse conjunctival hyperemia, corneal edema, shallow anterior chamber, and fixed dilated pupils. Intraocular pressure was 47 mmHg in the right and 68 mmHg in the left eye. The diagnosis was acute angle-closure glaucoma, and the escitalopram medication was discontinued. She was treated with topical and systemic antiglaucomatous medication. After the cornea become clear, bilateral peripheral laser iridotomy was done. In the following year, she did not begin escitalopram medication again and no other acute angle-closure attack was seen. (Turk J Ophthalmol 2014; 44:396-9

Longitudinal Changes of Angle Configuration in Primary Angle-Closure Suspects

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Jiang, Yuzhen; Chang, Dolly S.; Zhu, Haogang; Khawaja, Anthony P.; Aung, Tin; Huang, Shengsong; Chen, Qianyun; Munoz, Beatriz; Grossi, Carlota M.

2015-01-01

Objective To determine longitudinal changes in angle configuration in the eyes of primary angle-closure suspects (PACS) treated by laser peripheral iridotomy (LPI) and in untreated fellow eyes. Design Longitudinal cohort study. Participants Primary angle-closure suspects aged 50 to 70 years were enrolled in a randomized, controlled clinical trial. Methods Each participant was treated by LPI in 1 randomly selected eye, with the fellow eye serving as a control. Angle width was assessed in a masked fashion using gonioscopy and anterior segment optical coherence tomography (AS-OCT) before and at 2 weeks, 6 months, and 18 months after LPI. Main Outcome Measures Angle width in degrees was calculated from Shaffer grades assessed under static gonioscopy. Angle configuration was also evaluated using angle opening distance (AOD250, AOD500, AOD750), trabecular-iris space area (TISA500, TISA750), and angle recess area (ARA) measured in AS-OCT images. Results No significant difference was found in baseline measures of angle configuration between treated and untreated eyes. At 2 weeks after LPI, the drainage angle on gonioscopy widened from a mean of 13.5° at baseline to a mean of 25.7° in treated eyes, which was also confirmed by significant increases in all AS-OCT angle width measures (Pgonioscopy (P = 0.18), AOD250 (P = 0.167) and ARA (P = 0.83). In untreated eyes, angle width consistently decreased across all follow-up visits after LPI, with a more rapid longitudinal decrease compared with treated eyes (P values for all variables ≤0.003). The annual rate of change in angle width was equivalent to 1.2°/year (95% confidence interval [CI], 0.8–1.6) in treated eyes and 1.6°/year (95% CI, 1.3–2.0) in untreated eyes (P<0.001). Conclusions Angle width of treated eyes increased markedly after LPI, remained stable for 6 months, and then decreased significantly by 18 months after LPI. Untreated eyes experienced a more consistent and rapid decrease in angle width over the

Detection of primary angle closure using anterior segment optical coherence tomography in Asian eyes.

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Nolan, Winifred P; See, Jovina L; Chew, Paul T K; Friedman, David S; Smith, Scott D; Radhakrishnan, Sunita; Zheng, Ce; Foster, Paul J; Aung, Tin

2007-01-01

To evaluate noncontact anterior segment optical coherence technology (AS-OCT) as a qualitative method of imaging the anterior chamber angle and to determine its ability to detect primary angle closure when compared with gonioscopy in Asian subjects. Prospective observational case series. Two hundred three subjects were recruited from glaucoma clinics in Singapore with diagnoses of primary angle closure, primary open-angle glaucoma, ocular hypertension, or cataract. Both eyes (if eligible) of each patient were included in the study. Exclusion criteria were pseudophakia or previous glaucoma surgery. Images of the nasal, temporal, and inferior angles were obtained with AS-OCT in dark and then light conditions. Gonioscopic angle width was graded using the Spaeth classification for each quadrant in low lighting conditions. Angle closure was defined by AS-OCT as contact between the peripheral iris and angle wall anterior to the scleral spur and by gonioscopy as a Spaeth grade of 0 degree (posterior trabecular meshwork not visible). Comparison of the 2 methods in detecting angle closure was done by eye and by individual. Sensitivities and specificities of AS-OCT were calculated using gonioscopy as the reference standard. Complete data were available for 342 eyes of 200 patients. Of the patients, 70.9% had a clinical diagnosis of treated or untreated primary angle closure. Angle closure in > or =1 quadrants was detected by AS-OCT in 142 (71%) patients (228 [66.7%] eyes) and by gonioscopy in 99 (49.5%) patients (152 [44.4%] eyes). The inferior angle was closed more frequently than the nasal or temporal quadrants using both AS-OCT and gonioscopy. When performed under dark conditions, AS-OCT identified 98% of those subjects found to have angle closure on gonioscopy (95% confidence interval [CI], 92.2-99.6) and led to the characterization of 44.6% of those found to have open angles on gonioscopy to have angle closure as well. With gonioscopy as the reference standard

Gonioscopy in primary angle closure glaucoma.

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Bruno, Christina A; Alward, Wallace L M

2002-06-01

Primary angle closure is a condition characterized by obstruction to aqueous humor outflow by the peripheral iris, and results in changes in the iridocorneal angle that are visible through gonioscopic examination. Gonioscopy in these eyes, however, can be difficult. This chapter discusses techniques that might help in the examination. These include beginning the examination with the inferior angle, methods to help in looking over the iris, cycloplegia, locating the corneal wedge, indentation, van Herick estimation, examining the other eye, and topical glycerin. Finally, there is a discussion about the pathology associated with the closed angle, with emphasis on the appearance of iris bombé, plateau iris, and the distinction between iris processes and peripheral anterior synechiae.

Profile of angle closure in a tertiary care center in north India

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Ichhpujani Parul

2010-01-01

Full Text Available Purpose: To study the demographic and clinical profile of the types of primary angle closure patients presenting at a tertiary care center in North India. Materials and Methods: Clinic records of patients diagnosed as primary angle closure were reviewed. International Society of Geographical and Epidemiological Ophthalmology (ISGEO classification scheme was used to categorize patients. Demographic and clinical data including prior management was collected and analyzed. Main Outcome measures were age, sex, symptomatology, best corrected visual acuity (BCVA, intraocular pressure (IOP, gonioscopy, optic disc assessment and visual field defects. Logistic regression model and receiver operating curve (ROC were calculated for predictors of type of glaucoma. Results: Eight hundred and fourteen patients (1603 eyes; males: 380, females: 434 were diagnosed to have various subtypes of angle closure. Mean (±SD age at presentation was significantly higher for males (57.57 ± 11.62 years as compared to females (53.64 ± 10.67 years ( P < 0001. Primary angle closure glaucoma (PACG was most frequently diagnosed subtype (49.38% followed by Primary angle closure (PAC (39.68% and Primary angle closure suspect (PACS (10.93% respectively. The three subtypes differed significantly among their mean IOP (on ANOVA, F = 14.04; P < 0001 using Greenhouse-Geisser correction. Univariate analysis was done to find significant predictors for the outcome of PACG. Logistic regression model and ROC containing the significant predictors yielded a very high AUC of 0.93 with strong discriminatory ability for PACG. Conclusion: In our hospital-based study, the significant predictors for the outcome of PACG included male gender, diminution of vision, the presence of pain and worsening grades of BCVA. Nearly half of PACG presented with advanced disease. In spite of one-third of the patients being diagnosed as angle closure prior to referral, only 8.34% had iridotomy (laser or surgical

Increased risk of acute angle closure in retinitis pigmentosa: a population-based case-control study.

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Yu-Chieh Ko

Full Text Available To investigate the association between retinitis pigmentosa (RP and acute angle closure during a 15-year follow-up period.Using the Taiwan Longitudinal Health Insurance Database 2000, we identified 382 RP patients based on the diagnostic code of RP (International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM 362.74 made during 1996-2010, excluding subjects under age of 20 years at diagnosis or subjects undergoing lens extraction before the index date. The control group included 3820 randomly selected non-RP subjects matched with the RP patients in age, gender and the index date of diagnosis. The incidence of acute angle closure during the study period was observed based on an ICD-9-CM code of 365.22. Cochran-Mantel-Haenszel test was used to determine the odds ratio (OR of having acute angle closure in RP patients.The mean age at the diagnosis of RP was 51.1 years (standard deviation [SD] 16.7. Acute angle closure occurred in 5 RP patients (1.3% and in 15 controls (0.4%. The mean age with the acute angle closure was 53.3 years (SD 8.0 in RP patients and 64.6 years (SD 8.4 in controls (P = 0.015. After adjusting for age, gender and comorbid disorders, RP patients had 3.64-fold (95% confidence interval [CI], 1.29-10.25, P<0.001 greater odds of having acute angle closure. After stratification for gender and age, the risk of acute angle closure in RP was higher in patients under age of 60 years (adjusted OR 11.84; 95% CI, 2.84-49.48 and male patients (adjusted OR 19.36; 95% CI, 3.43-109.40 (both P = 0.001.RP patients had increased risk of acute angle closure than controls. Contrary to the fact that angle closure disease is more prevalent in elderly females in general population, acute angle closure attack occurred earlier in life and the risk was higher in males among RP patients.

Comparison of EyeCam and anterior segment optical coherence tomography in detecting angle closure.

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Baskaran, Mani; Aung, Tin; Friedman, David S; Tun, Tin A; Perera, Shamira A

2012-12-01

To compare the diagnostic performance of EyeCam (Clarity Medical Systems, Pleasanton, CA, USA) and anterior segment optical coherence tomography (ASOCT, Visante; Carl Zeiss Meditec, Dublin, CA, USA) in detecting angle closure, using gonioscopy as the reference standard. Ninety-eight phakic patients, recruited from a glaucoma clinic, underwent gonioscopy by a single examiner, and EyeCam and ASOCT imaging by another examiner. Another observer, masked to gonioscopy findings, graded EyeCam and ASOCT images. For both gonioscopy and EyeCam, a closed angle in a particular quadrant was defined if the posterior trabecular meshwork was not visible. For ASOCT, angle closure was defined by any contact between the iris and angle anterior to the scleral spur. An eye was diagnosed as having angle closure if ≥2 quadrants were closed. Agreement and area under the receiver operating characteristic curves (AUC) were evaluated. The majority of subjects were Chinese (69/98, 70.4%) with a mean age of 60.6 years. Angle closure was diagnosed in 39/98 (39.8%) eyes with gonioscopy, 40/98 (40.8%) with EyeCam and 56/97 (57.7%) with ASOCT. The agreement (kappa statistic) for angle closure diagnosis for gonioscopy versus EyeCam was 0.89; gonioscopy versus ASOCT and EyeCam versus ASOCT were both 0.56. The AUC for detecting eyes with gonioscopic angle closure with EyeCam was 0.978 (95% CI: 0.93-1.0) and 0.847 (95% CI: 0.76-0.92, p < 0.01) for ASOCT. The diagnostic performance of EyeCam was better than ASOCT in detecting angle closure when gonioscopic grading was used as the reference standard. The agreement between the two imaging modalities was moderate. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

Trabecular Meshwork Height in Primary Open-Angle Glaucoma Versus Primary Angle-Closure Glaucoma.

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Masis, Marisse; Chen, Rebecca; Porco, Travis; Lin, Shan C

2017-11-01

To determine if trabecular meshwork (TM) height differs between primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) eyes. Prospective, cross-sectional clinical study. Adult patients were consecutively recruited from glaucoma clinics at the University of California, San Francisco, from January 2012 to July 2015. Images were obtained from spectral-domain optical coherence tomography (Cirrus OCT; Carl Zeiss Meditec, Inc, Dublin, California, USA). Univariate and multivariate linear mixed models comparing TM height and glaucoma type were performed to assess the relationship between TM height and glaucoma subtype. Mixed-effects regression was used to adjust for the use of both eyes in some subjects. The study included 260 eyes from 161 subjects, composed of 61 men and 100 women. Mean age was 70 years (SD 11.77). There were 199 eyes (123 patients) in the POAG group and 61 eyes (38 patients) in the PACG group. Mean TM heights in the POAG and PACG groups were 812 ± 13 μm and 732 ± 27 μm, respectively, and the difference was significant in univariate analysis (P = .004) and in multivariate analysis (β = -88.7 [24.05-153.5]; P = .008). In this clinic-based population, trabecular meshwork height is shorter in PACG patients compared to POAG patients. This finding may provide insight into the pathophysiology of angle closure and provide assistance in future diagnosis, prevention, and management of the angle-closure spectrum of disorders. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparison of axial lengths in occludable angle and angle-closure glaucoma-The Bhaktapur Glaucoma Study

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Thapa, S.S.; Paudyal, I.; Khanal, S.; Paudel, N.; van Rens, G.H.M.B.

2011-01-01

Purpose. To compare the anterior chamber depth (ACD) and axial length of eyes in a population-based sample among normal, occludable angle, and primary angle-closure glaucoma (PACG) groups. Methods. Totally, 3979 subjects from a population-based glaucoma prevalence study underwent complete ocular

Assessment of circumferential angle-closure by the iris-trabecular contact index with swept-source optical coherence tomography.

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Baskaran, Mani; Ho, Sue-Wei; Tun, Tin A; How, Alicia C; Perera, Shamira A; Friedman, David S; Aung, Tin

2013-11-01

To evaluate the diagnostic performance of the iris-trabecular contact (ITC) index, a measure of the degree of angle-closure, using swept-source optical coherence tomography (SSOCT, CASIA SS-1000, Tomey Corporation, Nagoya, Japan) in comparison with gonioscopy. Prospective observational study. A total of 108 normal subjects and 32 subjects with angle-closure. The SSOCT 3-dimensional angle scans, which obtain radial scans for the entire circumference of the angle, were performed under dark conditions and analyzed using customized software by a single examiner masked to the subjects' clinical details. The ITC index was calculated as a percentage of the angle that was closed on SSOCT images. First-order agreement coefficient (AC1) statistics and area under the receiver operating characteristic curve (AUC) analyses were performed for angle-closure on the basis of the ITC index in comparison with gonioscopy. Angle-closure on gonioscopy was defined as nonvisibility of posterior trabecular meshwork for at least 2 quadrants. Agreement of the ITC index with gonioscopically defined angle-closure was assessed using the AC1 statistic. Study subjects were predominantly Chinese (95.7%) and female (70.7%), with a mean age of 59.2 (standard deviation, 8.9) years. The median ITC index was 15.24% for gonioscopically open-angle eyes (n = 108) and 48.5% for closed-angle eyes (n = 32) (P = 0.0001). The agreement for angle-closure based on ITC index cutoffs (>35% and ≥50%) and gonioscopic angle-closure was 0.699 and 0.718, respectively. The AUC for angle-closure detection using the ITC index was 0.83 (95% confidence interval, 0.76-0.89), with an ITC index >35% having a sensitivity of 71.9% and specificity of 84.3%. The ITC index is a summary measure of the circumferential extent of angle-closure as imaged with SSOCT. The index had moderate agreement and good diagnostic performance for angle-closure with gonioscopy as the reference standard. Copyright © 2013 American Academy of

Comparing approaches to screening for angle closure in older Chinese adults

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Andrews, J; Chang, D S; Jiang, Y; He, M; Foster, P J; Munoz, B; Kashiwagi, K; Friedman, D S

2012-01-01

Aims Primary angle-closure glaucoma is expected to account for nearly 50% of bilateral glaucoma blindness by 2020. This study was conducted to assess the performance of the scanning peripheral anterior chamber depth analyzer (SPAC) and limbal anterior chamber depth (LACD) as screening methods for angle closure. Methods This study assessed two clinical populations to compare SPAC, LACD, and gonioscopy: the Zhongshan Angle-closure Prevention Trial, from which 370 patients were eligible as closed-angle participants and the Liwan Eye Study, from which 72 patients were selected as open-angle controls. Eligible participants were assessed by SPAC, LACD, and gonioscopy. Results Angle status was defined by gonioscopy. Area under the receiver operating characteristic curve (AUROC) for SPAC was 0.92 (0.89–0.95) whereas AUROC for LACD was 0.94 (0.92–0.97). Using conventional cutoff points, sensitivity/specificity was 93.0%/70.8% for SPAC and 94.1%/87.5% for LACD. Sequential testing using both SPAC and LACD increased the specificity to 94.4% and decreased the sensitivity to 87.0%. Conclusion SPAC has significantly lower specificity than LACD measurement using conventional cutoffs but interpretation of the findings can be performed by modestly trained personnel. PMID:21997356

Unilateral Optic Neuropathy and Acute Angle-Closure Glaucoma following Snake Envenomation

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Osman Okan Olcaysu

2015-01-01

Full Text Available Purpose. We aimed to describe a unique case in which a patient developed unilateral optic neuritis and angle-closure glaucoma as a result of snake envenomation. Case Report. Approximately 18 hours after envenomation, a 67-year-old female patient described visual impairment and severe pain in her left eye (LE. The patient’s best corrected visual acuity was 10/10 in the RE and hand motion in the LE. Cranial magnetic resonance imaging showed signs of neuropathy in the left optic nerve. In the LE, corneal haziness, closure of the iridocorneal angle, and mild mydriasis were observed and pupillary light reflex was absent. Intraocular pressure was 25 mmHg and 57 mmHg in the RE and LE, respectively. The patient was diagnosed with acute angle-closure glaucoma in the LE. Optic neuropathy was treated with intravenous pulse methylprednisolone. Left intraocular pressure was within normal range starting on the fourth day. One month after the incident, there was no sign of optic neuropathy; relative afferent pupillary defect and optic nerve swelling disappeared. Conclusions. Patients with severe headache and visual loss after snake envenomation must be carefully examined for possible optic neuropathy and angle-closure glaucoma. Early diagnosis and treatment of these cases are necessary to prevent permanent damage to optic nerves.

Ocular Biometry in Primary Angle-Closure Glaucoma Associated with Retinitis Pigmentosa

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Jiangang Xu

2017-01-01

Full Text Available Background. Retinitis pigmentosa (RP comprises a group of inherited disorders in which patients typically lose night vision in adolescence and then lose peripheral vision in young adulthood before eventually losing central vision later in life. A retrospective case-control study was performed to evaluate differences in ocular biometric parameters in primary angle-closure glaucoma (PACG patients with and without concomitant RP to determine whether a relationship exists between PACG and RP. Methods. We used ultrasound biomicroscopy (UBM to measure anterior chamber depth (ACD. A-scan biometry was carried out to measure lens thickness (LT and axial length (AL. Propensity score matching and mixed linear regression model analysis were conducted. 23 patients with chronic primary angle-closure glaucoma (CPACG associated with RP, 21 patients with acute primary angle-closure glaucoma (APACG associated with RP, 270 patients with CPACG, and 269 patients with APACG were recruited for this study. Results. There were no significant differences on ACDs, ALs, and relative lens position (RLP (P>0.05 between patients with PACG associated with RP and patients with PACG; however, patients with APACG associated with RP had a significantly greater LT than patients with APACG (P<0.05. Conclusion. Patients with PACG associated with RP had the same biometric parameter characteristic as the patients with CPACG and APACG. This may suggest that RP is a coincidental relationship with angle-closure glaucoma.

Comparison of efficacy of procedures in the treatment of acute angle-closure glaucoma

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Lian-Rong Su

2013-06-01

Full Text Available AIM: To observe the clinical effects of 3 different surgery treatments for acute angle-closure glaucoma. METHODS: Totally 60 cases of acute angle-closure glaucoma were randomly divided into 3 groups. Iris root excision or laser iridotomy was applied to group A, cataract phacoemulsification with artificial lens implantation and goniosynechialysis for group B, crabeculectomy for group C. The changes of vision, intraocular pressure, chamber angle, anterior chamber depth before and after operation were observed, while the postoperative complications and following operations were analyzed. The period of follow-up was one week, one month, three months and six months.RESULTS: No statistical significance was found for treatments of group A and C(P>0.05. For group C the treatment was statistically significant(PPPCONCLUSION: Cataract phacoemulsification with artificial lens implantation and goniosynechialysis is a safe and effective surgery for treatment of acute angle-closure glaucoma, which can effectively improve vision, decrease intraocular pressure, open anterior chamber angle.

The analysis of clinical effect of phacoemulsification on primary angle-closure glaucoma with cataract

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Ling Zhao

2013-07-01

Full Text Available AIM:To evaluate the clinical outcomes and affected factors of prognosis of cataract extraction by phacoemulsification with intraocular lens implantation in eyes with primary angle-closure glaucoma(PACGand co-existing cataract.METHODS: Totally 60 cases(70 eyesof PACG with cataract, including 43 eyes with acute primary angle-closure glaucoma(APACG, 27 eyes of chronic primary angle-closure glaucoma(CPACG. The main outcome measures included: visual acuity, intraocular pressure, gonioscopy, depth of anterior chamber(ACD. Patients were examined 6 months after surgery.RESULTS: After phacoemulsification, visual acuity was improved(PPPPCONCLUSION:Phacoemulsification is more effective for acute APACG than for CPACG.

Anterior segment changes after pharmacologic mydriasis using Pentacam and optical coherence tomography in angle closure suspects

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Jing-Min Guo

2015-10-01

Full Text Available AIM:To compare the dynamic changes of anterior segment parameters especially iris morphology induced by pharmacologic mydriasis between angle closure suspects and normal controls.METHODS:The study group comprised 19 eyes of 19 angle closure suspects and 19 eyes of 19 age- and sex-matched normal open-angle eyes. Pentacam and optical coherence tomography measurements before and 30min after instillation of compound tropicamide eye drop were performed and compared. Biometric evaluations of iris tomography and anterior chamber angle were estimated by a customized image-processing software.RESULTS:Baseline axial length, iris cross sectional area and volume did not differ significantly between angle closure suspects and normal controls. Angle closure suspects had smaller pupil size, narrower anterior segment dimension and axial length, thinner iris with greater curve in comparison with normal controls. Pharmacologic mydriasis led to significant increments in iris thickness at 750 μm, anterior chamber depth and volume, whereas significant decrements in iris curve, cross sectional area and volume in both groups. Angle opening distance at 500 μm was increased significantly in normal controls (from 0.465±0.115 mm to 0.539±0.167 mm, P=0.009, but not in angle closure suspects (from 0.125±0.100 mm to 0.145±0.131 mm, P=0.326. Iris volume change per millimeter of pupil dilation (△IV/△PD decreased significantly less in angle closure suspects than normal controls (-2.47±1.33 mm2 vs -3.63±1.58 mm2, P=0.019. Linear regression analysis showed that the change of angle opening distance at 500 μm was associated most with the change of central anterior chamber depth (β=0.841, P=0.002 and △IV/△PD (β=0.028, P=0.002, followed by gender (β=0.062, P=0.032.CONCLUSION:Smaller iris volume decrement per millimeter of pupil dilation is related significantly with the less anterior angle opening in angle closure suspects after pharmacologic mydriasis. Dynamic

Secondary Angle Closure due to Crystalline Lens Dislocation in a Patient with Atopic Dermatitis and Chronic Eye Rubbing

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Justin Kuiper

2018-03-01

Full Text Available Purpose: To report an unusual case of ectopia lentis and angle closure in a patient with chronic eye rubbing. Methods: A 57-year-old male with a history of poorly controlled atopic dermatitis presented with right eye pain, decreased vision, and an intraocular pressure (IOP of 55 mm Hg. He had no past history of ocular disease and no reported history of trauma. He did report a history of chronic eye rubbing. Results: Best corrected visual acuity was hand motions. The examination revealed severe atopic keratoconjunctivitis in both eyes, microcystic corneal edema of the right eye, and 2+ nuclear sclerosis in both eyes. Gonioscopy showed no visible angle structures OD and an open angle OS. Topical and oral IOP-lowering medications and a laser iridotomy were unsuccessful at lowering IOP. He was taken to the operating room for a lensectomy and was found to have 9 clock hours of zonular dehiscence and a dislocated lens. After lensectomy, the IOP improved to 9 mm Hg on postoperative day 1. A follow-up examination at 2 weeks showed improved acuity to 20/150 with a pinhole and an IOP of 10 mm Hg. A dilated examination OS did not reveal significant phacodonesis, and the patient was referred for a possible sutured sulcus lens or anterior chamber intraocular lens. Conclusions: It is important for the provider to consider ectopia lentis in the differential for patients with pupillary block angle closure. For patients with atopic disease, one should be aware that eye rubbing may be a cause of zonular dehiscence, even in the absence of reported trauma or prior intraocular surgery.

Biometric parameters in different stages of primary angle closure using low-coherence interferometry.

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Yazdani, Shahin; Akbarian, Shadi; Pakravan, Mohammad; Doozandeh, Azadeh; Afrouzifar, Mohsen

2015-03-01

To compare ocular biometric parameters using low-coherence interferometry among siblings affected with different degrees of primary angle closure (PAC). In this cross-sectional comparative study, a total of 170 eyes of 86 siblings from 47 families underwent low-coherence interferometry (LenStar 900; Haag-Streit, Koeniz, Switzerland) to determine central corneal thickness, anterior chamber depth (ACD), aqueous depth (AD), lens thickness (LT), vitreous depth, and axial length (AL). Regression coefficients were applied to show the trend of the measured variables in different stages of angle closure. To evaluate the discriminative power of the parameters, receiver operating characteristic curves were used. Best cutoff points were selected based on the Youden index. Sensitivity, specificity, positive and negative predicative values, positive and negative likelihood ratios, and diagnostic accuracy were determined for each variable. All biometric parameters changed significantly from normal eyes to PAC suspects, PAC, and PAC glaucoma; there was a significant stepwise decrease in central corneal thickness, ACD, AD, vitreous depth, and AL, and an increase in LT and LT/AL. Anterior chamber depth and AD had the best diagnostic power for detecting angle closure; best levels of sensitivity and specificity were obtained with cutoff values of 3.11 mm for ACD and 2.57 mm for AD. Biometric parameters measured by low-coherence interferometry demonstrated a significant and stepwise change among eyes affected with various degrees of angle closure. Although the current classification scheme for angle closure is based on anatomical features, it has excellent correlation with biometric parameters.

Clinical investigation on angle-closure glaucoma patients with cataract treated by phacoemulsification combined with trabeculectomy

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Yu-Sheng Wang

2013-11-01

Full Text Available AIM: To investigate the effectiveness of phacoemulsification with intraocular lens(IOLimplantation combined with trabeculectomy in patients with cataract and angle-closure glaucoma.METHODS: In 36 cases(46 eyesof angle-closure glaucoma with cataract, phacoemulsification with foldable IOL implantation combined with trabeculectomy was performed. Data of pre- and post-operation, including visual acuity, intraocular pressure, filtering bleb, anterior chamber depth, chamber angle, and funds were all recorded and analyzed in detail.RESULTS: During the follow-up of 3 months to 2 years,visual acuity of 43 eyes(93.5%got improved, and intraocular pressure in 44 eyes(95.7%were controlled in normal range(CONCLUSION: Phacoemulsification with IOL implantation combined with trabeculectomy is an effective and safe surgical technique for patients with angle-closure glaucoma and cataract, with satisfied control of intraocular pressure, deepening of anterior chamber, opening of anterior chamber angle, and improving visual function.

Agreement of angle closure assessments between gonioscopy, anterior segment optical coherence tomography and spectral domain optical coherence tomography

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Tay, Elton Lik Tong; Yong, Vernon Khet Yau; Lim, Boon Ang; Sia, Stelson; Wong, Elizabeth Poh Ying; Yip, Leonard Wei Leon

2015-01-01

AIM: To determine angle closure agreements between gonioscopy and anterior segment optical coherence tomography (AS-OCT), as well as gonioscopy and spectral domain OCT (SD-OCT). A secondary objective was to quantify inter-observer agreements of AS-OCT and SD-OCT assessments. METHODS: Seventeen consecutive subjects (33 eyes) were recruited from the study hospital’s Glaucoma clinic. Gonioscopy was performed by a glaucomatologist masked to OCT results. OCT images were read independently by 2 ...

Transcatheter closure of patent ductus arteriosus using the angled duct occluder

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Yongwen, Qin; Xianxian, Zhao; Hong, Wu; Xing, Zheng; Jijun, Ding; Jianqiang, Hu [Second Military Medical Univ., Shanghai (China). Changhai Hospital, Dept. of Cardiology

2004-04-01

Objective: To assess the immediate efficacy of transcatheter closure of patent ductus arteriosus(PDA) using the angled duct occluder (ADO). Methods: 9 patients (1 male, 8 female) underwent transcatheter closure of PDA using the ADO. The mean PDA diameter at its narrowest segment was (5.8 {+-} 1.9) mm, ranging 3 to 10 mm. A 6 - 9F long sheath was used for the delivery of ADO. Results: The devices were deployed successfully in all patients. Angiographies showed no shunt across the device 15 min after the implantation of ADO. Within 1 week, echocardiography revealed complete closure in all patients. There were no complications. Conclusions: The transcatheter closure of PDA using ADO is an effective and safe procedure. The device matches with the shape of aortic cavity much more precisely than Amplatzer duct occluder. (authors)

Transcatheter closure of patent ductus arteriosus using the angled duct occluder

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Qin Yongwen; Zhao Xianxian; Wu Hong; Zheng Xing; Ding Jijun; Hu Jianqiang

2004-01-01

Objective: To assess the immediate efficacy of transcatheter closure of patent ductus arteriosus(PDA) using the angled duct occluder (ADO). Methods: 9 patients (1 male, 8 female) underwent transcatheter closure of PDA using the ADO. The mean PDA diameter at its narrowest segment was (5.8 ± 1.9) mm, ranging 3 to 10 mm. A 6 - 9F long sheath was used for the delivery of ADO. Results: The devices were deployed successfully in all patients. Angiographies showed no shunt across the device 15 min after the implantation of ADO. Within 1 week, echocardiography revealed complete closure in all patients. There were no complications. Conclusions: The transcatheter closure of PDA using ADO is an effective and safe procedure. The device matches with the shape of aortic cavity much more precisely than Amplatzer duct occluder. (authors)

Argon laser iridoplasty : A primary mode of therapy in primary angle closure glaucoma

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Agarwal H

1991-01-01

Full Text Available Argon laser iridoplasty was performed in 40 eyes of 33 patients of primary angle closure glaucoma. There were 12 male and 21 female patients. The mean ages of the male and female patients were 51 years and 48.4 years respectively. Forty eyes were divided into two groups. Group I consisted of ten eyes of subacute angle closure glaucoma and group II included thirty eyes of chronic angle closure glaucoma. Argon laser iridoplasty was performed with Coherent 9000 model using laser settings of spot size 200 micron, duration 0.2 second and power 0.7 watt. A total of 80 spots were applied over 360 degree circumference. The intraocular pressure control (below 22 mm Hg was achieved after iridoplasty in all the eyes (100% in group I, where as in group II the intraocular pressure was controlled in 70% eyes. The follow up period varied from 3 months to one year with a mean of eight months. The success rate with iridoplasty was directly related to the extent of peripheral anterior synechiae, optic disc cupping and presence of visual field changes.

Small-incision cataract extraction combined trabeculectomy for primary angle-closure glaucoma with cataract

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Yu-Feng Wu

2014-09-01

Full Text Available AIM: To observe the curative effect of treating small-incision cataract extraction by intraocular lens implantation combined with trabeculectomy for primary angle-closure glaucoma with cataract. METHODS: Totally 44 cases(52 eyesof primary angle-closure glaucoma combined with cataract were selected to undergo the combined surgery, in order to observe the patients' pre- and postoperative eyesights, intraocular pressures and the postoperative complications.RESULTS: The postoperative eyesight was improved significantly as compared with the preoperative eyesight. The intraocular pressure was declined dramatically. The result was of statistical significance(P0.05. All the 52 cases' surgeries were performed by the same surgeon. The surgeries were processed smoothly, with 6 postoperative eyes of anterior chamber inflammation cell response, 3 eyes of anterior chamber fibrinoid exudate, 2 eyes of shallow anterior chamber through mydriasis and treatment with glucocorticoids and non-steroidal eyedrops before absorption, and no complications like malignant glaucoma, cyclodialysis, etc. were reported through mydriasis and pressure bandaging before recovery.CONCLUSION: Treating the primary angle-closure glaucoma combined with cataract through the combined surgery has high reliability and desirable curative effect. The surgical method is simple to learn and applicable for promotion on the basic level.

Primary versus secondary closure of cutaneous abscesses in the emergency department: a randomized controlled trial.

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Singer, Adam J; Taira, Breena R; Chale, Stuart; Bhat, Rahul; Kennedy, David; Schmitz, Gillian

2013-01-01

Cutaneous abscesses have traditionally been treated with incision and drainage (I&D) and left to heal by secondary closure. The objective was to compare the healing rates of cutaneous abscesses following I&D after primary or secondary closure. This was a randomized, controlled, trial, balanced by center, with blocked randomization created by a random-number generator. One urban and one suburban academic emergency department (ED) participated. Subjects were randomized to primary or secondary wound closure following I&D of the abscess. Main outcome measures were the percentage of healed wounds (wound was completely closed by visual inspection; a 40% difference in wound healing was sought) and overall failure rate (need for additional intervention including suture removal, additional drainage, antibiotics, or admission within 7 days after drainage). Fifty-six adult patients with simple localized cutaneous abscesses were included; 29 were randomized to primary closure, and 27 were randomized to secondary closure. Healing rates at 7 days were similar between the primary and secondary closure groups (69.6%, 95% confidence interval [CI] = 49.1% to 84.4% vs. 59.3%, 95% CI = 40.7% to 75.5%; difference 10.3%, 95% CI = -15.8% to 34.1%). Overall failure rates at 7 days were also similar between the primary and secondary closure groups (30.4%, 95% CI = 15.6% to 50.9% vs. 28.6%, 95% CI = 15.2% to 47.1%; difference 1.8%, 95% CI = -24.2% to 28.8%). The rates of wound healing and treatment failure following I&D of simple abscesses in the ED are similar after primary or secondary closure. The authors did not detect a difference of at least 40% in healing rates between primary and secondary closure. © 2013 by the Society for Academic Emergency Medicine.

Topiramate-associated acute, bilateral, angle-closure glaucoma: case report

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Lucas Barasnevicius Quagliato

2013-02-01

Full Text Available This paper describes a topiramate induced acute bilateral angle-closure glaucoma. This rare adverse effect is an idiosyncratic reaction characterized by uveal effusion and lens forward displacement, leading to increased intraocular pressure and vision loss. We describe a 55 year-old white woman with migraine, spasmodic torticollis and essential tremor, who developed bilateral acute angle-closure glaucoma, one week after starting topiramate 25 mg/day. She was seen at the Ophthalmology Emergency Department of the Fundação João Penido Burnier (Campinas, SP, Brazil with a 4 hours history of blurry vision, ocular pain and bright flashes vision. Slit lamp examination revealed moderate conjunctival injection and corneal edema, and shallow anterior chambers. Intraocular pressure was 48 mmHg in both eyes. Fundoscopic examination findings were normal. She was treated with timolol, brimonidine, dorzolamide, pilocarpine, prednisone acetate eye drops and acetazolamide. One hour after those measures, as the intraocular pressure was 30 mmHg, she received a manitol intravenous injection and the intraocular pressure normalized. After 24 hours an iridotomy with Yag laser was performed. Topiramate was discontinued and she was totally recovered after one week.

Evaluation of circumferential angle closure using iridotrabecular contact index after laser iridotomy by swept-source optical coherence tomography.

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Cho, Hyun-Kyung; Ahn, Dongsub; Kee, Changwon

2017-05-01

To investigate the quantitative changes of circumferential angle closure after laser iridotomy (LI) using the iridotrabecular contact (ITC) index by Swept-Source optical coherence tomography (OCT). In this prospective observational study conducted in a hospital setting, 42 eyes of 36 patients (five males, 31 females) who underwent LI were included. The mean age was 65.00 ± 8.13 years old and the diagnosis included primary angle closure (PAC, 21 eyes), PAC suspect (16 eyes) and PAC glaucoma (five eyes). Optical coherence tomography (OCT) images were obtained pre-LI and at 1 week post-LI. In each image frame, the scleral spur (SS) and the ITC end-point were marked, from which the ITC index was calculated as a percentage of the angle closure across 360°. Measurements inspected before and after LI included: central anterior chamber depth (ACD), anterior chamber volume (ACV), lens vault (LV), nasal and temporal angle opening distance (AOD), angle recess area (ARA), trabecular-iris space area (TISA), trabecular-iris angle (TIA) at 500 μm and 750 μm from the SS and intraocular pressure (IOP). The ITC index and IOP decreased significantly after LI from 71.52 ± 26.29 to 35.31 ± 27.19 and from 20.64 ± 12.72 mmHg to 14.02 ± 3.49 mmHg, respectively (p  0.05), but ACV increased significantly after LI (p angle parameters except for nasal TIAs increased significantly after LI (all p angle showed a significant decrease after LI, but part of the angle closure was not relieved after LI. Other mechanisms besides pupillary block may play a role together in causing angle closure. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Clinical experience of phacoemulsification for cataract patients with angle-closure glaucoma in 29 cases

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Yong-Hui Gu

2014-05-01

Full Text Available AIM: To observe the clinical effect of phacoemulsification with foldable intraocular lens implantation on cataract with angle-closure glaucoma. METHODS: Twenty-nine cases(29 eyesof angle-closure glaucoma with cataract underwent phacoemulsification with foldable intraocular lens implantation, and the data of visual acuity, intraocular pressure, gonioscopy and complications after operation were statistically analyzed.RESULTS:Postoperatively, 28 eyes(96.5%visual acuity were improved. Intraocular pressure of 25 eyes(86.2%were maintained at a normal level without any IOP lowering drug, intraocular pressure of 3 eyes(10.3%were controlled by IOP lowering eye drops, intraocular pressure of 1 eye(3.5%returned to normal by trabeculectomy. The chamber depth of 29 eyes was increased. 8 eyes were suffered from mild corneal edema, and returned to normal after treatment. CONCLUSION: Characterized by decreasing intraocular pressure, opening anterior chamber, and raising visual acuity, phacoemulsification with foldable intraocular lens implantation is a good operative therapy for primary angle-closure glaucoma complicated with cataract with preoperative goniosynechia closed ≤270°.

Angle parameter changes of phacoemulsification and combined phacotrabeculectomy for acute primary angle closure

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Shi-Wei Li

2015-08-01

Full Text Available AIM: To evaluate the difference in angle parameters and clinical outcome following phacoemulsification and combined phacotrabeculectomy in patients with acute primary angle closure (APAC using ultrasound biomicroscopy (UBM.METHODS: Patients (n=23, 31 eyes were randomized to receive phacoemulsification or combined phacotrabeculectomy (n=24, 31 eyes. Best-corrected visual acuity (BCVA, intraocular pressure (IOP, the main complications following surgery, and indentation gonioscopy and angle parameters measured using UBM were documented preoperatively and postoperatively.RESULTS:The improvement in BCVA in the phacoemulsification group was significantly greater than in the combined group (P<0.05. IOP in the phacoemulsification group was slightly higher than in the combined group following 1wk of follow-up (P<0.05, whereas there was no significant difference between the two groups at the latter follow-up (P>0.05. Phacoemulsification alone resulted in a slight increase in the trabecular ciliary processes distance compared with the combined surgery (P<0.05, whereas the other angle parameters showed no significant difference between the groups. Complications in combined group were greater than phacoemulsification only group.CONCLUSION:Both surgeries effectively opened the drainage angle and deepened the anterior chamber, and IOP was well controlled postoperatively. However, phacoemulsification showed better efficacy in improving visual function and showed reduced complications following surgery.

Bilateral acute angle-closure glaucoma as a first presentation of granulomatosis with polyangiitis (Wegener's

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Alper Mete

Full Text Available ABSTRACT We report a case of bilateral acute angle-closure glaucoma in a patient with undiagnosed granulomatosis with polyangiitis (Wegener's. A 59-year-old man presented with a severe headache, ocular pain, blurred vision, shortness of breath, and mild fever. Clinical examination revealed conjunctival chemosis, corneal edema, and shallow anterior chambers. Closed angles were observed bilaterally on gonioscopy. The patient was treated with intravenous mannitol, oral acetazolamide, and anti-glaucomatous eye drops. Over the following two days, his vision improved and intraocular pressures decreased. Subsequently, laser iridotomies were performed bilaterally and the patient attended consultations with our departments of respiratory medicine, nephrology, and rheumatology and was subsequently diagnosed with granulomatosis with polyangiitis. Bilateral acute angle-closure glaucoma is a very rare ocular manifestation of granulomatosis with polyangiitis. The association of this clinical entity with Wegener's granulomatosis remains unknown.

Evaluation of blotchy pigments in the anterior chamber angle as a sign of angle closure

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Harsha L Rao

2012-01-01

Full Text Available Background: Blotchy pigments in the anterior chamber (AC angle are considered diagnostic of primary angle closure (PAC. But there are no reports either on the prevalence of blotchy pigments in AC angles or the validity of this sign. Aims: To determine the prevalence of blotchy pigments in AC angles and to evaluate their relationship with glaucomatous optic neuropathy (GON in eyes with occludable angles. Setting and Design: Cross-sectional, comparative study. Materials and Methods: Gonioscopy was performed in 1001 eyes of 526 subjects (245 eyes of 148 consecutive, occludable angle subjects and 756 eyes of 378 non-consecutive, open angle subjects, above 35 years of age. Quadrant-wise location of blotchy pigments was documented. Statistical Analysis: Odds of blotchy pigments in occludable angles against that in open angles were evaluated. Relationship of GON with blotchy pigments in occludable angle eyes was evaluated using a multivariate model. Results: Prevalence of blotchy pigments in occludable angles was 28.6% (95% CI, 22.9-34.3 and in open angles was 4.7% (95% CI, 3.2-6.3. Blotchy pigments were more frequently seen in inferior (16% and superior quadrants (15% of occludable angles, and inferior quadrant of open angles (4%. Odds of superior quadrant blotchy pigments in occludable angles were 33 times that in open angles. GON was seen in 107 occludable angle eyes. Blotchy pigments were not significantly associated with GON (odds ratio = 0.5; P = 0.1. Conclusions: Blotchy pigments were seen in 28.6% of occludable angle eyes and 4.7% of open angles eyes. Presence of blotchy pigments in the superior quadrant is more common in occludable angles. Presence of GON in occludable angle eyes was not associated with blotchy pigments.

Evaluation of blotchy pigments in the anterior chamber angle as a sign of angle closure

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Rao, Harsha L; Mungale, Sachin C; Kumbar, Tukaram; Parikh, Rajul S; Garudadri, Chandra S

2012-01-01

Background: Blotchy pigments in the anterior chamber (AC) angle are considered diagnostic of primary angle closure (PAC). But there are no reports either on the prevalence of blotchy pigments in AC angles or the validity of this sign. Aims: To determine the prevalence of blotchy pigments in AC angles and to evaluate their relationship with glaucomatous optic neuropathy (GON) in eyes with occludable angles. Setting and Design: Cross-sectional, comparative study. Materials and Methods: Gonioscopy was performed in 1001 eyes of 526 subjects (245 eyes of 148 consecutive, occludable angle subjects and 756 eyes of 378 non-consecutive, open angle subjects), above 35 years of age. Quadrant-wise location of blotchy pigments was documented. Statistical Analysis: Odds of blotchy pigments in occludable angles against that in open angles were evaluated. Relationship of GON with blotchy pigments in occludable angle eyes was evaluated using a multivariate model. Results: Prevalence of blotchy pigments in occludable angles was 28.6% (95% CI, 22.9-34.3) and in open angles was 4.7% (95% CI, 3.2-6.3). Blotchy pigments were more frequently seen in inferior (16%) and superior quadrants (15%) of occludable angles, and inferior quadrant of open angles (4%). Odds of superior quadrant blotchy pigments in occludable angles were 33 times that in open angles. GON was seen in 107 occludable angle eyes. Blotchy pigments were not significantly associated with GON (odds ratio = 0.5; P = 0.1). Conclusions: Blotchy pigments were seen in 28.6% of occludable angle eyes and 4.7% of open angles eyes. Presence of blotchy pigments in the superior quadrant is more common in occludable angles. Presence of GON in occludable angle eyes was not associated with blotchy pigments. PMID:23202393

Segmentation and Quantification for Angle-Closure Glaucoma Assessment in Anterior Segment OCT.

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Fu, Huazhu; Xu, Yanwu; Lin, Stephen; Zhang, Xiaoqin; Wong, Damon Wing Kee; Liu, Jiang; Frangi, Alejandro F; Baskaran, Mani; Aung, Tin

2017-09-01

Angle-closure glaucoma is a major cause of irreversible visual impairment and can be identified by measuring the anterior chamber angle (ACA) of the eye. The ACA can be viewed clearly through anterior segment optical coherence tomography (AS-OCT), but the imaging characteristics and the shapes and locations of major ocular structures can vary significantly among different AS-OCT modalities, thus complicating image analysis. To address this problem, we propose a data-driven approach for automatic AS-OCT structure segmentation, measurement, and screening. Our technique first estimates initial markers in the eye through label transfer from a hand-labeled exemplar data set, whose images are collected over different patients and AS-OCT modalities. These initial markers are then refined by using a graph-based smoothing method that is guided by AS-OCT structural information. These markers facilitate segmentation of major clinical structures, which are used to recover standard clinical parameters. These parameters can be used not only to support clinicians in making anatomical assessments, but also to serve as features for detecting anterior angle closure in automatic glaucoma screening algorithms. Experiments on Visante AS-OCT and Cirrus high-definition-OCT data sets demonstrate the effectiveness of our approach.

Anterior ischemic optic neuropathy precipitated by acute primary angle closure

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Choudhari Nikhil

2010-01-01

Full Text Available A 59-year-old man with a history of longstanding systemic hypotension developed asymmetric non-arteritic anterior ischemic optic neuropathy (NAION apparently precipitated by bilateral sequential acute primary angle closure. NAION is very rarely reported in association with raised intraocular pressure. In contrast to optical coherence tomography, the failure of scanning laser polarimetry to detect axonal swelling was another interesting finding. Possible reasoning for these observations is discussed.

Gonioscopy and ultrasound biomicroscopy in the detection of angle closure in patients with shallow anterior chamber.

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Cui, Shan-shan; Zou, Yan-hong; Li, Qian; Li, Li-na; Zhang, Ning; Liu, Xi-pu

2014-12-01

To assess the agreement between gonioscopy and ultrasound biomicroscopy (UBM) in detecting angle closure in Chinese patients with shallow anterior chamber. An observational comparative study of the two different examination methods was conducted. Patients with normal intraocular pressure and temporal peripheral anterior chamber depth less than a quarter of corneal thickness based on slit lamp examination were included in this study from December 2007 to May 2009 in the outpatient clinic of First Hospital of Tsinghua University. Gonioscopy was performed with a Goldman goniolens in dark room first and followed by full beam light and indentation. If the filtering trabecular meshwork was invisible or any peripheral anterior synechia was found, that quadrant of the angle was considered closed. UBM was first undertaken in a darkened room then repeated with normal room lighting. If iridotrabecular apposition was showed, that quadrant of the angle was considered closed. The status of angle closure of each quadrant with different methods was recorded. 85 eyes of 46 patients were included in this study. The agreement between gonioscopy and UBM was poor (Κgonioscopy and UBM was hardly affected by age or sex, while in dark condition, eyes with deeper anterior chamber (P=0.005) or plateau iris configuration tended to produce different results (P=0.075) in the 2 methods. Gonioscopy and UBM are both indispensable methods for detecting angle closure, neither can completely replace the other.

Comparison of slitlamp optical coherence tomography and scanning peripheral anterior chamber depth analyzer to evaluate angle closure in Asian eyes.

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Wong, Hon-Tym; Chua, Jocelyn L L; Sakata, Lisandro M; Wong, Melissa H Y; Aung, Han T; Aung, Tin

2009-05-01

To evaluate the effectiveness of slitlamp optical coherence tomography (SL-OCT) and Scanning Peripheral Anterior Chamber depth analyzer (SPAC) in detecting angle closure, using gonioscopy as the reference standard. A total of 153 subjects underwent gonioscopy, SL-OCT, and SPAC. The anterior chamber angle (ACA) was classified as closed on gonioscopy if the posterior trabecular meshwork could not be seen; with SL-OCT, closure was determined by contact between the iris and angle wall anterior to the scleral spur; and with SPAC by a numerical grade of 5 or fewer and/or a categorical grade of suspect or potential. A closed ACA was identified in 51 eyes with gonioscopy, 86 eyes with SL-OCT, and 61 eyes with SPAC (gonioscopy vs SL-OCT, P gonioscopy vs SPAC, P = .10; SL-OCT vs SPAC, P gonioscopy, SL-OCT detected a closed ACA in 43, whereas SPAC identified 41 (P = .79). An open angle in all 4 quadrants was observed in 102 eyes with gonioscopy, but SL-OCT and SPAC identified 43 and 20 of these eyes, respectively, as having angle closure. The overall sensitivity and specificity for SL-OCT were 84% and 58% vs 80% and 80% for SPAC. Using gonioscopy as the reference, SL-OCT and SPAC showed good sensitivity for detecting eyes at risk of angle closure.

Evaluation of anterior chamber angle under dark and light conditions in angle closure glaucoma: An anterior segment OCT study.

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Masoodi, Habibeh; Jafarzadehpur, Ebrahim; Esmaeili, Alireza; Abolbashari, Fereshteh; Ahmadi Hosseini, Seyed Mahdi

2014-08-01

To evaluate changes of nasal and temporal anterior chamber angle (ACA) in subjects with angle closure glaucoma using Spectralis AS-OCT (SAS-OCT) under dark and light conditions. Based on dark-room gonioscopy, 24 subjects with open angles and 86 with narrow angles participated in this study. The nasal and temporal angle opening distance at 500 μm anterior to the scleral spur (AOD500), nasal and temporal ACA were measured using SAS-OCT in light and dark conditions. In 2 groups, ACA and AOD500 in nasal and temporal quadrants were significantly greater in light compared to dark (all with p=0.000). The AOD500 and ACA were significantly higher in nasal than temporal in measured conditions for 2 groups except the ACA and AOD500 of normal group measured in light. The difference between nasal and temporal in dark (29.07 ± 65.71 μm for AOD500 and 5.7 ± 4.07° for ACA) was greater than light (24.86 ± 79.85 μm for AOD500 and 2.09 ± 7.21° for ACA) condition. But the difference was only significant for ACA (p=0.000). The correlation analysis showed a negative correlation between AOD500 and pupil diameter in temporal and nasal quadrants (both with p=0.000). While temporal AOD500 difference correlated with spherical equivalent, temporal and asal gonioscopy, nasal AOD correlated with IOP, temporal and nasal gonioscopy. Clinically important changes in ACA structure could be detected with SAS-OCT in nasal and temporal quadrants under different illumination intensity. The results could help in improvement of examination condition for better and more accurate assessment of individuals with angle closure glaucoma. Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Effect of laser peripheral iridotomy on anterior chamber angle anatomy in primary angle closure spectrum eyes

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Kansara, Seema; Blieden, Lauren S.; Chuang, Alice Z.; Baker, Laura A.; Bell, Nicholas P.; Mankiewicz, Kimberly A.; Feldman, Robert M.

2015-01-01

Purpose To evaluate the change in trabecular-iris circumference volume (TICV) after laser peripheral iridotomy (LPI) in primary angle closure (PAC) spectrum eyes Patients and Methods Forty-two chronic PAC spectrum eyes from 24 patients were enrolled. Eyes with anterior chamber abnormalities affecting angle measurement were excluded. Intraocular pressure, slit lamp exam, and gonioscopy were recorded at each visit. Anterior segment optical coherence tomography (ASOCT) with 3D mode angle analysis scans were taken with the CASIA SS-1000 (Tomey Corp., Nagoya, Japan) before and after LPI. Forty-two pre-LPI ASOCT scans and 34 post-LPI ASOCT scans were analyzed using the Anterior Chamber Analysis and Interpretation (ACAI, Houston, TX) software. A mixed-effect model analysis was used to compare the trabecular-iris space area (TISA) changes among 4 quadrants, as well as to identify potential factors affecting TICV. Results There was a significant increase in all average angle parameters after LPI (TISA500, TISA750, TICV500, and TICV750). The magnitude of change in TISA500 in the superior angle was significantly less than the other angles. The changes in TICV500 and TICV750 were not associated with any demographic or ocular characteristics. Conclusion TICV is a useful parameter to quantitatively measure the effectiveness of LPI in the treatment of eyes with PAC spectrum disease. PMID:26066504

Comparing Gonioscopy With Visante and Cirrus Optical Coherence Tomography for Anterior Chamber Angle Assessment in Glaucoma Patients.

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Hu, Cindy X; Mantravadi, Anand; Zangalli, Camila; Ali, Mohsin; Faria, Bruno M; Richman, Jesse; Wizov, Sheryl S; Razeghinejad, M Reza; Moster, Marlene R; Katz, L Jay

2016-02-01

The aim of this study was to compare gonioscopy with Visante and Cirrus optical coherence tomography (OCT) for identifying angle structures and the presence of angle closure in patients with glaucoma. A secondary objective was to assess interrater agreement for gonioscopy grading among 3 independent examiners. Gonioscopy grading using Spaeth Classification and determination of angle-closure risk was performed on 1 randomly selected eye for 50 phakic patients. Images of the same eye using both Visante and Cirrus OCT were obtained in both light and dark conditions. Agreement of angle closure among 3 devices and interrater agreement for gonioscopy were determined using Cohen's κ (K) or Kendall's coefficient of concordance (W). Of the 50 patients, 60% were female, 64% were white, and the mean age was 62 years. Angle closure was detected in 18%, 16%, and 48% of quadrants with Visante, Cirrus, and gonioscopy, respectively. The scleral spur was identified in 56% and 50% of quadrants with Visante and Cirrus OCT, respectively. Visante and Cirrus OCT showed moderate agreement in detecting angle closure (K=0.42 light, K=0.53 dark) but slight-to-fair agreement with gonioscopy (Visante K=0.25, Cirrus K=0.15). Gonioscopy demonstrated substantial agreement in angle closure (K=0.65 to 0.68) and angle-closure risk assessment (W=0.83) among 3 examiners. Visante and Cirrus OCT imaging may have limited ability to identify angle closure because of difficulty identifying angle structures. Gonioscopy by well-trained clinicians had remarkably consistent agreement for identifying angle-closure risk.

Management of intermittent angle closure glaucoma with Nd: yag laser iridotomy as a primary procedure

International Nuclear Information System (INIS)

Ahmed, M.

2006-01-01

To assess the efficacy and complications of Nd: YAG laser iridotomy in patients with intermittent (sub-acute) angle closure glaucoma. Twenty-five eyes of twenty-three patients with periodic (intermittent) angle closure, selected in outpatient department, were kept on pilocarpine until YAG laser iridotomy was performed. After YAG laser iridotomy oral acetazolamide and topical dexamethasone was used to control post laser rise of IOP and inflammation respectively. Patency of iridotomy was confirmed and intra-ocular pressure was measured one hour after the procedure. Immediate complication, if any, was noted. Follow-up was done for six months. Prophylactic laser iridotomy was done in fellow eye with occludable angle. Levene's test for equality of variance and t-test for equality of means were used for statistical analysis. This study revealed a significant difference in IOP before and after YAG laser iridotomy (p = .002). Complete follow-up of 6 months was possible in 25 eyes of 23 subjects. After YAG Laser iridotomy, 21 (84%) eyes showed negative provocative test, intraocular pressure below 19mm Hg without medication and anterior chamber angle no more occludable and were labeled successful. Iridotomy remained patent in 96% of eyes. Iridotomy failed to reduce IOP in 4 (16%) eyes. The complications were minimal and transient. (author)

Efficacy of goniosynechialysis for advanced chronic angle-closure glaucoma

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Qing G

2012-10-01

Full Text Available Guoping Qing,1,2 Ningli Wang,1 Dapeng Mu11Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China; 2State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, ChinaPurpose: To evaluate the intraocular pressure (IOP-lowering efficacy of goniosynechialysis (GSL for advanced chronic angle-closure glaucoma (CACG using a simplified slit-lamp technique.Patients and methods: Patients with CACG with one severely affected eye with best-corrected visual acuity below 20/200 and a mildly or functionally unaffected fellow eye were enrolled in this study. All patients underwent ophthalmologic examinations including measurement of visual acuity, best-corrected visual acuity, and IOP; biomicroscopy; specular microscopy; fundus examination; and gonioscopy followed by anterior chamber paracentesis and GSL for nasal peripheral anterior synechiae in the eye with severe CACG.Results: Thirty patients (18 men, 12 women were identified as having CACG with an initial mean IOP of 47.1 ± 6.7 mmHg (range 39–61 mmHg in the severely affected eye. One week after GSL, the mean IOP of the treated eyes decreased to 19.3 ± 2.8 mmHg (range 14–26 mmHg without antiglaucoma medication (average decrease 27.7 ± 6.5 mmHg; range 16–41 mmHg, which was significant (P < 0.00001 compared with baseline. After an average follow-up period of 36.6 ± 1.0 months (range 35–38 months, the mean IOP stabilized at 17.4 ± 2.2 mmHg (range 12–21 mmHg. The nasal angle recess did not close again in any one of the patients during the follow-up period. The average significant (P < 0.00001 decrease in corneal endothelial cell density in the treated eyes was 260 ± 183 cells/mm2 (range 191–328 cells/mm2.Conclusions: Anterior chamber paracentesis and GSL lowers IOP in advanced CACG, though it may lead to mild corneal endothelial cell loss

Functional and Structural Changes in a Canine Model of Hereditary Primary Angle-Closure Glaucoma

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Kecova, Helga; Harper, Matthew M.; Nilaweera, Wijitha; Kuehn, Markus H.; Kardon, Randy H.

2010-01-01

Purpose. To characterize functional and structural changes in a canine model of hereditary primary angle-closure glaucoma. Methods. Intraocular pressure (IOP) was evaluated with tonometry in a colony of glaucomatous dogs at 8, 15, 18, 20, and 30 months of age. Retinal function was evaluated using electroretinography (scotopic, photopic, and pattern). Examination of anterior segment structures was performed using gonioscopy and high-frequency ultrasonography (HFU). Results. A gradual rise in IOP was observed with an increase in age: 8 months, 14 mm Hg (median value); 15 months, 15.5 mm Hg; 18 months, 17.5 mm Hg; 20 months, 24 mm Hg; 30 months, 36 mm Hg. Provocative testing with mydriatic agents (tropicamide and atropine 1%) caused significant increases in IOP (35% and 50%, respectively). HFU analysis showed complete collapse of iridocorneal angles by 20 months of age. Scotopic and photopic ERG analysis did not reveal significant deficits, but pattern ERG analysis showed significantly reduced amplitudes in glaucomatous dogs (glaucoma, 3.5 ± 0.4 μV; control, 6.2 ± 0.3 μV; P = 0.004; Student's t-test). Histologic analysis revealed collapse of the iridocorneal angle, posterior bowing of the lamina cribrosa, swelling and loss of large retinal ganglion cells, increased glial reactivity, and increased thickening of the lamina cribrosa. Conclusions. Canine hereditary angle-closure glaucoma is characterized by a progressive increase in intraocular pressure, loss of optic nerve function, and retinal ganglion cell loss. PMID:19661222

Amplatzer angled duct occluder for closure of patent ductus arteriosus larger than the aorta in an infant.

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Vijayalakshmi, I B; Chitra, N; Rajasri, R; Prabhudeva, A N

2005-01-01

Transcatheter closure of patent ductus arteriosus (PDA) by Amplatzer duct occluder is the treatment of choice. However, closure of very large ducts in infants with low weight is a challenge for the interventionalist because a large device may obstruct the aorta or left pulmonary artery. Difficulty is also encountered in advancing the device around the curve of the right ventricular outflow tract toward the pulmonary artery; this curve is tight, more or less at a right angle in infants, leading to kinking of the sheath, which increases fluoroscopic time. This is the first reported case of a very large PDA (8.7 mm), larger than the aorta (8.2 mm), successfully closed by an Amplatzer angled duct occluder in an infant weighing 5 kg.

Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial.

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Azuara-Blanco, Augusto; Burr, Jennifer; Ramsay, Craig; Cooper, David; Foster, Paul J; Friedman, David S; Scotland, Graham; Javanbakht, Mehdi; Cochrane, Claire; Norrie, John

2016-10-01

Primary angle-closure glaucoma is a leading cause of irreversible blindness worldwide. In early-stage disease, intraocular pressure is raised without visual loss. Because the crystalline lens has a major mechanistic role, lens extraction might be a useful initial treatment. From Jan 8, 2009, to Dec 28, 2011, we enrolled patients from 30 hospital eye services in five countries. Randomisation was done by a web-based application. Patients were assigned to undergo clear-lens extraction or receive standard care with laser peripheral iridotomy and topical medical treatment. Eligible patients were aged 50 years or older, did not have cataracts, and had newly diagnosed primary angle closure with intraocular pressure 30 mm Hg or greater or primary angle-closure glaucoma. The co-primary endpoints were patient-reported health status, intraocular pressure, and incremental cost-effectiveness ratio per quality-adjusted life-year gained 36 months after treatment. Analysis was by intention to treat. This study is registered, number ISRCTN44464607. Of 419 participants enrolled, 155 had primary angle closure and 263 primary angle-closure glaucoma. 208 were assigned to clear-lens extraction and 211 to standard care, of whom 351 (84%) had complete data on health status and 366 (87%) on intraocular pressure. The mean health status score (0·87 [SD 0·12]), assessed with the European Quality of Life-5 Dimensions questionnaire, was 0·052 higher (95% CI 0·015-0·088, p=0·005) and mean intraocular pressure (16·6 [SD 3·5] mm Hg) 1·18 mm Hg lower (95% CI -1·99 to -0·38, p=0·004) after clear-lens extraction than after standard care. The incremental cost-effectiveness ratio was £14 284 for initial lens extraction versus standard care. Irreversible loss of vision occurred in one participant who underwent clear-lens extraction and three who received standard care. No patients had serious adverse events. Clear-lens extraction showed greater efficacy and was more cost-effective than

Meta-analysis of the Efficacy and Safety of Latanoprost Monotherapy in Patients With Angle-closure Glaucoma.

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Chen, Ru; Yang, Ke; Zheng, Zhong; Ong, Moh-Lim; Wang, Ning-Li; Zhan, Si-Yan

2016-03-01

To systematically evaluate the safety and efficacy of latanoprost monotherapy for the treatment of patients with angle-closure glaucoma. We searched EMBASE, Medline, Cochrane Library, Chinese Journal Full-text Database (CNKI), Chinese Science and Technology Periodical Database (VIP), and Wang Fang using the search terms "latanoprost" (or its commercial name, Xalatan) and "angle-closure glaucoma." Resulting articles were then screened using preset inclusion criteria. Subgroup and sensitivity analyses were performed to evaluate the impact of research population, research type (blinded or controlled), and withdrawal/loss to follow-up. A total of 17 studies (n=807) were included in this meta-analysis. The primary outcome measure was intraocular pressure (IOP). Changes in the mean, peak, and trough IOP from baseline were used as effect measures. As I statistic revealed statistical heterogeneity, the random-effects model was applied. With the exception of 2 non-Asian populations from Australia and Peru, all 13 countries included in this study were from Asia. Latanoprost reduced mean IOP by 7.9 mm Hg (32.4%), peak IOP by 7.4 mm Hg (29.8%), and trough IOP by 7.9 mm Hg (32.5%). The most frequent ocular adverse effects were ocular hyperemia, discomfort (including eye irritation, ocular discomfort, foreign body sensation, and itching), and blurred vision with a total incidence rate of 9.4%, 8.7%, and 5.2%, respectively. Systemic adverse effects encompass rhinitis, dizziness, headache, and nonspecific skin pigmentation. Latanoprost is effective at reducing the IOP of patients with angle-closure glaucoma. Adverse reactions associated with latanoprost were mainly ocular in nature.

Combined Phacoemulsification and Goniosynechialysis under an Endoscope for Chronic Primary Angle-Closure Glaucoma

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Li Nie

2018-01-01

Full Text Available Purpose. To investigate the clinical efficacy and safety of combined phacoemulsification with goniosynechialysis (GSL under an ophthalmic endoscope for chronic primary angle-closure glaucoma and coexisting cataract. Methods. This is a retrospective study. The intraocular pressure (IOP, best-corrected visual acuity (BCVA, and number of glaucoma medications at baseline and each postoperative follow-up visit were recorded. Other measurements included supraciliochoroidal fluid measured by anterior segment optical coherence tomography, corneal endothelial cell density (ECD, and peripheral anterior synechia (PAS. All patients were followed for more than a year. Results. Thirty-eight eyes of 31 patients were included. The mean follow-up duration was 16.3 ± 3.9 months. The IOP decreased from 22.2 ± 9.3 mmHg at baseline to 15.4 ± 4.2 mmHg at the last follow-up (P<0.001. The mean number of glaucoma medications (0.1 ± 0.6 at the last follow-up was significantly lower than the preoperative number (2.3 ± 1.1 (P<0.001. All patients achieved improved or stable visual acuity after surgery. All patients achieved a complete opened angle after GSL. The postoperative complications included hyphema (7.9%, exudation (5.3%, transiently elevated IOP (55.3%, and supraciliochoroidal fluid (40%. Conclusions. Combined phacoemulsification and GSL under an endoscope can completely reopen PAS and is an effective and safe method for patients with chronic primary angle-closure glaucoma and coexisting cataract.

Changes of postoperative macular structure in primary angle closure disease complicated with cataract

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Wen-long Liu

2018-02-01

Full Text Available AIM: To explore the change of postoperative macular structure in primary angle closure disease(PACDcomplicated with cataract. METHODS: The clinical data of 200 cases of PACD patients complicated with cataract treated in our hospital were analyzed retrospectively. The patients were divided into the Group A(n=60, 60 eyes, treated with trabeculectomy, the Group B(n=72, 72 eyes, given the phacoemulsification combined with intraocular lens implantationand the Group C(n=68, 68 eyes, given the trabeculectomy and phacoemulsification combined with intraocular lens implantation. The vision changes before and after treatment and the changes of intraocular pressure and macular thickness(foveal area, near central area, foveal surrounding areabefore operation and at 1wk, 1 and 3mo after operation were compared and observed, and the incidence of complications was compared between the two groups. RESULTS: There were significant differences in the improvement rate and reduction rate of visual acuity among three groups at 3mo after operation(PPPPPPPPPCONCLUSION: Phacoemulsification combined with intraocular lens implantation can relieve angle closure caused by pupillary block and lens factors, and can significantly improve the vision and reduce intraocular pressure of PACD patients with cataract, and it has small effects on postoperative macular edema with few complications.

Changes in ocular biometry and anterior chamber parameters after pharmacologic mydriasis and peripheral iridotomy in primary angle closure suspects

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Mohammad Reza Razeghinejad

2016-07-01

Conclusions: This study showed no change in the ocular biometric and anterior chamber parameters including iridocorneal angle after PI and/or pharmacologic mydriasis except for increments in anterior chamber volume. This factor has the potential to be used as a numerical proxy for iris position in evaluating and monitoring patients with primary angle closure suspects after PI.

Angle observation of laser peripheral iridoplasty for the treatment of acute angle-closure glaucoma which could not be controlled by drugs

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Wei Han

2013-07-01

Full Text Available AIM: To evaluate the effect of laser peripheral iridoplasty(LPIPto treat acute angle-closure glaucoma(AACGwhich could not controlled by drugs and with persistent ocular hypertension. METHODS: Totally 67 patients(69 eyeswith AACG were performed LPIP when intraocular pressure(IOPwas still over 30mmHg after the medicine therapy for 3-6 hours. Visual acuity and intraocular pressure were under detection before laser treatment and 30 minutes, 60 minutes and 2 hours after laser treatment. We measured the anterior chamber depth, width of angle, iris thickness with ultrasound biomicroscope(UBM. Dynamic gonioscopy was used to evaluate the degree of peripheral anterior synechia(PAS.RESULTS: Angle open distance(AODafter iridoplasty was increased(PPF=151.79, PCONCLUSION: LPIP can deepen peripheral anterior chamber, increase the angle access and lower the IOP immediately. It is an important ongoing adjuvant treatment, which can reduce the patients suffering by lowering the IOP quickly, reduce the damage of visual function caused by long-term high intraocular pressure, avoid side effect of the drugs, and can improve the prognosis.

Oseltamivir (Tamiflu-induced bilateral acute angle closure glaucoma and transient myopia

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Ji Woong Lee

2014-01-01

Full Text Available A 27-year-old woman developed bilateral acute angle closure glaucoma (AACG and transient myopia after taking oseltamivir for four days. On the fourth day, she received systemic and topical intraocular pressure (IOP-lowering agents, and IOP decreased in both eyes. However, her visual acuity was unchanged. A myopic shift of -5.25 D OD and -5.0 D OS was estimated to have occurred in the acute phase. A-scan ultrasonography and Pentacam showed markedly shallow anterior chambers and increased lens thickness. Ultrasound biomicroscopy revealed an annular ciliochoroidal effusion with forward displacement of the lens-iris diaphragm. Ciliochoroidal effusion and transient myopia were resolved after discontinuation of oseltamivir.

A comparison of two approaches to managing acute primary angle closure in Asian eyes

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Ho H

2013-06-01

Full Text Available Henrietta Ho,1 Paul T Chew,2 Chelvin Sng,1,2 Huiqi Huang,1 Tin Aung,1,2 Shamira A Perera1,21Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; 2Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, SingaporePurpose: To review the management regimes of acute primary angle closure (APAC in two hospitals in Singapore, and to identify the incidence of and risk factors for progression to glaucomatous optic neuropathy.Methods: We conducted a retrospective review of 40 patients from National University Hospital (NUH and 52 patients from Singapore National Eye Centre (SNEC who were diagnosed with APAC. Patients were treated with similar protocols of intensive medical therapy until laser peripheral iridotomy could be performed. In the event of failed medical treatment, patients at NUH only underwent laser iridoplasty. The 1-year outcomes were reviewed.Results: The demographic features of patients and presenting intraocular pressures (IOP were similar in both centers. More patients from NUH presented within 3 days of symptom onset, compared to those from SNEC (90.0% versus 71.2%, respectively (P = 0.037. The mean ± standard deviation time to break the attack was 18.2 ± 32.9 hours at SNEC and 9.80 ± 10.6 hours at NUH (P = 0.11. The mean follow up duration was 18.8 ± 14.0 months. Nineteen patients (36.5% from SNEC and six patients (22.5% from NUH developed raised IOP (P = 0.032 within 1-year of the attack. Of these, glaucomatous optic neuropathy developed in thirteen patients (68.4% from SNEC and all six patients (100% from NUH. At final review, the mean IOP of the APAC eye was 14.8 ± 4.3 mmHg from SNEC and 13.4 ± 3.0 mmHg from NUH. There was no significant difference in final visual acuity or IOP between both groups.Conclusion: Treatment strategies in both centers were effective in aborting an APAC attack. The development of raised IOP appears to be associated with a longer

Effect of gender and Frankfort mandibular plane angle on orthodontic space closure: a randomized controlled trial.

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Ireland, A J; Songra, G; Clover, M; Atack, N E; Sherriff, M; Sandy, J R

2016-05-01

To determine the effect of gender and Frankfort mandibular plane angle (FMPA) on extraction space closure. A single district general hospital. The sample population were 11- to 18-year-olds undergoing upper and lower fixed appliance therapy following the loss of a premolar in each quadrant. A total of 100 patients undergoing upper and lower fixed appliance therapy following the loss of four premolars were randomized with stratification on two age ranges (11-14 years and 15-18 years) and three FMPAs (high, medium and low). Allocation was to one of three treatment groups: conventional, active or passive self-ligating brackets, with an allocation ratio of 1:2:2. All subjects were treated using the same archwire sequence and space closing mechanics. Space closure was measured on models taken every 12 weeks throughout treatment. All measurements were taken by one operator, blinded to bracket type. A total of 98 patients were followed to completion. Data were analysed using linear mixed models and demonstrated no statistically significant difference between bracket types with respect to space closure. Therefore, the data were pooled to determine the effect of gender and FMPA on space closure. At all stages of space closure, there was a significant effect of gender (results are presented as effect size, lower and upper 95% confidence intervals and probability), that is passive [1.064, 0.521, 1.607, 0.001], active [0.825, 0.312, 1.339, 0.002] and total space closure [1.029, 0.527, 1.531, 0.001]. There was no statistically significant effect of FMPA on space closure. Space closure during fixed appliance therapy is affected by gender but is unaffected by FMPA. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Argon laser peripheral iridoplasty versus systemic intraocular pressure-lowering medications as immediate management for acute phacomorphic angle closure

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Lee JW

2013-01-01

Full Text Available Jacky WY Lee,1 Jimmy SM Lai,1 Doris WF Yick,2 Can YF Yuen21Department of Ophthalmology, University of Hong Kong, 2Department of Ophthalmology, The Caritas Medical Centre, Kowloon West Cluster, Hong Kong, People’s Republic of ChinaBackground: The purpose of this study was to compare the efficacy and safety of argon laser peripheral iridoplasty (ALPI and systemic intraocular pressure (IOP-lowering medications in the immediate management of acute phacomorphic angle closure.Methods: Consecutive cases of acute phacomorphic angle closure were randomized to receive ALPI and an intravenous or oral carbonic anhydrase inhibitor as initial treatment. Intravenous mannitol was administered for presenting IOP > 60 mmHg or IOP > 40 mmHg 2 hours posttreatment in both arms.Results: Of 10 consecutive cases, six received medical therapy and four received ALPI. Fifty percent in the medical group and none in the ALPI group required intravenous mannitol. The ALPI group took less time to achieve IOP < 25 mmHg (18.8 ± 7.5 minutes versus 115.0 ± 97.0 minutes, P = 0.001, F test; had a greater IOP reduction within 30 minutes (69.8% ± 7.7% versus 40.9 ± 23.9%, P = 0.03, t-test; and had a consistently smaller post-attack cup to disc ratio (0.50 ± 0.02 versus 0.60 ± 0.20, P = 0.002, F test.Conclusion: ALPI offers greater safety, consistency, and efficacy than systemic IOP-lowering medications as initial treatment for phacomorphic angle closure.Keywords: phacomorphic, glaucoma, argon laser peripheral iridoplasty, medical, intraocular pressure

Comparison of circumferential peripheral angle closure using iridotrabecular contact index after laser iridotomy versus combined laser iridotomy and iridoplasty.

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Cho, Hyun-Kyung; Kee, Changwon; Yang, Heon; Huh, Hyoun Do; Kim, Su Jin; Park, Young Min; Park, Jong Moon

2017-11-01

To compare the quantitative changes of peripheral angle after laser iridotomy (LI) alone (group A) or combined LI and Iridoplasty (group B) using iridotrabecular contact (ITC) index by swept-source anterior segment optical coherence tomography (AS-OCT). In this prospective comparative observational study, OCT images were obtained before and after the procedure. In each image frame, scleral spur (SS) and the ITC end point (EP) were marked and ITC index was calculated as a percentage of the angle closure from 360°. Age, gender, diagnosis and initial ITC index in Group B were matched with group A. Changes in ITC index, anterior chamber angle parameters, and intraocular pressure (IOP) were inspected. Thirty-three eyes (20 patients) with shallow anterior chamber were included in each group. Initial ITC index and initial IOP were not significantly different between the two groups (both p > 0.05). However, ITC index and IOP after the procedure were significantly lower in group B than those in group A (ITC index: 31.3 ± 23.2 in group A, 19.0 ± 21.3 in group B, p = 0.011, IOP: p = 0.004). All anterior chamber angle parameters in group B and all parameters in group A except nasal trabecular-iris angles (TIA) were significantly increased after the laser procedure (all p angle better than LI alone. Iridoplasty may be able to additionally relieve the peripheral angle closure caused by other mechanisms than pupillary block. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Variants in Nebulin (NEB) Are Linked to the Development of Familial Primary Angle Closure Glaucoma in Basset Hounds

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Ahram, D.F.; Grozdanic, S.D.; Kecova, H.; Henkes, A.; Collin, R.W.J.; Kuehn, M.H.

2015-01-01

Several dog breeds are susceptible to developing primary angle closure glaucoma (PACG), which suggests a genetic basis for the disease. We have identified a four-generation Basset Hound pedigree with characteristic autosomal recessive PACG that closely recapitulates PACG in humans. Our aim is to

The Effects of Phacoemulsification and Intraocular Lens Implantation on Anatomical and Functional Parameters in Patients with Primary Angle Closure: A Prospective Study. (An American Ophthalmological Society Thesis).

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Traverso, Carlo Enrico; Cutolo, Carlo Alberto

2017-08-01

To investigate the clinical, anatomical, and patient-reported outcomes of phacoemulsification (PE) with intraocular lens implantation performed to treat primary angle closure (PAC) and primary angle-closure glaucoma (PACG). Patients were evaluated at baseline and at 6 months after PE. The examination included visual acuity, intraocular pressure (IOP), visual field, optic nerve head, endothelial cell count (ECC), aqueous depth, and ocular biometric parameters. Patient-reported visual function and health status were assessed. Coprimary outcome measures were IOP changes, angle widening, and patient-reported visual function; secondary outcome measures were visual acuity changes, use of IOP-lowering medications, and complications. Univariate and multivariate analyses were performed to determine the predictors of IOP change. Thirty-nine cases were identified, and postoperative data were analyzed for 59 eyes, 39 with PACG and 20 with PAC. Globally, PE resulted in a mean reduction in IOP of -6.33 mm Hg (95% CI, -8.64 to -4.01, P <.001). Aqueous depth and angle measurements improved ( P <.01), whereas ECC significantly decreased ( P <.001). Both corrected and uncorrected visual acuity improved ( P <.01). The EQ visual analog scale did not change ( P =.16), but VFQ-25 improved ( P <.01). The IOP-lowering effect of PE was greater in the PACG compared to the PAC group ( P =.04). In both groups, preoperative IOP was the most significant predictor of IOP change ( P <.01). No sight-threatening complications were recorded. Our data support the usefulness of PE in lowering the IOP in patients with PAC and PACG. Although PE resulted in several anatomical and patient-reported visual improvements, we observe that a marked decrease in ECC should be carefully weighed before surgery.

Air pressure-induced iridocornea contact in a patient with primary angle closure observed with a dynamic Scheimpflug analyzer.

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Kawashima, Rumi; Matsushita, Kenji; Fujimoto, Hisataka; Maeda, Naoyuki; Nishida, Kohji

2015-01-01

To report air pressure-induced corneal deformation and iridocornea contact in eyes with primary angle closure (PAC) during intraocular pressure (IOP) measurement performed using a novel noncontact tonometer. A single case report. We report a patient with bilateral angle closure. One eye had acute PAC and the other had PAC. The latter was evaluated by the movements of the cornea and iris during IOP measurement using a noncontact tonometer. During the examination, the corneal endothelium and the iris came into contact at the mid-peripheral pupillary area in the left eye with PAC during the corneal reaction to an air puff. In contrast, the corneal endothelium in the pupillary area did not come into contact with the iris. Although we observed only 1 case and there could be limitations in its interpretation, IOP measurements using a noncontact tonometer may create mechanical stress on the corneal endothelium in eyes with PAC with a very shallow anterior chamber.

Structure-function correlations using scanning laser polarimetry in primary angle-closure glaucoma and primary open-angle glaucoma.

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Lee, Pei-Jung; Liu, Catherine Jui-Ling; Wojciechowski, Robert; Bailey-Wilson, Joan E; Cheng, Ching-Yu

2010-05-01

To assess the correlations between retinal nerve fiber layer (RNFL) thickness measured with scanning laser polarimetry and visual field (VF) sensitivity in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Prospective, comparative, observational cases series. Fifty patients with POAG and 56 patients with PACG were examined using scanning laser polarimetry with variable corneal compensation (GDx VCC; Laser Diagnostic Technologies, Inc.) and Humphrey VF analyzer (Carl Zeiss Meditec, Inc.) between August 2005 and July 2006 at Taipei Veterans General Hospital. Correlations between RNFL thickness and VF sensitivity, expressed as mean sensitivity in both decibel and 1/Lambert scales, were estimated by the Spearman rank correlation coefficient (r(s)) and multivariate median regression models (pseudo R(2)). The correlations were determined globally and for 6 RNFL sectors and their corresponding VF regions. The correlation between RNFL thickness and mean sensitivity (in decibels) was weaker in the PACG group (r(s) = 0.38; P = .004; pseudo R(2) = 0.17) than in the POAG group (r(s) = 0.51; P polarimetry. Compared with eyes with POAG, fewer RNFL sectors have significant structure-function correlations in eyes with PACG. Copyright 2010 Elsevier Inc. All rights reserved.

Monsoon and primary acute angle closure in malaysia.

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Ch'ng, T W; Mosavi, S A A; Noor Azimah, A A; Azlan, N Z; Azhany, Y; Liza-Sharmini, A T

2013-10-01

Acute angle closure (AAC) without prompt treatment may lead to optic neuropathy. Environmental factor such as climate change may precipitate pupillary block, the possible mechanism of AAC. To determine the association of northeast monsoon and incidence of AAC in Malaysia. A retrospective study was conducted on AAC patients admitted to two main tertiary hospitals in Kelantan, Malaysia between January 2001 and December 2011. The cumulative number of rainy day, amount of rain, mean cloud cover and 24 hours mean humidity at the estimated day of attack were obtained from the Department of Meteorology, Malaysia. A total 73 cases of AAC were admitted with mean duration of 4.1SD 2.0 days. More than half have previous history of possibility of AAC. There was higher incidence of AAC during the northeast monsoon (October to March). There was also significant correlation of number of rainy day (r=0.718, pclimate as the potential risk factor. Prompt treatment to arrest pupillary block and reduction of the intraocular pressure is important to prevent potential glaucomatous damage. Public awareness of AAC and accessibility to treatment should be part of preparation to face the effect of northeast monsoon.

Nonimaging secondary concentrators for large rim angle parabolic troughs with tubular absorbers.

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Ries, H; Spirkl, W

1996-05-01

For parabolic trough solar collectors with tubular absorbers, we design new tailored secondary concentrators. The design is applicable for any rim angle of a parabolic reflector. With the secondary, the concentration can be increased by a factor of more than 2 with a compact secondary reflector consisting of a single piece, even for the important case of a rim angle of 90 deg. The parabolic reflector can be used without changes; the reduced absorber is still tubular but smaller than the original absorber and slightly displaced toward the primary.

Prediction of backbone dihedral angles and protein secondary structure using support vector machines

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Hirst Jonathan D

2009-12-01

Full Text Available Abstract Background The prediction of the secondary structure of a protein is a critical step in the prediction of its tertiary structure and, potentially, its function. Moreover, the backbone dihedral angles, highly correlated with secondary structures, provide crucial information about the local three-dimensional structure. Results We predict independently both the secondary structure and the backbone dihedral angles and combine the results in a loop to enhance each prediction reciprocally. Support vector machines, a state-of-the-art supervised classification technique, achieve secondary structure predictive accuracy of 80% on a non-redundant set of 513 proteins, significantly higher than other methods on the same dataset. The dihedral angle space is divided into a number of regions using two unsupervised clustering techniques in order to predict the region in which a new residue belongs. The performance of our method is comparable to, and in some cases more accurate than, other multi-class dihedral prediction methods. Conclusions We have created an accurate predictor of backbone dihedral angles and secondary structure. Our method, called DISSPred, is available online at http://comp.chem.nottingham.ac.uk/disspred/.

Scanning electron microscopy of the trabecular meshwork: Understanding the pathogenesis of primary angle closure glaucoma

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Ramanjit Sihota

2012-01-01

Full Text Available Purpose: To study ultrastructural changes of the trabecular meshwork in acute and chronic primary angle closure glaucoma (PACG and primary open angle glaucoma (POAG eyes by scanning electron microscopy. Materials and Methods: Twenty-one trabecular meshwork surgical specimens from consecutive glaucomatous eyes after a trabeculectomy and five postmortem corneoscleral specimens were fixed immediately in Karnovsky solution. The tissues were washed in 0.1 M phosphate buffer saline, post-fixed in 1% osmium tetraoxide, dehydrated in acetone series (30-100%, dried and mounted. Results: Normal trabecular tissue showed well-defined, thin, cylindrical uveal trabecular beams with many large spaces, overlying flatter corneoscleral beams and numerous smaller spaces. In acute PACG eyes, the trabecular meshwork showed grossly swollen, irregular trabecular endothelial cells with intercellular and occasional basal separation with few spaces. Numerous activated macrophages, leucocytes and amorphous debris were present. Chronic PACG eyes had a few, thickened posterior uveal trabecular beams visible. A homogenous deposit covered the anterior uveal trabeculae and spaces. Converging, fan-shaped trabecular beam configuration corresponded to gonioscopic areas of peripheral anterior synechiae. In POAG eyes, anterior uveal trabecular beams were thin and strap-like, while those posteriorly were wide, with a homogenous deposit covering and bridging intertrabecular spaces, especially posteriorly. Underlying corneoscleral trabecular layers and spaces were visualized in some areas. Conclusions: In acute PACG a marked edema of the endothelium probably contributes for the acute and marked intraocular pressure (IOP elevation. Chronically raised IOP in chronic PACG and POAG probably results, at least in part, from decreased aqueous outflow secondary to widening and fusion of adjacent trabecular beams, together with the homogenous deposit enmeshing trabecular beams and spaces.

Ring closure in actin polymers

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Sinha, Supurna, E-mail: supurna@rri.res.in [Raman Research Institute, Bangalore 560080 (India); Chattopadhyay, Sebanti [Doon University, Dehradun 248001 (India)

2017-03-18

We present an analysis for the ring closure probability of semiflexible polymers within the pure bend Worm Like Chain (WLC) model. The ring closure probability predicted from our analysis can be tested against fluorescent actin cyclization experiments. We also discuss the effect of ring closure on bend angle fluctuations in actin polymers. - Highlights: • Ring closure of biopolymers. • Worm like chain model. • Predictions for experiments.

Appositional Closure Identified by Ultrasound Biomicroscopy in Population-Based Primary Angle-Closure Glaucoma Suspects: The Liwan Eye Study

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Kong, Xiangbin; Foster, Paul J.; Huang, Qunxiao; Zheng, Yingfeng; Huang, Wenyong; Cai, Xiaoyu

2011-01-01

Purpose. To describe the characteristics of the iridocorneal angle using ultrasound biomicroscopy (UBM) in Chinese people classified gonioscopically as having suspected primary angle-closure (PACS) glaucoma. Methods. PACS were defined as not having visible posterior (usually pigmented) trabecular meshwork in two or more quadrants examined by static gonioscopy. The PACS and 1 of 10 those who did not meet this criterion were identified from a population-based survey. Iridotrabecular meshwork contact (ITC) was identified and further classified into low and high, according to standard UBM images. Those with high ITC were further classified according the configuration of ITC: B-type, with contiguous ITC from the base of the angle, and S-type, with ITC localized to the region of Schwalbe's line. Results. ITC was identified in 78.6% of the superior, 40.2% of the nasal, 59.8% of the inferior, and 25.6% of the temporal quadrants in the PACS (n = 117). These proportions were 43.9%, 15.8%, 29.8%, and 14.0% in the controls (n = 57), respectively. About two thirds of the eyes with ITC were classified as high. In those with high ITC, the number with B- and S-type ITC was very similar. The proportions of any high ITCs increased substantially from 15.4% in those with Shaffer angle grade 4 and 45.0% in grade 3, to 71.0% in grade 2, 70.2% in grade 1, and 86.4% in grade 0. Conclusions. More ITC is identified on UBM imaging than by gonioscopy. Careful consideration should be given to the assessment modality regarded as the reference standard in defining anatomic risk factors for glaucomatous visual loss and the need for treatment. PMID:21357394

Closure of laryngotracheal cavity and tracheostomy for intractable aspiration secondary to radiation encephalopathy or radiation damage of cranial nerve after radiotherapy of nasopharyngeal carcinoma.

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Qu, Shenhong; Su, Zhengzhong; He, Xiaoguang; Li, Min; Li, Tianying

2006-09-01

Closure of the laryngotracheal cavity and tracheostomy is especially suitable for intractable aspiration secondary to radiation encephalopathy or damage of cranial nerve after radiation for nasopharyngeal carcinoma (NPC). To investigate the clinical value, technique, indications and contraindications of closure of the laryngotracheal cavity and tracheostomy for intractable aspiration secondary to radiation encephalopathy (REP) or radiation damage of cranial nerve after radiotherapy of NPC. Thirty patients, suffering from intractable aspiration secondary to radiotherapy for nasopharyngeal carcinoma, were treated with closure of the laryngotracheal cavity and tracheostomy and were observed for at least 1 year. Intractable aspiration and dyspnea were completely eradicated in all patients. The quality of their life was greatly improved.

New comparative clinical and biometric findings between acute primary angle-closure and glaucomatous eyes with narrow angle

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Rafael Vidal Mérula

2010-12-01

Full Text Available Purpose: To compare, clinically and biometrically, affected and fellow acute primary angle-closure (APAC eyes and glaucomatous eyes with narrow angle (NA. Methods: Comparative case series; 30 patients with APAC and 27 glaucomatous patients with NA were evaluated. Keratometry (K, central corneal thickness (CCT, lens thickness (LT, axial length (AL and anterior chamber depth (ACD were measured. Parameters defined as lens posisiton (LP and relative lens position (RLP were calculated. Results: Biometric difference between APAC-affected and fellow eyes was found only in LP (P=0.046. When fellow eyes were compared to glaucomatous eyes with NA, differences were found in ACD (P=0.009, AL (P=0.010, and LT/AL (P=0.005. The comparison between APAC-affected and glaucomatous eyes with NA showed significant differences in almost all biometric parameters, except for LT (P=0.148 and RLP (P=0.374. We found that the logistic regression model (LRM, built with three parameters (K, CCT and LT/AL, higher than 0.334 could be a reasonable instrument to differentiate APAC eyes from glaucomatous eyes with NA. Conclusions: This study showed that APAC-affected and fellow eyes have similar biometric features, and glaucomatous eyes with NA have a less crowded anterior segment. The LRM built showed promising results in distinguishing APAC from glaucomatous eyes with NA.

[The prevalence of blindness caused by primary angle closure glaucoma in middle-aged Chinese population: a systematic review and meta-analysis].

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Liu, M L; Wang, Y X

2017-05-11

Objective: To evaluate the rate of blindness caused by primary angle closure glaucoma (PACG) in Chinese population of more than 40 years old, and to explore the effectiveness of a prevention and treatment system on PACG. Methods: We searched the databases of Pubmed, ScienceDirect, Springer Link, CNKI and Wanfang Data and collected all the original studies of the prevalence and blindness of angle closure glaucoma in China. The population was limited to over 40 years old. The research site was limited to the community-based, while the published time was not limited. Two researchers completed the literature search, data extraction and methodological quality assessment independently, with same criteria. Meta analysis was performed using R software. Results: Five papers were included in this study finally. A total of 26 437 cases of natural population over the age of 40 were observed, and 306 cases of angle closure glaucoma were found, of which 113 cases had binocular or monocular blindness caused by PACG. The random effect model meta-analysis results showed that the overall blindness rate was 38.3% [95% CI (28.1%, 49.6%)]. In Beijing, where the prevention and treatment system was well established, the blindness rate was far lower than that in the areas where the system was poorly established. Compared with the past, the blindness rate caused by PACG in Beijing decreased sharply. Conclusions: The rate of blindness caused by PACG is still high in the mainland of China. The prevention and treatment system is effective and worth promoting. (Chin J Ophthalmol, 2017, 53: 373 - 377) .

Use of EyeCam for imaging the anterior chamber angle.

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Perera, Shamira A; Baskaran, Mani; Friedman, David S; Tun, Tin A; Htoon, Hla M; Kumar, Rajesh S; Aung, Tin

2010-06-01

To compare EyeCam (Clarity Medical Systems, Pleasanton, CA) imaging with gonioscopy for detecting angle closure. In this prospective, hospital-based study, subjects underwent gonioscopy by a single observer and EyeCam imaging by a different operator. EyeCam images were graded by two masked observers. The anterior chamber angle in a quadrant was classified as closed if the trabecular meshwork could not be seen. The eye was classified as having angle closure if two or more quadrants were closed. One hundred fifty-two subjects were studied. The mean age was 57.4 years (SD 12.9) and there were 82 (54%) men. Of the 152 eyes, 21 (13.8%) had angle closure. The EyeCam provided clear images of the angles in 98.8% of subjects. The agreement between the EyeCam and gonioscopy for detecting angle closure in the superior, inferior, nasal, and temporal quadrants based on agreement coefficient (AC1) statistics was 0.73, 0.75, 0.76, and 0.72, respectively. EyeCam detected more closed angles than did gonioscopy in all quadrants (P gonioscopy, 21/152 (13.8%) eyes were diagnosed as angle closure compared to 41 (27.0%) of 152 with EyeCam (P gonioscopy for detecting angle closure. However, it detected more closed angles than did gonioscopy in all quadrants.

Transcatheter closure of patent foramen ovale for secondary prevention of ischemic stroke: Quantitative synthesis of pooled randomized trial data.

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Hakeem, Abdul; Cilingiroglu, Mehmet; Katramados, Angelos; Boudoulas, Konstantinos Dean; Iliescu, Cezar; Gundogdu, Betul; Marmagkiolis, Konstantinos

2018-01-14

To evaluate the safety and efficacy of percutaneous device closure of patent foramen ovale (PFO) for secondary prevention of ischemic stroke BACKGROUND: Stroke remains the leading cause of serious long-term disability in the United States. The effectiveness of a percutaneous PFO closure in the prevention of recurrent cryptogenic strokes has not been established. We performed a literature search using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar, and Internet-based sources from January 2003 to September 2017. Randomized controlled trails (RCTs) comparing percutaneous PFO closure to medical therapy alone. Five RCTs (CLOSURE I, PC Trial, REDUCE, RESPECT, and CLOSE) with 1,829 patients in the device group and 1,611 patients in the medical group met inclusion criteria. The cumulative incidence of recurrent stroke was 2.02% in the PFO closure arm and 4.4% in the medical therapy group (RR 0.42, 95%CI 0.20, 0.91; P = 0.03). There was no difference in the incidence of death [0.7% vs. 0.9%; RR 0.76 (95% CI 0.35, 1.64), P = 0.49] or adverse events during the follow-up period [24.6% vs. 23.7% (RR 1.03; 95% CI 0.91, 1.16), P = 0.65] between the closure and medical therapy groups. Incidence of atrial fibrillation was significantly higher in closure group compared to medical therapy [4% vs. 0.6% (RR 4.73; 95% CI 2.09, 10.70), P = 0.0002]. The comparative effectiveness of PFO closure (compared to medical therapy) was significantly more pronounced in those younger than 45 years, males, larger shunts and disc design platforms (P < 0.05). Based on the results of this analysis of randomized trial data, percutaneous PFO closure appears to be a safe and effective therapeutic option for the secondary prevention of ischemic stroke in patients with PFO and cryptogenic stroke. © 2018 Wiley Periodicals, Inc.

Angle assessment by EyeCam, goniophotography, and gonioscopy.

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Baskaran, Mani; Perera, Shamira A; Nongpiur, Monisha E; Tun, Tin A; Park, Judy; Kumar, Rajesh S; Friedman, David S; Aung, Tin

2012-09-01

To compare EyeCam (Clarity Medical Systems, Pleasanton, CA) and goniophotography in detecting angle closure, using gonioscopy as the reference standard. In this hospital-based, prospective, cross-sectional study, participants underwent gonioscopy by a single observer, and EyeCam imaging and goniophotography by different operators. The anterior chamber angle in a quadrant was classified as closed if the posterior trabecular meshwork could not be seen. A masked observer categorized the eyes as per the number of closed quadrants, and an eye was classified as having angle closure if there were 2 or more quadrants of closure. Agreement between the methods was analyzed by κ statistic and comparison of area under receiver operating characteristic curves (AUC). Eighty-five participants (85 eyes) were included, the majority of whom were Chinese. Angle closure was detected in 38 eyes (45%) with gonioscopy, 40 eyes (47%) using EyeCam, and 40 eyes (47%) with goniophotography (P=0.69 in both comparisons, McNemar test). The agreement for angle closure diagnosis (by eye) between gonioscopy and the 2 imaging modalities was high (κ=0.86; 95% Confidence Interval (CI), 0.75-0.97), whereas the agreement between EyeCam and goniophotography was not as good (κ=0.72; 95% CI, 0.57-0.87); largely due to lack of agreement in the nasal and temporal quadrants (κ=0.55 to 0.67). The AUC for detecting eyes with gonioscopic angle closure was similar for goniophotography and EyeCam (AUC 0.93, sensitivity=94.7%, specificity=91.5%; P>0.95). EyeCam and goniophotography have similarly high sensitivity and specificity for the detection of gonioscopic angle closure.

Glaucoma agudo bilateral em paciente jovem secundário ao uso de topiramato: relato de caso Bilateral acute angle closure glaucoma in a young patient receiving oral topiramate: case report

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Fausto Stangler

2007-02-01

, a new anticonvulsivant medication. Rarely, some drugs have produced uveal effusions, forward shift of the iris-lens diaphragm, transient myopia and secondary angle closure glaucoma. A 40-year old white woman was seen at the emergency department of the "Hospital Banco de Olhos de Porto Alegre (RS" - Brazil, with severe headaches and blurry vision in both eyes. Her medications included topiramate, started 10 days before. Slit lamp examination revealed conjunctival injection, chemosis and shallow anterior chambers. Intraocular pressure measured 40 and 38 mmHg. Fundoscopic examination findings were normal. Ultrasound scan was performed and demonstrated separation between the choroidal layer and the sclera. A diagnosis of bilateral uveal effusion associated with the use of oral topiramate was made. Topiramate was then discontinued. The patient reported symptomatic improvement by the third day after initial examination. Symptoms were resolved and visual acuity returned to normal. Topiramate may cause ciliary body edema and relaxation of zonules, which induces a forward shift of the lens-iris diaphragm with acute myopia and angle closure. As the mechanism of angle closure does not involve pupillary block, peripheral iridectomy and topical miotics are not useful in the treatment of this type of secondary angle-closure glaucoma. Drug-induced uveal effusions occur rarely. The patient improved after topiramate discontinuation.

Variants in Nebulin (NEB) Are Linked to the Development of Familial Primary Angle Closure Glaucoma in Basset Hounds

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Ahram, D.F.; Grozdanic, S.D.; Kecova, H.; Henkes, A.; Collin, R.W.J.; Kuehn, M.H.

2015-01-01

Several dog breeds are susceptible to developing primary angle closure glaucoma (PACG), which suggests a genetic basis for the disease. We have identified a four-generation Basset Hound pedigree with characteristic autosomal recessive PACG that closely recapitulates PACG in humans. Our aim is to utilize gene mapping and whole exome sequencing approaches to identify PACG-causing sequence variants in the Basset. Extensive clinical phenotyping of all pedigree members was conducted. SNP-chip geno...

[Comparison of anterior chamber angle examination by UBM, SL-OCT and gonioscopy].

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Liu, Rui-jue; Wang, Men; Xia, Wen-tao; Yu, Xiao-ying; Chen, Jie-min; Zhou, Shu; Peng, Shu-ya; Liu, Dong-mei

2014-08-01

To compare the agreement of anterior chamber angle examination by ultrasound biomicroscope (UBM), slit lamp optical coherence tomography (SL-OCT), and gonioscopy in angle recession and angle closure. The anterior chamber angle was measured with UBM, SL-OCT and gonioscopy in turns for temporal, nasal, superior and inferior quadrant in the same dark room. The results were compared with the agreement of the three methods in angle recession and angle closure by χ2 test and Kappa test. There were no statistically significant differences of the three methods in testing angle closure and angle recession (P>0.05). The consistency of UBM and gonioscopy was better (Kappa value of 0.882) than that of SL-OCT and gonioscopy (Kappa value of 0.624). When testing angle recession, UBM is better than SL-OCT with gonioscopy as the standard. When testing angle closure, UBM, SL-OCT and gonioscopy have good agreement.

Primary Angle Closure and Sequence Variants within MicroRNA Binding Sites of Genes Involved in Eye Development.

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Haihong Shi

Full Text Available The formation of primary angle closure (PAC and primary angle closure glaucoma (PACG is regulated by a tissue remodeling pathway that plays a critical role in eye development. MicroRNAs (miRNAs are powerful gene expression regulators and may exert their effects on tissue remodeling genes. This study investigated the associations between gene variants (single-nucleotide polymorphism, SNP in miRNA binding sites in the 3'-UTR region of genes involved in eye development and PAC.The sample consisted of 232 PAC subjects and 306 controls obtained from a population-based cohort in the Funing District of Jiangsu, China. The markers include 9 SNPs in the COL11A1, PCMTD1, ZNRF3, MTHFR, and ALPPL2 genes respectively. SNP genotyping was performed with a TaqMan-MGB probe using an RT-PCR system.Of the 9 SNPs studied, the frequency of the minor A allele of COL11A1 rs1031820 was higher in the PAC group than in the control group in allele analysis (p = 0.047. The genotype analysis indicated that MTHFR rs1537514 is marginally associated with PAC (p = 0.014. The CC genotype of rs1537514 was present solely in the PAC group. However, the differences lost significance after Bonferroni correction.Our study reveals a possible association of COL11A1 and MTHFR with PAC in the Han Chinese population. These results will contribute to an improved understanding of the genetic basis of PACG.

Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial

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Azuara-Blanco, Augusto; Burr, Jennifer; Ramsay, Craig; Cooper, David; Foster, Paul J.; Friedman, David S.; Scotland, Graham; Javanbakht, Mehdi; Cochrane, Claire; Norrie, John; For the EAGLE study group

2016-01-01

PJF is supported by salary funding from the National Institute for Health Research (NIHR) through a grant to the Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology. This work is supported by the Medical Research Council (MRC G0701604) and funding is managed by the NIHR (NIHR-EME 09-800-26) on behalf of the MRC–NIHR partnership. Background . Primary angle-closure glaucoma is a leading cause of irreversible blindness worldwide. In early-stage disease, in...

Nitric oxide in guard cells as an important secondary messenger during stomatal closure

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Gunja eGayatri

2013-10-01

Full Text Available he modulation of guard cell function is the basis of stomatal closure, essential for optimizing water use and CO2 uptake by leaves. Nitric oxide (NO in guard cells plays a very important role as a secondary messenger during stomatal closure induced by effectors, including hormones. For example, exposure to abscisic acid (ABA triggers a marked increase in NO of guard cells, well before stomatal closure. In guard cells of multiple species, like Arabidopsis, Vicia and pea, exposure to ABA or methyl jasmonate or even microbial elicitors (e.g. chitosan induces production of NO as well as reactive oxygen species (ROS. The role of NO in stomatal closure has been confirmed by using NO donors (e.g. SNP and NO scavengers (like cPTIO and inhibitors of NOS (L-NAME or NR (tungstate. Two enzymes: a L-NAME-sensitive, nitric oxide synthase (NOS-like enzyme and a tungstate-sensitive nitrate reductase (NR, can mediate ABA-induced NO rise in guard cells. However, the existence of true NOS in plant tissues and its role in guard cell NO-production are still a matter of intense debate. Guard cell signal transduction leading to stomatal closure involves the participation of several components, besides NO, such as cytosolic pH, ROS, free Ca2+ and phospholipids. Use of fluorescent dyes has revealed that the rise in NO of guard cells occurs after the increase in cytoplasmic pH and ROS. The rise in NO causes an elevation in cytosolic free Ca2+ and promotes the efflux of cations as well as anions from guard cells. Stomatal guard cells have become a model system to study the signalling cascade mechanisms in plants, particularly with NO as a dominant component. The interrelationships and interactions of NO with cytosolic pH, ROS, and free Ca2+ are quite complex and need further detailed examination. While assessing critically the available literature, the present review projects possible areas of further work related to NO-action in stomatal guard cells.

Comparison of gonioscopy and anterior segment ocular coherence tomography in detecting angle closure in different quadrants of the anterior chamber angle.

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Sakata, Lisandro M; Lavanya, Raghavan; Friedman, David S; Aung, Han T; Gao, Hong; Kumar, Rajesh S; Foster, Paul J; Aung, Tin

2008-05-01

To compare the performance of gonioscopy and anterior segment (AS) optical coherence tomography (OCT) in detecting angle closure in the different quadrants of the anterior chamber angle (ACA). Cross-sectional observational study. Five hundred two consecutive subjects more than 50 years of age with no previous ophthalmic problems recruited from a community clinic in Singapore. All subjects underwent gonioscopy and AS OCT imaging in the dark. Using gonioscopy, the ACA was graded using the Scheie system by a single examiner masked to AS OCT findings. The ACA in a particular quadrant was classified as closed if the posterior trabecular meshwork could not be seen on gonioscopy. A closed ACA on AS OCT imaging was defined by the presence of any contact between the iris and angle wall anterior to the scleral spur. After excluding eyes with poor image quality, a total of 423 right eyes were included in the analysis. A closed angle in at least 1 quadrant was observed in 59% of the eyes by AS OCT and in 33% of the eyes by gonioscopy (Pgonioscopy were 48% versus 29% superiorly, 43% versus 22% inferiorly, 18% versus 14% nasally, and 12% versus 20% temporally, respectively. Of the 119 of 1692 quadrants that were closed on gonioscopy but open on AS OCT, a steep iris profile was present in 61 (51%) of 119 quadrants on AS OCT, and of the 276 of 1692 quadrants that were open on gonioscopy but closed on AS OCT, 196 (71%) of 276 quadrants showed short iridoangle contact on AS OCT. The highest rates of closed angles on gonioscopy and AS OCT images were observed in the superior quadrant. Anterior segment OCT tended to detect more closed ACAs than gonioscopy, particularly in the superior and inferior quadrants. Variations in the iris profile and level of iridoangle contact also may explain some of the differences seen between gonioscopy and AS OCT.

Interocular asymmetry of the visual field defects in newly diagnosed normal-tension glaucoma, primary open-angle glaucoma, and chronic angle-closure glaucoma.

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Huang, Ping; Shi, Yan; Wang, Xin; Liu, Mugen; Zhang, Chun

2014-09-01

To compare the interocular asymmetry of visual field loss in newly diagnosed normal-tension glaucoma (NTG), primary open-angle glaucoma (POAG), and chronic angle-closure glaucoma (CACG) patients. Visual field results of 117 newly diagnosed, treatment-naive glaucoma patients (42 NTG, 38 POAG, and 37 CACG) were studied retrospectively. The following 3 visual field defect parameters were used to evaluate the interocular asymmetry: (1) global indices; (2) local mean deviations (MDs) of 6 predefined visual field areas; and (3) stage designated by glaucoma staging system 2. The differences of the above parameters between the trial eye (the eye with greater MDs) and the fellow eye in each subject were defined as interocular asymmetry scores. Interocular asymmetry of visual field loss was presented in all the 3 groups (all P0.05). Interocular asymmetry scores of glaucoma staging system 2 had no significant difference among the 3 groups (P=0.068). All CACG, POAG, and NTG groups presented with interocular asymmetric visual field loss at the time of diagnosis. CACG had greater interocular asymmetry compared with NTG and POAG. No significant interocular asymmetry difference was observed between NTG and POAG.

A kinematic view of loop closure.

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Coutsias, Evangelos A; Seok, Chaok; Jacobson, Matthew P; Dill, Ken A

2004-03-01

We consider the problem of loop closure, i.e., of finding the ensemble of possible backbone structures of a chain segment of a protein molecule that is geometrically consistent with preceding and following parts of the chain whose structures are given. We reduce this problem of determining the loop conformations of six torsions to finding the real roots of a 16th degree polynomial in one variable, based on the robotics literature on the kinematics of the equivalent rotator linkage in the most general case of oblique rotators. We provide a simple intuitive view and derivation of the polynomial for the case in which each of the three pair of torsional axes has a common point. Our method generalizes previous work on analytical loop closure in that the torsion angles need not be consecutive, and any rigid intervening segments are allowed between the free torsions. Our approach also allows for a small degree of flexibility in the bond angles and the peptide torsion angles; this substantially enlarges the space of solvable configurations as is demonstrated by an application of the method to the modeling of cyclic pentapeptides. We give further applications to two important problems. First, we show that this analytical loop closure algorithm can be efficiently combined with an existing loop-construction algorithm to sample loops longer than three residues. Second, we show that Monte Carlo minimization is made severalfold more efficient by employing the local moves generated by the loop closure algorithm, when applied to the global minimization of an eight-residue loop. Our loop closure algorithm is freely available at http://dillgroup. ucsf.edu/loop_closure/. Copyright 2004 Wiley Periodicals, Inc. J Comput Chem 25: 510-528, 2004

Structure-Function Correlations using Scanning Laser Polarimetry in Primary Angle-Closure Glaucoma and Primary Open Angle Glaucoma

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Lee, Pei-Jung; Liu, Catherine Jui-Ling.; Wojciechowski, Robert; Bailey-Wilson, Joan E.; Cheng, Ching-Yu

2010-01-01

Purpose To assess the correlations between retinal nerve fiber layer (RNFL) thickness measured with scanning laser polarimetry (SLP) and visual field (VF) sensitivity in primary open angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Design Prospective, comparative, observational cases series Methods Fifty patients with POAG and 56 with PACG were examined using SLP with variable corneal compensation (GDx VCC) and Humphrey VF analyzer between August 2005 and July 2006 at Taipei Veterans General Hospital. Correlations between RNFL thickness and VF sensitivity, expressed as mean sensitivity (MS) in both decibel (dB) and 1/Lambert (L) scales, were estimated by Spearman's rank correlation coefficient (rs) and multivariate median regression models (pseudo R2). The correlations were determined globally and for six RNFL sectors and their corresponding VF regions. Results The correlation between RNFL thickness and MS (in dB) was weaker in the PACG group (rs = 0.38, P = 0.004, pseudo R2 = 0.17) than in the POAG group (rs = 0.51, P <0.001, pseudo R2 = 0.31), but the difference in the magnitude of correlation was not significant (P = 0.42).With Bonferroni correction, the structure-function correlation was significant in the superotemporal (rs = 0.62), superonasal (rs = 0.56), inferonasal (rs = 0.53), and inferotemporal (rs = 0.50) sectors in the POAG group (all P <0.001), while it was significant only in the superotemporal (rs = 0.53) and inferotemporal (rs = 0.48) sectors in the PACG group (both P <0.001). The results were similar when MS was expressed as 1/L scale. Conclusions Both POAG and PACG eyes had moderate structure-function correlations using SLP. Compared to eyes with POAG, fewer RNFL sectors have significant structure-function correlations in eyes with PACG. PMID:20202618

Anterior chamber angle imaging with swept-source optical coherence tomography: measuring peripheral anterior synechia in glaucoma.

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Lai, Isabel; Mak, Heather; Lai, Gilda; Yu, Marco; Lam, Dennis S C; Leung, Christopher K S

2013-06-01

To investigate the use of swept-source optical coherence tomography (OCT) for measuring the area and degree of peripheral anterior synechia (PAS) involvement in patients with angle-closure glaucoma. Cross-sectional study. Twenty-three eyes with PAS (detected by indentation gonioscopy) from 20 patients with angle-closure glaucoma (20 eyes had primary angle-closure glaucoma and 3 eyes had angle-closure glaucoma secondary to chronic anterior uveitis [n = 2] and Axenfeld-Rieger syndrome [n = 1]). The anterior chamber angles were evaluated with indentation gonioscopy and imaged by swept-source OCT (Casia OCT, Tomey, Nagoya, Japan) in room light and in the dark using the "angle analysis" protocol, which was composed of 128 radial B-scans each with 512 A-scans (16-mm scan length). The area and degree of PAS involvement were measured in each eye after manual detection of the scleral spur and the anterior irido-angle adhesion by 2 masked observers. The interobserver variability of the PAS measurements was calculated. The agreement of PAS assessment by gonioscopy and OCT, the area and the degree of PAS involvement, and the intraclass correlation coefficient (ICC) of interobserver PAS measurements. The area of PAS (mean ± standard deviation) was 20.8 ± 16.9 mm(2) (range, 3.9-74.9 mm(2)), and the degree of PAS involvement was 186.5 ± 79.9 degrees (range, 42-314 degrees). There was no difference in the area of PAS (P = 0.90) and the degree of PAS involvement (P = 0.95) between images obtained in room light and in the dark. The interobserver ICCs were 0.99 (95% confidence interval [CI], 0.98-1.00) for the area of PAS and 0.99 (95% CI, 0.97-1.00) for the degree of PAS involvement. There was good agreement of PAS assessment between gonioscopy and OCT images (kappa = 0.79; 95% CI, 0.67-0.91). Swept-source OCT allows visualization and reproducible measurements of the area and degree of PAS involvement, providing a new paradigm for evaluation of PAS progression and risk assessment

Characterization of ocular biometrics and aqueous humor dynamics in primary angle closure suspects.

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Guo, Li; Deng, Yuan; Fang, Li; Liu, Chaoqi; Guo, Tao

2017-02-01

Detailed characterizations of ocular biometrics and parameters of aqueous humor dynamics are lacking in primary angle closure suspect (PACS) patients. This study aims to characterize these parameters and compare them with age-matched healthy volunteers.Elderly healthy volunteers (60.6 ± 7.2 years of age, mean ± SD, n = 28) and PACS patients (64.1 ± 11.6 years, n = 30) completed the study. Parameters investigated were axial length (AXL), anterior chamber depth (ACD), anterior chamber volume (ACV), central cornea thickness (CCT), intraocular pressure (IOP), aqueous flow (Fa), outflow facility (C), episcleral venous pressure (EVP), and uveoscleral outflow (Fu). Comparisons and correlations were made between and within groups.In healthy volunteers, ocular biometric parameters, IOP, and EVP correlated very well between the 2 eyes of each individual, but Fa, C, and Fu were not significantly correlated. Biometric parameters of the PACS group significantly (P biometrics, or C.

Gonioscopy findings and prevalence of occludable angles in a Burmese population: the Meiktila Eye Study.

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Casson, R J; Newland, H S; Muecke, J; McGovern, S; Abraham, L M; Shein, W K; Selva, D; Aung, T

2007-07-01

To determine the prevalence of preglaucomatous angle-closure disease in central Myanmar. A population-based survey of inhabitants >or=40 years in the Meiktila District was carried out; 2481 subjects were identified, 2076 participated and 2060 underwent gonioscopy of at least one eye. Eyes with angles traditionally described as "occludable" were recorded as primary angle-closure suspects (PACS); eyes with PACS and peripheral anterior synechiae (PAS), or an increased intraocular pressure but without primary angle-closure glaucoma, were recorded as primary angle closure (PAC). The prevalence of PACS in at least one eye was 5.7% (95% CI 4.72 to 6.62); prevalence increased with age and was more common in women (p<0.001). The prevalence of PAC in at least one eye was 1.50% (95% CI 1.47 to 1.53). All participants with PAS had at least 90 degrees of closure (range 90-360 degrees). The prevalence of preglaucomatous angle-closure disease (PACS and PAC) in this population was 5.7% and 1.5%, respectively. PACS was more common in women, and its prevalence increased with age.

Aqueous proinflammatory cytokines in acute primary angle-closure eyes

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Yao-Ming Liu

2017-05-01

Full Text Available AIM: To evaluate changes of proinflammatory cytokines in aqueous humor of patients with acute primary angle-closure (APAC and age-related cataracts. METHODS: Twenty eyes of 20 APAC patients and 15 eyes of 15 age-related cataract patients were included in this cross-sectional study. Aqueous humor samples were collected prospectively. The levels of 20 proinflammatory cytokines were evaluated in the aqueous humor of the APAC and cataract patients using the multiplex bead immunoassay technique. Clinical data were collected for correlation analysis. RESULTS: Seven of the 20 proinflammatory cytokines included in the magnetic bead panel were detectable in both APAC eyes and cataract eyes: interleukin (IL-10, IL-12, IL-15, IL-21, IL-6, chemokine (C-C motif ligand 20, and tumor necrosis factor alpha (TNF-α. IL-27 was only detectable in APAC eyes. Compared with the cataract eyes, the APAC eyes had significantly elevated concentrations of IL-12 (P=0.036, IL-15 (P=0.001, IL-6 (P=0.012, and IL-27 (only detectable in APAC eyes. Age was positively correlated with IL-12 (P=0.022 and IL-6 (P=0.037, and time elapsed between APAC onset and aqueous humor samples collection was positively correlated with IL-15 (P=0.037, IL-27 (P=0.040, and TNF-α (P=0.042. CONCLUSION: Several proinflammatory cytokines including IL-12，IL-15, IL-6 and IL-27, were elevated in the APAC eyes and may be implicated in its pathologic mechanism.

Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial

Science.gov (United States)

Javanbakht, Mehdi; Azuara-Blanco, Augusto; Burr, Jennifer M; Ramsay, Craig; Cooper, David; Cochran, Claire; Norrie, John; Scotland, Graham

2017-01-01

Objective To investigate the cost-effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care. Design Cost-effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed-up for 36 months, and data on health service usage and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5-year and 10-year time horizon. Setting 22 hospital eye services in the UK. Population Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC). Interventions Lens extraction compared to standard care (ie, laser iridotomy followed by medical therapy and glaucoma surgery). Outcome measures Costs of primary and secondary healthcare usage (UK NHS perspective), quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for lens extraction versus standard care. Results The mean age of participants was 67.5 (8.42), 57.5% were women, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. The mean health service costs were higher in patients randomised to lens extraction: £2467 vs £1486. The mean adjusted QALYs were also higher with early lens extraction: 2.602 vs 2.533. The ICER for lens extraction versus standard care was £14 284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7090 per QALY gained by 5 years and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions. Conclusions We find that lens extraction has a 67–89% chance of being cost-effective at 3 years and that it may be cost saving by 10 years. Trial registration number ISRCTN44464607; Results. PMID:28087548

Spontaneous, late, in-the-bag intraocular lens subluxation in a patient with a previous acute angle-closure glaucoma attack.

Science.gov (United States)

Su, Wei-Wen; Chang, Shirley H L

2004-08-01

Cataract surgery was performed in a 49-year-old woman 16 months after an acute angle-closure glaucoma attack. Zonular dialysis was observed during surgery, but the intraocular lens (IOL) was implanted in the capsular bag uneventfully. At 4 1/2 months, 1 IOL loop wrapped in the bag herniated into the anterior chamber. The patient had no history of trauma. The IOL loop remained in the anterior chamber for 9 months, until the subluxated IOL spontaneously returned to its original position. Six months later, the IOL again dislocated into the anterior chamber.

Prevalence of plateau iris configuration in primary angle closure glaucoma using ultrasound biomicroscopy in the Indian population

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Gaurav Kumar

2012-01-01

Full Text Available Purpose: To report the prevalence of plateau iris in patients with primary angle closure glaucoma (PACG, in North India. Materials and Methods: The patients with PACG, attending the glaucoma services at a tertiary care center in North India were included in the study. All patients had undergone Nd-YAG laser peripheral iridotomy at least four weeks prior to inclusion in the study. Four weeks prior to inclusion in the study, none of the patients had used pilocarpine. Ultrasound Biomicroscopy (UBM images were qualitatively evaluated and plateau iris configuration was defined in an eye if the following criteria were fulfilled in two or more quadrants: anteriorly directed ciliary process supporting the peripheral iris, steep rise of iris root from its point of insertion followed by a downward angulation from the corneoscleral wall, absent ciliary sulcus, and iridotrabecular contact in the same quadrant. Results: One hundred and one eyes were included in the study. There were 63 (62.4% females and 38 (37.6% males. The mean age of the patients was 57.8 ± 9.5 years (range: 42 to 78 years. The mean axial length in the study population was 22.2 ± 1.1 mm. The mean spherical equivalent refraction was 0.06 ± 1.12 D. The mean intraocular pressure was 18.5 ± 4.7 mmHg (range: 12 - 24 mmHg. Twenty-nine (28.7% subjects were diagnosed with plateau iris on the basis of above-defined criteria. Of the 29 eyes, 18 (62.1% subjects had plateau iris in two quadrants, nine (31.03% in three quadrants, and two (6.8% had this configuration in all the four quadrants. Conclusions: Approximately 30% of the eyes with PACG had plateau iris on UBM. Plateau iris was very often the cause for residual angle closure following laser peripheral iridotomy in Indian eyes with PACG.

Dynamic changes of anterior segment in patients with different stages of primary angle-closure in both eyes and normal subjects.

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Jialiu Lin

Full Text Available To compare changes in anterior segment parameters under light and dark (light-to-dark conditions among eyes with chronic primary angle-closure glaucoma (CPACG, fellow eyes with confirmed or suspect primary angle-closure (PAC or PACS, and age-matched healthy eyes.Consecutive patients with CPACG in one eye and PAC/PACS in the fellow eye, as well as age-matched healthy subjects were recruited. Anterior segment optical coherence tomography measurements were conducted under light and dark conditions, and anterior chamber, lens, and iris parameters compared. Demographic and biometric factors associated with light-to-dark change in iris area were analyzed by linear regression.Fifty-seven patients (mean age 59.6±8.9 years and 30 normal subjects matched for age (60.6±9.3 years and sex ratio were recruited. In regards to differences under light-to-dark conditions, angle opening distance at 500 μm (AOD500μm and iris area during light-to-dark transition were smaller in CPACG eyes than fellow PACS/PAC eyes and normal eyes (P<0.017. Pupil diameter change was largest in normal eyes, and larger in PACS/PAC eyes than CPACG eyes (P<0.017. There was an average reduction of 0.145 mm2 in iris area for each millimeter of pupil diameter increase in CPACG eyes, 0.161 mm2 in fellow PAC/PACS eyes, and 0.165 mm2 in normal eyes. Larger iris curvature in the dark and diagnosis of PACG were significantly associated with less light-to-dark iris area changes.Dynamic changes in iris parameters with light-to-dark transition differed significantly among CPACG eyes, fellow PAC/PACS eyes, and normal eyes. Greater iris curvature under dark conditions was correlated with reduced light-to-dark change in iris area and pupil diameter, which may contribute to disease progression.

Unusual Case of Angle Closure Glaucoma in a Patient with Neurofibromatosis Type 1

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Flavio Mantelli

2014-11-01

Full Text Available We report the case of a 29-year-old female patient who presented with an acute onset of anisocoria, blurred vision, nausea and severe left-sided headache. There was no history of trauma, drug abuse, or instillation of topical mydriatic compounds. The ocular history was negative for similar events. On presentation, her visual acuity was 0.2 in the left and 1.0 in the right eye with a +2.5 dpt sph. correction. Slit-lamp examination demonstrated a shallow anterior chamber as well as the presence of iris nodules in both eyes. These nodules were identified as Lisch nodules as the patient referred to the previous diagnosis as being neurofibromatosis type 1. A third nerve palsy was considered, but a brain MRI showed normal results. Her ocular motility was normal, but the left pupil was mydriatic and poorly reacting to light, with an associated raised intraocular pressure (IOP of 38 mm Hg. An examination of the fellow eye was normal, with the IOP measuring 18 mm Hg. Gonioscopy of the right eye showed a narrow angle. On further anamnestic investigation, the patient revealed that the pain and the blurred vision begun in the morning while she was helping her mother in the garden. Finally, after showing the patient a picture of Datura flowers, which she recognized immediately, we made the unusual diagnosis of angle closure glaucoma by Datura, a well-known toxic plant with mydriatic properties. The patient was successfully treated with systemic acetazolamide and topical pilocarpine.

Impact of Different Standard Type A7A Drum Closure-Ring Practices on Gasket Contraction and Bolt Closure Distance– 15621

Energy Technology Data Exchange (ETDEWEB)

Ketusky, Edward [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Blanton, Paul [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Bobbitt, John H. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

2015-03-11

The Department of Energy, the Savannah River National Laboratory, several manufacturers of specification drums, and the United States Department of Transportation (DOT) are collaborating in the development of a guidance document for DOE contractors and vendors who wish to qualify containers to DOT 7A Type A requirements. Currently, the effort is focused on DOT 7A Type A 208-liter (55-gallons) drums with a standard 12-gauge bolted closure ring. The U.S. requirements, contained in Title 49, Part 178.350 “Specification 7A; general packaging, Type A specifies a competent authority review of the packaging is not required for the transport of (Class 7) radioactive material containing less than Type A quantities of radioactive material. For Type AF drums, a 4 ft. regulatory free drop must be performed, such that the drum “suffers maximum damage.” Although the actual orientation is not defined by the specification, recent studies suggest that maximum damage would result from a shallow angle top impact, where kinetic energy is transferred to the lid, ultimately causing heavy damage to the lid, or even worse, causing the lid to come off. Since each vendor develops closure recommendations/procedures for the drums they manufacture, key parameters applied to drums during closing vary based on vendor. As part of the initial phase of the collaboration, the impact of the closure variants on the ability of the drum to suffer maximum damage is investigated. Specifically, closure testing is performed varying: 1) the amount of torque applied to the closure ring bolt; and, 2) stress relief protocol, including: a) weight of hammer; and, b) orientation that the hammer hits the closure ring. After closure, the amount of drum lid gasket contraction and the distance that the closure bolt moves through the closure ring is measured.

Variants in Nebulin (NEB Are Linked to the Development of Familial Primary Angle Closure Glaucoma in Basset Hounds.

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Dina F Ahram

Full Text Available Several dog breeds are susceptible to developing primary angle closure glaucoma (PACG, which suggests a genetic basis for the disease. We have identified a four-generation Basset Hound pedigree with characteristic autosomal recessive PACG that closely recapitulates PACG in humans. Our aim is to utilize gene mapping and whole exome sequencing approaches to identify PACG-causing sequence variants in the Basset. Extensive clinical phenotyping of all pedigree members was conducted. SNP-chip genotyping was carried out in 9 affected and 15 unaffected pedigree members. Two-point and multipoint linkage analyses of genome-wide SNP data were performed using Superlink-Online SNP-1.1 and a locus was mapped to chromosome 19q with a maximum LOD score of 3.24. The locus contains 12 Ensemble predicted canine genes and is syntenic to a region on chromosome 2 in the human genome. Using exome-sequencing analysis, a possibly damaging, non-synonymous variant in the gene Nebulin (NEB was found to segregate with PACG which alters a phylogenetically conserved Lysine residue. The association of this variants with PACG was confirmed in a secondary cohort of unrelated Basset Hounds (p = 3.4 × 10-4, OR = 15.3 for homozygosity. Nebulin, a protein that promotes the contractile function of sarcomeres, was found to be prominently expressed in the ciliary muscles of the anterior segment. Our findings may provide insight into the molecular mechanisms that underlie PACG. The phenotypic similarities of disease presentation in dogs and humans may enable the translation of findings made in this study to patients with PACG.

Variants in Nebulin (NEB) Are Linked to the Development of Familial Primary Angle Closure Glaucoma in Basset Hounds.

Science.gov (United States)

Ahram, Dina F; Grozdanic, Sinisa D; Kecova, Helga; Henkes, Arjen; Collin, Rob W J; Kuehn, Markus H

2015-01-01

Several dog breeds are susceptible to developing primary angle closure glaucoma (PACG), which suggests a genetic basis for the disease. We have identified a four-generation Basset Hound pedigree with characteristic autosomal recessive PACG that closely recapitulates PACG in humans. Our aim is to utilize gene mapping and whole exome sequencing approaches to identify PACG-causing sequence variants in the Basset. Extensive clinical phenotyping of all pedigree members was conducted. SNP-chip genotyping was carried out in 9 affected and 15 unaffected pedigree members. Two-point and multipoint linkage analyses of genome-wide SNP data were performed using Superlink-Online SNP-1.1 and a locus was mapped to chromosome 19q with a maximum LOD score of 3.24. The locus contains 12 Ensemble predicted canine genes and is syntenic to a region on chromosome 2 in the human genome. Using exome-sequencing analysis, a possibly damaging, non-synonymous variant in the gene Nebulin (NEB) was found to segregate with PACG which alters a phylogenetically conserved Lysine residue. The association of this variants with PACG was confirmed in a secondary cohort of unrelated Basset Hounds (p = 3.4 × 10-4, OR = 15.3 for homozygosity). Nebulin, a protein that promotes the contractile function of sarcomeres, was found to be prominently expressed in the ciliary muscles of the anterior segment. Our findings may provide insight into the molecular mechanisms that underlie PACG. The phenotypic similarities of disease presentation in dogs and humans may enable the translation of findings made in this study to patients with PACG.

Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic Stroke: Updated Meta-Analysis of Randomized Clinical Trials.

Science.gov (United States)

Vaduganathan, Muthiah; Qamar, Arman; Gupta, Ankur; Bajaj, Navkaranbir; Golwala, Harsh B; Pandey, Ambarish; Bhatt, Deepak L

2018-05-01

Patent foramen ovale closure represents a potential secondary prevention strategy for cryptogenic stroke, but available trials have varied by size, device studied, and follow-up. We conducted a systematic search of published randomized clinical trials evaluating patent foramen ovale closure versus medical therapy in patients with recent stroke or transient ischemic attack using PubMED, EMBASE, and Cochrane through September 2017. Weighting was by random effects models. Of 480 studies screened, we included 5 randomized clinical trials in the meta-analysis in which 3440 patients were randomized to patent foramen ovale closure (n = 1829) or medical therapy (n = 1611) and followed for an average of 2.0 to 5.9 years. Index stroke/transient ischemic attack occurred within 6 to 9 months of randomization. The primary end point was composite stroke/transient ischemic attack and death (in 3 trials) or stroke alone (in 2 trials). Patent foramen ovale closure reduced the primary end point (0.70 vs 1.48 events per 100 patient-years; risk ratio [RR], 0.52 [0.29-0.91]; I 2  = 55.0%) and stroke/transient ischemic attack (1.04 vs 2.00 events per 100 patient-years; RR, 0.55 [0.37-0.82]; I 2  = 42.2%) with modest heterogeneity compared with medical therapy. Procedural bleeding was not different between study arms (1.8% vs 1.8%; RR, 0.94 [0.49-1.83]; I 2  = 29.2%), but new-onset atrial fibrillation/flutter was increased with patent foramen ovale closure (6.6% vs 0.7%; RR, 4.69 [2.17-10.12]; I 2  = 29.3%). In patients with recent cryptogenic stroke, patent foramen ovale closure reduces recurrent stroke/transient ischemic attack compared with medical therapy, but is associated with a higher risk of new-onset atrial fibrillation/flutter. Copyright © 2018 Elsevier Inc. All rights reserved.

Safety and efficacy of device closure for patent foramen ovale for secondary prevention of neurological events: Comprehensive systematic review and meta-analysis of randomized controlled trials

International Nuclear Information System (INIS)

Hakeem, Abdul; Marmagkiolis, Konstantinos; Hacioglu, Yalcin; Uretsky, Barry F.; Gundogdu, Betul; Leesar, Massoud; Bailey, Steven R.; Cilingiroglu, Mehmet

2013-01-01

Background: Controversy persists regarding the management of patients with cryptogenic stroke and patent foramen ovale (PFO). We performed a meta-analysis of randomized controlled trials comparing PFO closure with medical therapy. Methods and Results: A prospective protocol was developed and registered using the following data sources: PubMed, Cochrane Register of Controlled Trials, conference proceedings, and Internet-based resources of clinical trials. Primary analyses were performed using the intention-to-treat method. Three randomized trials comparing percutaneous PFO closure vs. medical therapy for secondary prevention of embolic neurological events formed the data set. Baseline characteristics were similar. During long-term follow-up, the pooled incidence of the primary endpoint (composite of stroke, death, or fatal stroke) was 3.4% in the PFO closure arm and 4.8% in the medical therapy group [risk-reduction (RR) 0.7 (0.48–1.06); p = 0.09]. The incidence of recurrent neurological events (secondary endpoint) was 1.7% for PFO closure and 2.7% for medical therapy [RR 0.66 (0.35–1.24), p = 0.19]. There was no difference in terms of death or adverse events between the two groups. Conclusions: While this meta-analysis of randomized clinical trials demonstrated no statistical significance in comparison to medical therapy, there was a trend towards overall improvement in outcomes in the PFO closure group

Safety and efficacy of device closure for patent foramen ovale for secondary prevention of neurological events: Comprehensive systematic review and meta-analysis of randomized controlled trials

Energy Technology Data Exchange (ETDEWEB)

Hakeem, Abdul [University of Arkansas for Medical Sciences, Little Rock, AR (United States); Marmagkiolis, Konstantinos [Citizens Memorial Hospital Heart and Vascular Institute, Bolivar, MO (United States); Hacioglu, Yalcin; Uretsky, Barry F.; Gundogdu, Betul [University of Arkansas for Medical Sciences, Little Rock, AR (United States); Leesar, Massoud [University of Alabama at Birmingham, Birmingham, AL (United States); Bailey, Steven R. [University of Texas Health Sciences Center at San Antonio, San Antonio, TX (United States); Cilingiroglu, Mehmet, E-mail: mcilingiroglu@yahoo.com [Arkansas Heart Hospital, Little Rock, AR (United States)

2013-11-15

Background: Controversy persists regarding the management of patients with cryptogenic stroke and patent foramen ovale (PFO). We performed a meta-analysis of randomized controlled trials comparing PFO closure with medical therapy. Methods and Results: A prospective protocol was developed and registered using the following data sources: PubMed, Cochrane Register of Controlled Trials, conference proceedings, and Internet-based resources of clinical trials. Primary analyses were performed using the intention-to-treat method. Three randomized trials comparing percutaneous PFO closure vs. medical therapy for secondary prevention of embolic neurological events formed the data set. Baseline characteristics were similar. During long-term follow-up, the pooled incidence of the primary endpoint (composite of stroke, death, or fatal stroke) was 3.4% in the PFO closure arm and 4.8% in the medical therapy group [risk-reduction (RR) 0.7 (0.48–1.06); p = 0.09]. The incidence of recurrent neurological events (secondary endpoint) was 1.7% for PFO closure and 2.7% for medical therapy [RR 0.66 (0.35–1.24), p = 0.19]. There was no difference in terms of death or adverse events between the two groups. Conclusions: While this meta-analysis of randomized clinical trials demonstrated no statistical significance in comparison to medical therapy, there was a trend towards overall improvement in outcomes in the PFO closure group.

Evaluation of the efficacy of laser peripheral iridoplasty in reversing the darkroom provocative test result in Chinese patients with primary angle closure status post laser iridotomy

Institute of Scientific and Technical Information of China (English)

Ping; Huang; Ling-Ling; Wu

2015-01-01

AIM: To investigate the efficacy and safety of krypton laser peripheral iridoplasty(LPIP) for Chinese patients with primary angle closure(PAC) or primary angle-closure glaucoma(PACG) status post laser iridotomy in reversing the positive results of the dark room provocative test(DRPT).METHODS: This study was prospective, noncomparative,interventional case series. Thirty-three patients(thirty-eight eyes) with PAC or PACG status post patent laser iridotomy and maintained normal intraocular pressure(IOP) but with positive DRPT results were enrolled. All the subjects were treated with krypton LPIP. DRPT was repeated after krypton LPIP. Results of DRPT were recorded. The visual acuity, IOP and gonioscopy were analyzed before and after krypton LPIP. A minimum time limit for follow-up was 6mo.RESULTS: Thirty-three patients(thirty-eight eyes)were followed for 17.7 ±8.37mo(range 7-41mo) after LPIP. Positive results of DRPT decreased from 38 eyes to9 eyes(23.7%) after LPIP. Peripheral anterior synechiae of angle in 34 of 38 eyes(89.5%) remained unchanged at dynamic gonioscopy throughout the follow-up period after LPIP.CONCLUSION: LPIP decreased positive rates of the DRPT significantly. The mechanism may be that LPIP minimized contact between the peripheral iris and trabecular meshwork, which is a key factor for developing peripheral anterior synechiae.

Evaluation of the efficacy of laser peripheral iridoplasty in reversing the darkroom provocative test result in Chinese patients with primary angle closure status post laser iridotomy

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Ping Huang

2015-06-01

Full Text Available AIM: To investigate the efficacy and safety of krypton laser peripheral iridoplasty (LPIP for Chinese patients with primary angle closure (PAC or primary angle-closure glaucoma (PACG status post laser iridotomy in reversing the positive results of the dark room provocative test (DRPT.METHODS:This study was prospective, noncomparative, interventional case series. Thirty-three patients (thirty-eight eyes with PAC or PACG status post patent laser iridotomy and maintained normal intraocular pressure (IOP but with positive DRPT results were enrolled. All the subjects were treated with krypton LPIP. DRPT was repeated after krypton LPIP. Results of DRPT were recorded. The visual acuity, IOP and gonioscopy were analyzed before and after krypton LPIP. A minimum time limit for follow-up was 6mo.RESULTS:Thirty-three patients (thirty-eight eyes were followed for 17.7±8.37mo (range 7-41mo after LPIP. Positive results of DRPT decreased from 38 eyes to 9 eyes (23.7% after LPIP. Peripheral anterior synechiae of angle in 34 of 38 eyes (89.5% remained unchanged at dynamic gonioscopy throughout the follow-up period after LPIP.CONCLUSION:LPIP decreased positive rates of the DRPT significantly. The mechanism may be that LPIP minimized contact between the peripheral iris and trabecular meshwork, which is a key factor for developing peripheral anterior synechiae.

Page 1 '---------------------------- Presenting features ofprimary angle ...

African Journals Online (AJOL)

coma were assessed. The diagnosis of primary angle-closure glaucoma was made on presentation if the intra-ocular pressure was > 21 mmHg, or if a glaucomatous visual field was found, in the presence of a partially or totally closed angle or peripheral anterior synechiae. Provocation tests were not performed. Patients ...

Network Centrality of Resting-State fMRI in Primary Angle-Closure Glaucoma Before and After Surgery.

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Fengqin Cai

Full Text Available Using voxel-wise degree centrality (DC, as measured by resting-state fMRI, we aimed to study alterations in the brain functional networks in patients with primary angle-closure glaucoma (PACG and to reveal the plastic trajectories of surgery.A total of 23 preoperative PACG patients (49.48 ± 14.37 years old were recruited to undergo a resting-state fMRI scan, and 9 of them were rescanned 3 months after surgery. All PACG patients underwent a complete ophthalmologic examination, including intraocular pressure (IOP, retinal nerve fiber layer (RNFL thickness, vertical cup to disc ratio (V C/D, and average cup to disc ratio (A C/D. Another 23 gender- and age-matched healthy controls (48.18 ± 9.40 years old underwent scanning once for comparison. The group difference in DC was calculated in each voxel, and the correlations between the DC value and each of the clinical variables were analyzed in the PACG patients.Preoperative PACG (pre-PACG patients showed significantly decreased DC in the bilateral visual cortices but increased DC in the left anterior cingulate cortex (ACC and caudate (p < 0.05, corrected compared with the controls. Statistical analysis showed a significantly negative correlation between DC in the bilateral visual cortices and the IOP score and between DC in the anterior cingulate cortex (ACC and both the A C/D and V C/D scores in the pre-PACG patients. Three months after surgery, these postoperative PACG (post-PACG patients showed a significantly increased DC in both the bilateral visual cortices and the left precentral gyrus compared with the pre-PACG patients.Our results suggest that PACG may contribute to decreased functional centrality in the visual system and to increased degree centrality in cognition-emotional processing regions. Alterations in visual areas seem to parallel the cup to disc ratio, but not the duration of angle closure. The changes of functional centrality in PACG patients after operation may reveal the

Numerical exploration of non-axisymmetric divertor closure in the small angle slot (SAS) divertor at DIII-D

Science.gov (United States)

Frerichs, H.; Schmitz, O.; Covele, B.; Feng, Y.; Guo, H. Y.; Hill, D.

2018-05-01

Numerical simulations of toroidal asymmetries in a tightly baffled small angle slot (SAS) divertor on the DIII-D tokamak show that toroidal asymmetries in divertor closure result in (non-axisymmetric) local onset of detachment within a density window of 10-15% on top of the nominal threshold separatrix density. The SAS divertor is explored at DIII-D for improving access to cold, dissipative/detached divertor conditions. The narrow width of the slot divertor coupled with a small magnetic field line-to-target angle facilitates the buildup of neutral density, thereby increasing radiative and neutrals-related (atoms and molecules) losses in the divertor. Small changes in the strike point location can be expected to have a large impact on divertor conditions. The combination of misaligned slot structure and non-axisymmetric perturbations to the magnetic field configuration causes the strike point to move along the divertor target plate, possibly leaving the divertor slot at some locations. The latter extreme case essentially introduces an opening in the divertor slot from where recycling neutrals can easily escape, and thereby degrade the performance of the slot divertor. Such a strike point dislocation is approximated by a finite gap in the divertor baffle for which 3D edge plasma and neutral gas simulations are performed with the EMC3-EIRENE code.

A New Acute Attack of Angle Closure Glaucoma Animal Model with Healon 5

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Silvania Y. F. Lau

2011-05-01

Full Text Available Acute angle closure glaucoma (AACG is an ocular emergency and sight -threatening disease in which the intraocular ocular pressure (IOP rises suddenly due to blockage of aqueous humor outflow. It can cause permanent loss in visual acuity and visual field. In animal study, the well-established model to study AACG is by fluid infusion and by adjusting the bottle level, a high IOP can be induced in a few seconds. However, there is no blockage of aqueous outflow and the pressure rise is unrealistically fast. To mimic human AACG, we suggest to use Healon 5, an ophthalmic viscosurgical device, which is injected intracamerally to block the aqueous outflow. The IOP is allowed to build up naturally. We found that, with this technique, the IOP elevated at a rate of 0.57 mmHg/min before it hit 40 mmHg, which is considered as AACG in human. The maximum IOP registered was above 70 mmHg. Thinning of retinal nerve fiber layer (RNFL and neural cells lost were seen. Visual function evaluated by ERG showed reduction in a-wave, b-wave, photopic negative response (PhNR and oscillatory potentials (OPs activities. In conclusion, Healon 5 is effective in inducing acute transient rise in IOP which mimics human AACG.

Assessment of narrow angles by gonioscopy, Van Herick method and anterior segment optical coherence tomography.

Science.gov (United States)

Park, Seong Bae; Sung, Kyung Rim; Kang, Sung Yung; Jo, Jung Woo; Lee, Kyoung Sub; Kook, Michael S

2011-07-01

To evaluate anterior chamber (AC) angles using gonioscopy, Van Herick technique and anterior segment optical coherence tomography (AS-OCT). One hundred forty-eight consecutive subjects were enrolled. The agreement between any two of three diagnostic methods, gonioscopy, AS-OCT and Van Herick, was calculated in narrow-angle patients. The area under receiver-operating characteristic curves (AUC) for discriminating between narrow and open angles determined by gonioscopy was calculated in all participants for AS-OCT parameter angle opening distance (AOD), angle recess area, trabecular iris surface area and anterior chamber depth (ACD). As a subgroup analysis, capability of AS-OCT parameters for detecting angle closure defined by AS-OCT was assessed in narrow-angle patients. The agreement between the Van Herick method and gonioscopy in detecting angle closure was excellent in narrow angles (κ = 0.80, temporal; κ = 0.82, nasal). However, agreement between gonioscopy and AS-OCT and between the Van Herick method and AS-OCT was poor (κ = 0.11-0.16). Discrimination capability of AS-OCT parameters between open and narrow angles determined by gonioscopy was excellent for all AS-OCT parameters (AUC, temporal: AOD500 = 0.96, nasal: AOD500 = 0.99). The AUCs for detecting angle closure defined by AS-OCT image in narrow angle subjects was good for all AS-OCT parameters (AUC, 0.80-0.94) except for ACD (temporal: ACD = 0.70, nasal: ACD = 0.63). Assessment of narrow angles by gonioscopy and the Van Herick technique showed good agreement, but both measurements revealed poor agreement with AS-OCT. The angle closure detection capability of AS-OCT parameters was excellent; however, it was slightly lower in ACD.

Distinct iris gene expression profiles of primary angle closure glaucoma and primary open angle glaucoma and their interaction with ocular biometric parameters.

Science.gov (United States)

Seet, Li-Fong; Narayanaswamy, Arun; Finger, Sharon N; Htoon, Hla M; Nongpiur, Monisha E; Toh, Li Zhen; Ho, Henrietta; Perera, Shamira A; Wong, Tina T

2016-11-01

This study aimed to evaluate differences in iris gene expression profiles between primary angle closure glaucoma (PACG) and primary open angle glaucoma (POAG) and their interaction with biometric characteristics. Prospective study. Thirty-five subjects with PACG and thirty-three subjects with POAG who required trabeculectomy were enrolled at the Singapore National Eye Centre, Singapore. Iris specimens, obtained by iridectomy, were analysed by real-time polymerase chain reaction for expression of type I collagen, vascular endothelial growth factor (VEGF)-A, -B and -C, as well as VEGF receptors (VEGFRs) 1 and 2. Anterior segment optical coherence tomography (ASOCT) imaging for biometric parameters, including anterior chamber depth (ACD), anterior chamber volume (ACV) and lens vault (LV), was also performed pre-operatively. Relative mRNA levels between PACG and POAG irises, biometric measurements, discriminant analyses using genes and biometric parameters. COL1A1, VEGFB, VEGFC and VEGFR2 mRNA expression was higher in PACG compared to POAG irises. LV, ACD and ACV were significantly different between the two subgroups. Discriminant analyses based on gene expression, biometric parameters or a combination of both gene expression and biometrics (LV and ACV), correctly classified 94.1%, 85.3% and 94.1% of the original PACG and POAG cases, respectively. The discriminant function combining genes and biometrics demonstrated the highest accuracy in cross-validated classification of the two glaucoma subtypes. Distinct iris gene expression supports the pathophysiological differences that exist between PACG and POAG. Biometric parameters can combine with iris gene expression to more accurately define PACG from POAG. © 2016 The Authors. Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists.

Cranial Suture Closure in Domestic Dog Breeds and Its Relationships to Skull Morphology.

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Geiger, Madeleine; Haussman, Sinah

2016-04-01

Bulldog-type brachycephalic domestic dog breeds are characterized by a relatively short and broad skull with a dorsally rotated rostrum (airorhynchy). Not much is known about the association between a bulldog-type skull conformation and peculiar patterns of suture and synchondrosis closure in domestic dogs. In this study, we aim to explore breed-specific patterns of cranial suture and synchondrosis closure in relation to the prebasial angle (proxy for airorhynchy and thus bulldog-type skull conformation) in domestic dogs. For this purpose, we coded closure of 18 sutures and synchondroses in 26 wolves, that is, the wild ancestor of all domestic dogs, and 134 domestic dogs comprising 11 breeds. Comparisons of the relative amount of closing and closed sutures and synchondroses (closure scores) in adult individuals showed that bulldog-type breeds have significantly higher closure scores than non-bulldog-type breeds and that domestic dogs have significantly higher closure scores than the wolf. We further found that the prebasial angle is significantly positively correlated with the amount of closure of the basispheno-presphenoid synchondrosis and sutures of the nose (premaxillo-nasal and maxillo-nasal) and the palate (premaxillo-maxillary and interpalatine). Our results show that there is a correlation between patterns of suture and synchondrosis closure and skull shape in domestic dogs, although the causal relationships remain elusive. © 2016 Wiley Periodicals, Inc.

Clinical evaluation of RNFL and GCC for diagnosis in early stage of chronic primary angle-closure glaucoma

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Shi Liu

2015-08-01

Full Text Available AIM:To explore the diagnosis value of retina nerve fiber layer(RNFLand ganglion cell complex(GCCin the early stage of chronic primary angle-closure glaucoma(CPACG, and investigate their relationship with mean defect(MDof visual field.METHODS: Twenty-one patients with CPACG(38 eyes, 25 patients with suspected glaucoma(SG(46 eyesand 25 normal controls(49 eyeswere selected to perform SD-OCT. Statistical difference was analyzed the thickness of RNFL and GCC of average and all quadrants, and correlation between RNFL, GCC and MD of visual field. RESULTS:There were significant differences in average and all quadrant thickness of RNFL and GCC between CPACG group and control group(PPPPPr=0.65, GCC(r=0.72in CPACG group. CONCLUSION:RNFL and GCC are useful to diagnose and monitor the early stage of CPACG, and GCC may be more significant for the disease.

Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection.

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Camacho-Mauries, Daniel; Rodriguez-Díaz, José Luis; Salgado-Nesme, Noel; González, Quintín H; Vergara-Fernández, Omar

2013-02-01

The use of temporary stomas has been demonstrated to reduce septic complications, especially in high-risk anastomosis; therefore, it is necessary to reduce the number of complications secondary to ostomy takedowns, namely wound infection, anastomotic leaks, and intestinal obstruction. To compare the rates of superficial wound infection and patient satisfaction after pursestring closure of ostomy wound vs conventional linear closure. Patients undergoing colostomy or ileostomy closure between January 2010 and February 2011 were randomly assigned to linear closure (n = 30) or pursestring closure (n = 31) of their ostomy wound. Wound infection within 30 days of surgery was defined as the presence of purulent discharge, pain, erythema, warmth, or positive culture for bacteria. Patient satisfaction, healing time, difficulty managing the wound, and limitation of activities were analyzed with the Likert questionnaire. The infection rate for the control group was 36.6% (n = 11) vs 0% in the pursestring closure group (p ostomy wound closure (shorter healing time and improved patient satisfaction).

[Uveitic Secondary Glaucoma].

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Lommatzsch, Claudia; Heinz, Carsten

2018-05-01

An intraocular pressure increase with development of glaucomatous damage is a common complication of uveitis. The prevalence has a wide range depending on various factors such as the underlying uveitis type and the duration of the disease. Pathogenetically, a distinction must be made between a secondary angle closure component and the more frequently occurring open-angle glaucoma. In diagnostics, in addition to the clinical optic nerve head assessment, perimetry and tonometry, the use of imaging examination equipment, such as OCT and HRT, are recommended. In the context of uveitic glaucoma, it must be considered in the evaluation, because the glaucoma-typical changes are generally less pronounced or can be concealed by retinal swelling in comparison with other forms of glaucoma. Therapeutically, drug therapy in the form of eye drops continues to be a first-line recommendation, with the use of topical carbonic anhydrase inhibitors or beta-blockers primarily preferred, depending on the contraindications. An operative therapy follows after unsuccessful or inadequate conservative therapy: the adequate surgical technique depends on the respective finding and includes actually techniques such as filtering procedures and glaucoma drainage devices. Georg Thieme Verlag KG Stuttgart · New York.

An Elongated Leading Edge Facilitates Rotation Flap Closure: In Vivo Demonstration.

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Lichon, Vanessa; Barbosa, Naiara; Gomez, Doug; Goldman, Glenn

2016-01-01

Variation in the design of a rotation flap may affect wound closure tension. Lengthening the leading edge of a rotation flap has been a method of reducing the tension of closure in the primary motion. An in vitro study negating this tenant has been published. The authors set out to design an in vivo experiment to determine if lengthening the leading edge of a rotation flap has the effect of reducing closure tension in the primary motion of the repair. An animal study approved by Institutional Animal Care and Use Committee was undertaken in a pig model. A tension-measuring apparatus was designed using Teflon-coated wires and digital tensiometers. Rotation flaps of a standard design and with elongated leading edges were incised on the flanks of pigs under general anesthesia. Flap closure tensions were measured at points along the leading edge of the flap and in the secondary motion. Elongating the leading edge of a flap led to a statistically significant reduction in closure tension in the primary motion of the flap and at the flap tip. The secondary motion closure tensions were essentially unaffected. The authors confirm that elongating the leading edge of a standard rotation flap will reduce closure tension in the primary flap motion.

On the prediction of turbulent secondary flows

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Speziale, C. G.; So, R. M. C.; Younis, B. A.

1992-01-01

The prediction of turbulent secondary flows, with Reynolds stress models, in circular pipes and non-circular ducts is reviewed. Turbulence-driven secondary flows in straight non-circular ducts are considered along with turbulent secondary flows in pipes and ducts that arise from curvature or a system rotation. The physical mechanisms that generate these different kinds of secondary flows are outlined and the level of turbulence closure required to properly compute each type is discussed in detail. Illustrative computations of a variety of different secondary flows obtained from two-equation turbulence models and second-order closures are provided to amplify these points.

Full cyclic coordinate descent: solving the protein loop closure problem in Cα space

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Hamelryck Thomas

2005-06-01

Full Text Available Abstract Background Various forms of the so-called loop closure problem are crucial to protein structure prediction methods. Given an N- and a C-terminal end, the problem consists of finding a suitable segment of a certain length that bridges the ends seamlessly. In homology modelling, the problem arises in predicting loop regions. In de novo protein structure prediction, the problem is encountered when implementing local moves for Markov Chain Monte Carlo simulations. Most loop closure algorithms keep the bond angles fixed or semi-fixed, and only vary the dihedral angles. This is appropriate for a full-atom protein backbone, since the bond angles can be considered as fixed, while the (φ, ψ dihedral angles are variable. However, many de novo structure prediction methods use protein models that only consist of Cα atoms, or otherwise do not make use of all backbone atoms. These methods require a method that alters both bond and dihedral angles, since the pseudo bond angle between three consecutive Cα atoms also varies considerably. Results Here we present a method that solves the loop closure problem for Cα only protein models. We developed a variant of Cyclic Coordinate Descent (CCD, an inverse kinematics method from the field of robotics, which was recently applied to the loop closure problem. Since the method alters both bond and dihedral angles, which is equivalent to applying a full rotation matrix, we call our method Full CCD (FCDD. FCCD replaces CCD's vector-based optimization of a rotation around an axis with a singular value decomposition-based optimization of a general rotation matrix. The method is easy to implement and numerically stable. Conclusion We tested the method's performance on sets of random protein Cα segments between 5 and 30 amino acids long, and a number of loops of length 4, 8 and 12. FCCD is fast, has a high success rate and readily generates conformations close to those of real loops. The presence of constraints

The incidence angle influence on the structure of secondary-emission characteristics of single crystals

International Nuclear Information System (INIS)

Gasanov, E.R.; Aliyev, B.Z.

2012-01-01

Full text : The dependences of Wand MO single crystals in different atom planes have been studied in this work. It is revealed that maximums are added to each dependency and also minimums of first and second degree. This fact is explained by diffraction dynamic theory. It is established that electron diffraction oriented not perpendicularly to crystal surface is the reason of appearance of second order structure on studied secondary-emission characteristics. In the present work being the continuation and development of SEE investigations of high-melting metal single crystals begun earlier by authors, the structure dependence of SEE main characteristics of angle has been studied. This angle has been chosen because as it is mentioned before the bad repeatability in different experiments for it is observed

The effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle-closure glaucoma (EAGLE): study protocol for a randomized controlled trial.

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Azuara-Blanco, Augusto; Burr, Jennifer M; Cochran, Claire; Ramsay, Craig; Vale, Luke; Foster, Paul; Friedman, David; Quayyum, Zahidul; Lai, Jimmy; Nolan, Winnie; Aung, Tin; Chew, Paul; McPherson, Gladys; McDonald, Alison; Norrie, John

2011-05-23

Glaucoma is the leading cause of irreversible blindness. Although primary open-angle glaucoma is more common, primary angle-closure glaucoma (PACG) is more likely to result in irreversible blindness. By 2020, 5·3 million people worldwide will be blind because of PACG. The current standard care for PACG is a stepped approach of a combination of laser iridotomy surgery (to open the drainage angle) and medical treatment (to reduce intraocular pressure). If these treatments fail, glaucoma surgery (eg, trabeculectomy) is indicated. It has been proposed that, because the lens of the eye plays a major role in the mechanisms leading to PACG, early clear lens extraction will improve glaucoma control by opening the drainage angle. This procedure might reduce the need for drugs and glaucoma surgery, maintain good visual acuity, and improve quality of life compared with standard care.EAGLE aims to evaluate whether early lens extraction improves patient-reported, clinical outcomes, and cost-effectiveness, compared with standard care. EAGLE is a multicentre pragmatic randomized trial. All people presenting to the recruitment centres in the UK and east Asia with newly diagnosed PACG and who are at least 50 years old are eligible.The primary outcomes are EQ-5D, intraocular pressure, and incremental cost per quality adjusted life year (QALY) gained. Other outcomes are: vision and glaucoma-specific patient-reported outcomes, visual acuity, visual field, angle closure, number of medications, additional surgery (e.g., trabeculectomy), costs to the health services and patients, and adverse events.A single main analysis will be done at the end of the trial, after three years of follow-up. The analysis will be based on all participants as randomized (intention to treat). 400 participants (200 in each group) will be recruited, to have 90% power at 5% significance level to detect a difference in EQ-5D score between the two groups of 0·05, and a mean difference in intraocular pressure of

The effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle-closure glaucoma (EAGLE: study protocol for a randomized controlled trial

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Chew Paul

2011-05-01

Full Text Available Abstract Background Glaucoma is the leading cause of irreversible blindness. Although primary open-angle glaucoma is more common, primary angle-closure glaucoma (PACG is more likely to result in irreversible blindness. By 2020, 5·3 million people worldwide will be blind because of PACG. The current standard care for PACG is a stepped approach of a combination of laser iridotomy surgery (to open the drainage angle and medical treatment (to reduce intraocular pressure. If these treatments fail, glaucoma surgery (eg, trabeculectomy is indicated. It has been proposed that, because the lens of the eye plays a major role in the mechanisms leading to PACG, early clear lens extraction will improve glaucoma control by opening the drainage angle. This procedure might reduce the need for drugs and glaucoma surgery, maintain good visual acuity, and improve quality of life compared with standard care. EAGLE aims to evaluate whether early lens extraction improves patient-reported, clinical outcomes, and cost-effectiveness, compared with standard care. Methods/Design EAGLE is a multicentre pragmatic randomized trial. All people presenting to the recruitment centres in the UK and east Asia with newly diagnosed PACG and who are at least 50 years old are eligible. The primary outcomes are EQ-5D, intraocular pressure, and incremental cost per quality adjusted life year (QALY gained. Other outcomes are: vision and glaucoma-specific patient-reported outcomes, visual acuity, visual field, angle closure, number of medications, additional surgery (e.g., trabeculectomy, costs to the health services and patients, and adverse events. A single main analysis will be done at the end of the trial, after three years of follow-up. The analysis will be based on all participants as randomized (intention to treat. 400 participants (200 in each group will be recruited, to have 90% power at 5% significance level to detect a difference in EQ-5D score between the two groups of 0·05

GCFR 1/20-scale PCRV central core cavity closure model test

International Nuclear Information System (INIS)

Robinson, G.C.; Dougan, J.R.

1981-06-01

Oak Ridge National Laboratory has been conducting structural response tests of the prestressed concrete reactor vessel (PCRV) closures for the 300-MW(e) gas-cooled fast reactor demonstration power plant. This report describes the third in a series of tests of small-scale closure plug models. The model represents a redesign of the central core cavity closure plug. The primary objective was to demonstrate structural performance and ultimate load capacity of the closure plug. Secondary objectives included obtaining data on crack development and propagation and on mode of failure of the composite structure

Changes in Anterior Segment Morphology and Predictors of Angle Widening after Laser Iridotomy in South Indian Eyes.

Science.gov (United States)

Zebardast, Nazlee; Kavitha, Srinivasan; Krishnamurthy, Palaniswamy; Friedman, David S; Nongpiur, Monisha E; Aung, Tin; Quigley, Harry A; Ramulu, Pradeep Y; Venkatesh, Rengaraj

2016-12-01

To compare anterior segment optical coherence tomography (ASOCT) angle morphology before and after laser peripheral iridotomy (LPI) in a cohort of South Indian subjects with primary angle-closure suspect (PACS) or primary angle-closure/primary angle-closure glaucoma (PAC/PACG) and to examine baseline parameters associated with angle widening. Prospective observational study. A total of 244 subjects aged ≥30 years with PACS or PAC/PACG in at least 1 eye. The ASOCT images and angle gonioscopic grades were analyzed for all subjects at baseline and 2 weeks after LPI. Multivariable linear and logistic regression models were used to determine predictors of angle widening (change in mean angle opening distance [AOD750]) and angle opening (all 4 quadrants with trabecular meshwork [TM] visible on gonioscopy after LPI). Change in ASOCT parameters with LPI and baseline predictors of angle widening. Laser peripheral iridotomy resulted in angle widening on ASOCT with significant increases in AOD750, angle recess area, and trabecular iris surface area (P gonioscopy, although some degree of persistent iridotrabecular contact was present in approximately half of PACS eyes and approximately two thirds of PAC/PACG eyes on gonioscopy. The greatest widening by ASOCT was observed in eyes with features most consistent with greater baseline pupillary block. Copyright © 2016 American Academy of Ophthalmology. All rights reserved.

Depth distribution of secondary phases in kesterite Cu2ZnSnS4 by angle-resolved X-ray absorption spectroscopy

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J. Just

2017-12-01

Full Text Available The depth distribution of secondary phases in the solar cell absorber material Cu2ZnSnS4 (CZTS is quantitatively investigated using X-ray Absorption Near Edge Structure (XANES analysis at the K-edge of sulfur at varying incidence angles. Varying information depths from several nanometers up to the full thickness is achieved. A quantitative profile of the phase distribution is obtained by a self-consistent fit of a multilayer model to the XANES spectra for different angles. Single step co-evaporated CZTS thin-films are found to exhibit zinc and copper sulfide secondary phases preferentially at the front or back interfaces of the film.

Angle imaging: Advances and challenges

Science.gov (United States)

Quek, Desmond T L; Nongpiur, Monisha E; Perera, Shamira A; Aung, Tin

2011-01-01

Primary angle closure glaucoma (PACG) is a major form of glaucoma in large populous countries in East and South Asia. The high visual morbidity from PACG is related to the destructive nature of the asymptomatic form of the disease. Early detection of anatomically narrow angles is important and the subsequent prevention of visual loss from PACG depends on an accurate assessment of the anterior chamber angle (ACA). This review paper discusses the advantages and limitations of newer ACA imaging technologies, namely ultrasound biomicroscopy, Scheimpflug photography, anterior segment optical coherence tomography and EyeCam, highlighting the current clinical evidence comparing these devices with each other and with clinical dynamic indentation gonioscopy, the current reference standard. PMID:21150037

Dynamic modelling of costs and health consequences of school closure during an influenza pandemic

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Xue Yiting

2012-11-01

Full Text Available Abstract Background The purpose of this article is to evaluate the cost-effectiveness of school closure during a potential influenza pandemic and to examine the trade-off between costs and health benefits for school closure involving different target groups and different closure durations. Methods We developed two models: a dynamic disease model capturing the spread of influenza and an economic model capturing the costs and benefits of school closure. Decisions were based on quality-adjusted life years gained using incremental cost-effectiveness ratios. The disease model is an age-structured SEIR compartmental model based on the population of Oslo. We studied the costs and benefits of school closure by varying the age targets (kindergarten, primary school, secondary school and closure durations (1–10 weeks, given pandemics with basic reproductive number of 1.5, 2.0 or 2.5. Results The cost-effectiveness of school closure varies depending on the target group, duration and whether indirect costs are considered. Using a case fatality rate (CFR of 0.1-0.2% and with current cost-effectiveness threshold for Norway, closing secondary school is the only cost-effective strategy, when indirect costs are included. The most cost-effective strategies would be closing secondary schools for 8 weeks if R0=1.5, 6 weeks if R0=2.0, and 4 weeks if R0= 2.5. For severe pandemics with case fatality rates of 1-2%, similar to the Spanish flu, or when indirect costs are disregarded, the optimal strategy is closing kindergarten, primary and secondary school for extended periods of time. For a pandemic with 2009 H1N1 characteristics (mild severity and low transmissibility, closing schools would not be cost-effective, regardless of the age target of school children. Conclusions School closure has moderate impact on the epidemic’s scope, but the resulting disruption to society imposes a potentially great cost in terms of lost productivity from parents’ work absenteeism.

Ultrasound biomicroscopic evaluation of anterior segment cysts as a risk factor for ocular hypertension and closure angle glaucoma

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Abdurrahim Dusak

2013-08-01

Full Text Available AIM:To investigate the relationship between the ultrasound biomicroscopic (UBM features of anterior-segment cysts (ASCs and increased intraocular pressure (IOP as a risk factor for closed-angle glaucoma (CAG.METHODS:Totally 24 eyes with recently diagnosed ASCs were divided into two groups . First group with ASC and ocular normotension (n=13, second group with ASC and ocular hypertension (n=11. An ophthalmologic examination, including tonometry, slit-lamp biomicroscopy (SLBM, gonioscopy, fundoscopy, pentacam, and UBM, was performed. The features of the ASCs were compared with the IOP.RESULTS:ASCs were accurately diagnosed and delineated in 24 eyes using UBM. IOP was elevated in those ASCs with a secondary aetiology (P=0.027, iridociliary location (P=0.006, deformed shape (P=0.013, increased size (P=0.001 and elongated pupillary aperture (P=0.009. However, the count (P=0.343 of ASCs, anterior chamber depth (ACD; P=0.22 and axial lenght (AL; P=0.31 were not associated with ocular hypertension. Correlations were found between the IOP and ASC size (r=-0.712; P=0.003, anterior chamber angle (ACA; r=-0.985; Pr=0.885; Pr=-0.776, Pr =-0.655, P=0.002.CONCLUSION:Ocular hypertension in some eyes with ASC might be associated with various mechanisms, including secondary aetiology, iridociliary location, deformed shape, increased size and elongated pupill, which can be determined by UBM.

Cleft Palate Fistula Closure Utilizing Acellular Dermal Matrix

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Omri Emodi, DMD

2018-03-01

Full Text Available Summary:. Fistulas represent failure of cleft palate repair. Secondary and tertiary fistula repair is challenging, with high recurrence rates. In the present retrospective study, we review the efficacy of using acellular dermal matrix as an interposition layer for cleft palate fistula closure in 20 consecutive patients between 2013 and 2016. Complete fistula closure was obtained in 16 patients; 1 patient had asymptomatic recurrent fistula; 2 patients had partial closure with reduction of fistula size and minimal nasal regurgitation; 1 patient developed a recurrent fistula without changes in symptoms (success rate of 85%. We conclude that utilizing acellular dermal matrix for cleft palate fistula repair is safe and simple with a high success rate.

Cleft Palate Fistula Closure Utilizing Acellular Dermal Matrix.

Science.gov (United States)

Emodi, Omri; Ginini, Jiriys George; van Aalst, John A; Shilo, Dekel; Naddaf, Raja; Aizenbud, Dror; Rachmiel, Adi

2018-03-01

Fistulas represent failure of cleft palate repair. Secondary and tertiary fistula repair is challenging, with high recurrence rates. In the present retrospective study, we review the efficacy of using acellular dermal matrix as an interposition layer for cleft palate fistula closure in 20 consecutive patients between 2013 and 2016. Complete fistula closure was obtained in 16 patients; 1 patient had asymptomatic recurrent fistula; 2 patients had partial closure with reduction of fistula size and minimal nasal regurgitation; 1 patient developed a recurrent fistula without changes in symptoms (success rate of 85%). We conclude that utilizing acellular dermal matrix for cleft palate fistula repair is safe and simple with a high success rate.

Percutaneous closure of patent foramen ovale in cryptogenic embolism.

Science.gov (United States)

Meier, Bernhard; Kalesan, Bindu; Mattle, Heinrich P; Khattab, Ahmed A; Hildick-Smith, David; Dudek, Dariusz; Andersen, Grethe; Ibrahim, Reda; Schuler, Gerhard; Walton, Antony S; Wahl, Andreas; Windecker, Stephan; Jüni, Peter

2013-03-21

The options for secondary prevention of cryptogenic embolism in patients with patent foramen ovale are administration of antithrombotic medications or percutaneous closure of the patent foramen ovale. We investigated whether closure is superior to medical therapy. We performed a multicenter, superiority trial in 29 centers in Europe, Canada, Brazil, and Australia in which the assessors of end points were unaware of the study-group assignments. Patients with a patent foramen ovale and ischemic stroke, transient ischemic attack (TIA), or a peripheral thromboembolic event were randomly assigned to undergo closure of the patent foramen ovale with the Amplatzer PFO Occluder or to receive medical therapy. The primary end point was a composite of death, nonfatal stroke, TIA, or peripheral embolism. Analysis was performed on data for the intention-to-treat population. The mean duration of follow-up was 4.1 years in the closure group and 4.0 years in the medical-therapy group. The primary end point occurred in 7 of the 204 patients (3.4%) in the closure group and in 11 of the 210 patients (5.2%) in the medical-therapy group (hazard ratio for closure vs. medical therapy, 0.63; 95% confidence interval [CI], 0.24 to 1.62; P=0.34). Nonfatal stroke occurred in 1 patient (0.5%) in the closure group and 5 patients (2.4%) in the medical-therapy group (hazard ratio, 0.20; 95% CI, 0.02 to 1.72; P=0.14), and TIA occurred in 5 patients (2.5%) and 7 patients (3.3%), respectively (hazard ratio, 0.71; 95% CI, 0.23 to 2.24; P=0.56). Closure of a patent foramen ovale for secondary prevention of cryptogenic embolism did not result in a significant reduction in the risk of recurrent embolic events or death as compared with medical therapy. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT00166257.).

Secondary glaucoma in CAPN5-associated neovascular inflammatory vitreoretinopathy

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Cham A

2016-06-01

Full Text Available Abdourahman Cham,1,2 Mayank Bansal,3 Himanshu K Banda,4 Young Kwon,1 Paul S Tlucek,1 Alexander G Bassuk,5 Stephen H Tsang,6,7 Warren M Sobol,8 James C Folk,1 Steven Yeh,4 Vinit B Mahajan1,2 1Department of Ophthalmology and Visual Sciences, 2Omics Laboratory, University of Iowa, Iowa City, IA, USA; 3Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; 4Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, 5Department of Pediatrics, University of Iowa, Iowa City, IA, 6Barbara and Donald Jonas Laboratory of Stem Cells and Regenerative Medicine and Bernard and Shirlee Brown Glaucoma Laboratory, Department of Pathology and Cell Biology, Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, 7Edward S Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, 8Retina Physicians & Surgeons, Inc., Dayton, OH, USA Objective: The objective of this study was to review the treatment outcomes of patients with secondary glaucoma in cases of autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV, a hereditary autoimmune uveitis due to mutations in CAPN5. Patients and methods: A retrospective, observational case series was assembled from ADNIV patients with secondary glaucoma. The main outcome measures were intraocular pressure (IOP, visual acuity, use of antiglaucoma medications, ocular surgeries, and adverse outcomes. Perimetry and optic disk optical coherence tomography (OCT were also analyzed. Results: Nine eyes of five ADNIV patients with secondary glaucoma were reviewed. Each received a fluocinolone acetonide (FA implant for the management of posterior uveitis. Following implantation, no eyes developed neovascular glaucoma. Five eyes (in patients 1, 2, and 5 required Ahmed glaucoma valve surgery for the management of steroid-responsive glaucoma. Patient 2 also developed angle closure with iris bombe and underwent laser

[Screening method for angle closure and angle closure glaucoma using scanning laser polarimeter GDxVCC and photodynamic gonioscopy in a darkened room. One-year outcomes of systematic peripheral iridotomy].

Science.gov (United States)

Malek-Chehire, N; Renard, G; Dreyfus, J-F; Lebuisson, D A; Pierre-Kahn, V

2013-12-01

Angle closure glaucoma, a recognized major world health issue disproportionately affecting women and Asians, is not often considered in our European populations, normotensive subjects, myopic patients, or subjects with a deep anterior chamber. Early diagnosis is worthwhile, as laser peripheral iridotomy (LPI) is an effective one-step treatment of the causal mechanism. We have performed a retrospective study of patients who underwent an LPI, the indication for which was based on "photodynamic" gonioscopy in a darkened room showing iridotrabecular contact in darkness. Such photodynamic gonioscopy was motivated by the presence of even minute defects in the nerve fiber layer as seen on the GDxVCC or the presence of a Van Herick sign (narrow limbal anterior chamber depth). One hundred and three eyes of 103 patients underwent LPI and a minimum 1-year follow-up (mean follow-up almost 2 years). Mean age was 63.7±11.8 years, and women accounted for 63.1% of cases. The vast majority (78.6%) of patients had neither glaucoma nor ocular hypertension. There were 60.1% hyperopes and 39.9% myopes. Over half (57%) had a deep or a very deep anterior chamber. After LPI, there was immediate deepening of the limbal depth of the anterior chamber in 100% of cases. The aqueous humor that flowed forward was almost always viscous-looking. After 1 year, the IOP was 1.3mm Hg±2.4 lower (Pgonioscopy with the Goldmann three-lens mirror (to avoid unintentional indentation with the small diameter lenses in these normotensive eyes) should be performed in a darkened room. LPI is an effective one-step treatment of the underlying cause, that is particularly beneficial if performed early. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

The open abdomen: temporary closure with a modified negative pressure therapy technique

DEFF Research Database (Denmark)

Hougaard, Helene T.; Pedersen, Mark Ellebæk; Holst, U. T.

2014-01-01

of applying the system - the narrowing technique - over a 5-year period. Endpoints included fascial closure and 30-day mortality rates and presence of enteroatmospheric fistulas. Secondary closure of the fascia was obtained in 92% (106/115) of the patients with a mortality rate of 17% (20/115) and a fistula...

A regenerative approach towards mucosal fenestration closure

Science.gov (United States)

Gandi, Padma; Anumala, Naveen; Reddy, Amarender; Viswa Chandra, Rampalli

2013-01-01

Mucosal fenestration is an opening or an interstice through the oral mucosa. A lesion which occurs with greater frequency than generally realised, its occurrence is attributed to a myriad of causes. Mucogingival procedures including connective tissue grafts, free gingival grafts and lateral pedicle grafts are generally considered to be the treatment of choice in the closure of a mucosal fenestration. More often, these procedures are performed in conjunction with other procedures such as periradicular surgery and with bone grafts. However, the concomitant use of gingival grafts and bone grafts in mucosal fenestrations secondary to infections in sites exhibiting severe bone loss is highly debatable. In this article, we report two cases of mucosal fenestrations secondary to trauma and their management by regenerative periodontal surgery with the placement of guided tissue regeneration membrane and bone graft. The final outcome was a complete closure of the fenestration in both the cases. PMID:23749826

Analysis of Krypton Laser Combined With ND:YAG Laser in the Treatment of Angle Closure Glaucoma Effect%氪激光联合ND：YAG激光治疗闭角型青光眼效果分析

Institute of Scientific and Technical Information of China (English)

张海涛; 刘岚; 王宇蕾

2015-01-01

青光眼位列全球不可逆致盲眼病第二位，致盲率高。我们用氪绿激光联合Nd：YAG激光，对原发性闭角型青光眼行周边虹膜成形术与周边虹膜切除术，采用超声生物显微镜（UBM）和房角镜对联合激光手术的有效性进行评价，结果证明联合激光治疗初次发作的急性闭角型青光眼安全、有效。%Glaucoma is a global irreversible blindness in the second rank, high rate of blindness. We use krypton green laser peripheral iris of primary angle closure glaucoma plasty. Combined Nd:YAG laser peripheral iris excision, the effectiveness of the combined laser surgery was evaluated by using the ultrasonic biological microscope (UBM) and the angle of the lens. The results show that the combined laser treatment of acute angle closure glaucoma is safe and effective.

Does Full Wound Rupture following Median Pilonidal Closure Alter Long-Term Recurrence Rate?

Science.gov (United States)

Doll, Dietrich; Matevossian, Edouard; Luedi, Markus M; Schneider, Ralf; van Zypen, Dominic; Novotny, Alexander

2015-01-01

The purpose of this study was to examine the recurrence rate of wound rupture in primary pilonidal sinus disease (PSD) after median closure. A total of 583 patients from the German military cohort were interviewed. We compared the choice of surgical therapy, wound dehiscence (if present) and long-term recurrence-free survival for patients with primary open treatment, marsupialization and primary median treatment (closed vs. secondary open, respectively). Actuarial recurrence rate was determined using the Kaplan-Meier calculation with a follow-up of up to 20 years after primary PSD surgery. Patients with excision followed by primary open wound treatment showed a significantly lower 5- than 10-year recurrence rate (8.3 vs. 11.2%) compared to the patients with primary midline closure (17.4 vs. 20.5%, p = 0.03). The 20-year recurrence rate was 28% in primary open wound treatment versus 44% in primary midline closure without wound rupture. In contrast to these findings, long-term recurrence rates following secondary open wound treatment (12.2% at 5 years vs. 17.1% at 10 years) tended to be higher (although not significantly, p = 0.57) compared to primary open treatment (8.3% at 5 years vs. 11.2% at 10 years). There was no statistical difference in long-term recurrence rates between secondary open and primary midline closure (p = 0.7). Hence, despite only a short wound closure time experienced before wound rupture, the patient does not fully benefit from an open wound treatment in terms of recurrence rate. The postoperative pilonidal sinus wound rupture of primary midline closures did not significantly increase the 5- and 10-year long-term recurrence rates compared to uneventfully healing primary midline closures. © 2015 S. Karger AG, Basel.

Comparison of fasciotomy wound closures using traditional dressing changes and the vacuum-assisted closure device.

Science.gov (United States)

Zannis, John; Angobaldo, Jeff; Marks, Malcolm; DeFranzo, Anthony; David, Lisa; Molnar, Joseph; Argenta, Louis

2009-04-01

Fasciotomy wounds can be a major contributor to length of stay for patients as well as a difficult reconstructive challenge. Once the compartment pressure has been relieved and stabilized, the wound should be closed as quickly and early as possible to avoid later complications. Skin grafting can lead to morbidity and scarring at both the donor and fasciotomy site. Primary closure results in a more functional and esthetic outcome with less morbidity for the patient, but can often be difficult to achieve secondary to edema, skin retraction, and skin edge necrosis. Our objective was to examine fasciotomy wound outcomes, including time to definitive closure, comparing traditional wet-to-dry dressings, and the vacuum-assisted closure (VAC) device. This retrospective chart review included a consecutive series of patients over a 10-year period. This series included 458 patients who underwent 804 fasciotomies. Of these fasciotomy wounds, 438 received exclusively VAC. dressings, 270 received only normal saline wet-to-dry dressings, and 96 were treated with a combination of both. Of the sample, 408 patients were treated with exclusively VAC therapy or wet-to-dry dressings and 50 patients were treated with a combination of both. In comparing all wounds, there was a statistically significant higher rate of primary closure using the VAC versus traditional wet-to-dry dressings (P lower extremities and P extremities). The time to primary closure of wounds was shorter in the VAC. group in comparison with the non-VAC group. This study has shown that the use of the VAC for fasciotomy wound closure results in a higher rate of primary closure versus traditional wet-to-dry dressings. In addition, the time to primary closure of wounds or time to skin grafting is shorter when the VAC was employed. The VAC used in the described settings decreases hospitalization time, allows for earlier rehabilitation, and ultimately leads to increased patient satisfaction.

Time-dependent first-principles study of angle-resolved secondary electron emission from atomic sheets

Science.gov (United States)

Ueda, Yoshihiro; Suzuki, Yasumitsu; Watanabe, Kazuyuki

2018-02-01

Angle-resolved secondary electron emission (ARSEE) spectra were analyzed for two-dimensional atomic sheets using a time-dependent first-principles simulation of electron scattering. We demonstrate that the calculated ARSEE spectra capture the unoccupied band structure of the atomic sheets. The excitation dynamics that lead to SEE have also been revealed by the time-dependent Kohn-Sham decomposition scheme. In the present study, the mechanism for the experimentally observed ARSEE from atomic sheets is elucidated with respect to both energetics and the dynamical aspects of SEE.

Numerical exploration of non-axisymmetric divertor closure in the small angle slot (SAS) divertor at DIII-D

Science.gov (United States)

Frerichs, Heinke; Schmitz, Oliver; Covele, Brent; Guo, Houyang; Hill, David; Feng, Yuhe

2017-10-01

In the Small Angle Slot (SAS) divertor in DIII-D, the combination of misaligned slot structure and non-axisymmetric perturbations to the magnetic field causes the strike point to vary radially along the divertor slot and even leave it at some toroidal locations. This effect essentially introduces an opening in the divertor slot from where recycling neutrals can easily escape, and thereby degrade performance of the slot divertor. This effect has been approximated by a finite gap in the divertor baffle. Simulations with EMC3-EIRENE show that a toroidally localized loss of divertor closure can result in non-axisymmetric divertor densities and temperatures. This introduces a density window of 10-15% on top of the nominal threshold separatrix density during which a non-axisymmetric onset of local detachment occurs, initially leaving the gap and up to 60 deg beyond that still attached. Conversely, the impact of such toroidally localized divertor perturbations on the toroidal symmetry of midplane separatrix conditions is small. This work has been funded by the U.S. Department of Energy under Early Career Award Grant DE-SC0013911, and Grant DE-FC02-04ER54698.

Waves and tides responsible for the intermittent closure of the entrance of a small, sheltered tidal wetland at San Francisco, CA

Science.gov (United States)

Hanes, D.M.; Ward, K.; Erikson, L.H.

2011-01-01

Crissy Field Marsh (CFM; http://www.nps.gov/prsf/planyourvisit/crissy-field-marsh-and-beach.htm) is a small, restored tidal wetland located in the entrance to San Francisco Bay just east of the Golden Gate. The marsh is small but otherwise fairly typical of many such restored wetlands worldwide. The marsh is hydraulically connected to the bay and the adjacent Pacific Ocean by a narrow sandy channel. The channel often migrates and sometimes closes completely, which effectively blocks the tidal connection to the ocean and disrupts the hydraulics and ecology of the marsh. Field measurements of waves and tides have been examined in order to evaluate the conditions responsible for the intermittent closure of the marsh entrance. The most important factor found to bring about the entrance channel closure is the occurrence of large ocean waves. However, there were also a few closure events during times with relatively small offshore waves. Examination of the deep-water directional wave spectra during these times indicates the presence of a small secondary peak corresponding to long period swell from the southern hemisphere, indicating that CFM and San Francisco Bay in general may be more susceptible to long period ocean swell emanating from the south or southwest than the more common ocean waves coming from the northwest. The tidal records during closure events show no strong relationship between closures and tides, other than that closures tend to occur during multi-day periods with successively increasing high tides. It can be inferred from these findings that the most important process to the intermittent closure of the entrance to CFM is littoral sediment transport driven by the influence of ocean swell waves breaking along the CFM shoreline at oblique angles. During periods of large, oblique waves the littoral transport of sand likely overwhelms the scour potential of the tidal flow in the entrance channel. ?? 2011.

Variation in emission and energy recovery concerning incident angle in a scheme recovering high energy ions by secondary electrons

International Nuclear Information System (INIS)

Wada, Takayuki; Konno, Shota; Nakamoto, Satoshi; Takeno, Hiromasa; Furuyama, Yuichi; Taniike, Akira

2016-01-01

As an energy recovery device for fast protons produced in D- 3 He nuclear fusion, secondary electron (SE) direct energy converter (SEDEC) was proposed in addition to traveling wave direct energy converter (TWDEC). Some protons passing through a TWDEC come into an SEDEC, where protons penetrate to a number of foil electrodes and emitted SEs are recovered. Following to a development of SE orbit control by magnetic field, dependence on incident angle of protons was examined to optimize structure of SEDEC. Based on a theoretical expectation, experiments were performed by changing incident angle of protons and variation in emission and energy recovery were measured. Both emission and energy recovery increased as the angle increased, and differences with theoretical expectation are discussed. (author)

Percutaneous patent foramen ovale closure: the Paradoxical Cerebral Embolism Prevention Registry.

Science.gov (United States)

Paiva, Luís; Dinis, Paulo; Providência, Rui; Costa, Marco; Margalho, Susana; Goncalves, Lino

2015-03-01

The natural history and therapeutic interventions for secondary prevention after a cerebrovascular event in patients with patent foramen ovale (PFO) are not yet established. This study aims to assess the safety and efficacy of percutaneous PFO closure in a population of patients with ischemic cerebrovascular disease of unknown etiology. This prospective observational study included patients with a history of cryptogenic transient ischemic attack (TIA) or stroke who underwent percutaneous PFO closure. The effectiveness of the device for the secondary prevention of TIA or stroke was assessed by comparing observed events in the sample with expected events for this clinical setting. The sample included 193 cases of percutaneous PFO closure (age 46.4 ± 13.1 years, 62.2% female) with a mean follow-up of 4.3 ± 2.2 years, corresponding to a total exposure to ischemic events of 542 patient-years. The high-risk characteristics of the PFO were assessed prior to device implantation. There were seven primary endpoint events during follow-up (1.3 per 100 patient-years), corresponding to a relative risk reduction of 68.2% in recurrent TIA or stroke compared to medical therapy alone. The procedure was associated with a low rate of device- or intervention-related complications (1.5%). In this long-term registry, percutaneous PFO closure was shown to be a safe and effective therapy for the secondary prevention of cryptogenic stroke or TIA. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Disturbed spontaneous brain activity pattern in patients with primary angle-closure glaucoma using amplitude of low-frequency fluctuation: a fMRI study

Directory of Open Access Journals (Sweden)

Huang X

2015-07-01

Full Text Available Xin Huang,1,* Yu-Lin Zhong,1,* Xian-Jun Zeng,2 Fuqing Zhou,2 Xin-Hua Liu,1 Pei-Hong Hu,1 Chong-Gang Pei,1 Yi Shao,1 Xi-Jian Dai21Department of Ophthalmology, 2Department of Radiology, The First Affiliated Hospital of Nanchang University, Nangchang, Jiangxi, People’s Republic of China*These authors contributed equally to this workObjective: The aim of this study is to use amplitude of low-frequency fluctuation (ALFF as a method to explore the local features of spontaneous brain activity in patients with primary angle -closure glaucoma (PACG and ALFFs relationship with the behavioral performances.Methods: A total of twenty one patients with PACG (eight males and 13 females, and twenty one healthy subjects (nine males and twelve females closely matched in age, sex, and education, each underwent a resting-state functional magnetic resonance imaging scan. The ALFF method was used to assess the local features of spontaneous brain activity. The correlation analysis was used to explore the relationships between the observed mean ALFF signal values of the different areas in PACG patients and the thickness of the retinal nerve fiber layer (RNFL. Results: Compared with the healthy subjects, patients with PACG had significant lower ALFF areas in the left precentral gyrus, bilateral middle frontal gyrus, bilateral superior frontal gyrus, right precuneus, and right angular gyrus, and higher areas in the right precentral gyrus. In the PACG group, there were significant negative correlations between the mean ALFF signal value of the right middle frontal gyrus and the left mean RNFL thickness (r=-0.487, P=0.033, and between the mean ALFF signal value of the left middle frontal gyrus and the right mean RNFL thickness (r=-0.504, P=0.020. Conclusion: PACG mainly involved in the dysfunction in the frontal lobe, which may reflect the underlying pathologic mechanism of PACG.Keywords: angle-closure glaucoma, amplitude of low-frequency fluctuation, functional

The Management of Secondary Glaucoma in Nanophthalmic Patients

Institute of Scientific and Technical Information of China (English)

Shengsong Huang; Minbin Yu; Changyu Qiu; Tiancai Ye

2002-01-01

Purpose: To investigate the clinical characteristcs, management of secondary glaucoma in nanophthalmos, and the prevention of its complications.Methods: Retrospectively, 9 cases (17 eyes) with nanophthalmic glaucoma were studied.Results: The axial length of the eyes ranged (14.36 ～ 19.33) mm; All of the cases combined with hyperopia ranged (+7.00～+16.00)D. All 17 eyes had the manifestation like angle-closure glaucoma.The glaucoma was controlled in 9 of 17 eyes at the early stage, which underwent laser iridotomy (4 of 9 eyes also underwent laser iridoplasty). 1 eye underwent ciliary photocoagulation because its visual acuity was lost and the patient complained of pain. The other 7 eyes underwent filtration surgery and 3 of them had permanent loss of vision caused by disastrous complications after the surgery.Conclusions: Management of secondary glaucoma in nanophthalmos is complicated. The laser iris surgery is safe and effective in glaucoma at the early stage. Vortex vein decompression, sclerotectomy or anterior sclerotomy may be performed to reduce disastrous complications.

Composite three-layer closure of oral antral communication with 10 months follow-up-a case study.

Science.gov (United States)

Weinstock, Robert J; Nikoyan, Levon; Dym, Harry

2014-02-01

We propose a 3-layer composite closure technique for an oral antral communication (OAC) while avoiding secondary donor site morbidity. A patient had developed a 1-cm OAC after extraction of right maxillary first molar. The patient subsequently developed acute maxillary sinusitis. The patient was taken to the operating room, and a Caldwell-Luc procedure was performed. The bony window from the Caldwell-Luc was "press fit" over the bony OAC defect. Soft tissue closure was then achieved with a buccal fat pad flap and a buccal mucosal advancement flap. The patient was examined on postoperative day 5 and 1, 2, 3, 6, and 10 months postoperatively. The acute sinusitis had resolved. The soft tissue closure was successful. The bone graft remained intact, prevented sinus pneumatization, and restored continuity to the floor of the maxillary sinus. The presented technique for 3-layer closure of OACs allows for the stability of a double-layer closure of OAC with the added benefit of bone grafting from single operative site, achieving stable oral antral closure, bone grafting, and the avoidance of secondary donor site morbidity. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Early intraocular pressure change after peripheral iridotomy with ultralow fluence pattern scanning laser and Nd:YAG laser in primary angle-closure suspect: Kowloon East Pattern Scanning Laser Study Report No. 3.

Science.gov (United States)

Chan, Jeffrey Chi Wang; Choy, Bonnie Nga Kwan; Chan, Orlando Chia Chieh; Li, Kenneth Kai Wang

2018-02-01

Our purpose was to assess the early intraocular pressure (IOP) changes of ultralow fluence laser iridotomy using pattern scanning laser followed by neodymium:yttrium-aluminum-gamet (Nd:YAG) laser. This is a prospective interventional study. Thirty-three eyes of 33 adult Chinese primary angle-closure suspect subjects were recruited for prophylactic laser peripheral iridotomy. Sequential laser peripheral iridotomy was performed using pattern scanning laser followed by Nd:YAG laser. Visual acuity (VA) and IOP were measured before treatment, at 1 h, 1 day, 1 week, 1 month, 3 months and 6 months after laser. Laser energy used and complications were documented. Corneal endothelial cell count was examined at baseline and 6 months. Patency of the iridotomy was assessed at each follow-up visit. All subjects achieved patent iridotomy in a single session. The mean energy used was 0.335+/-0.088 J for the pattern scanning laser, and 4.767+/-5.780 mJ for the Nd:YAG laser. The total mean energy was 0.339+/-0.089 J. None of the eyes developed a clinically significant IOP spike (≥ 8 mmHg) at 1 h and 1 day after laser use. Only four eyes developed higher IOP at 1 h and all were ≤3 mmHg compared to baseline. The mean IOP was 13.8+/-2.5 mmHg at 1 h and 11.5+/-2.2 mmHg at 1 day, both were significantly lower than baseline (15.8+/-2.1 mmHg) (P laser compared to baseline (0.23 vs 0.26). There was also no statistically significant difference in mean VA at other follow-up visits compared to baseline. Peripheral iridotomy closure was encountered in two (6.1%) eyes, one at 1 month and another at 6 months follow-up. There were no complications including hyphema, peripheral anterior synechia formation nor prolonged inflammation throughout the follow-up period. There was no significant loss in corneal endothelial cell counts at 6 months (2255+/-490) compared to baseline (2303+/-386) (P = 0.347). Sequential LPI using an ultralow fluence pattern scanning laser

Automatic anterior chamber angle assessment for HD-OCT images.

Science.gov (United States)

Tian, Jing; Marziliano, Pina; Baskaran, Mani; Wong, Hong-Tym; Aung, Tin

2011-11-01

Angle-closure glaucoma is a major blinding eye disease and could be detected by measuring the anterior chamber angle in the human eyes. High-definition OCT (Cirrus HD-OCT) is an emerging noninvasive, high-speed, and high-resolution imaging modality for the anterior segment of the eye. Here, we propose a novel algorithm which automatically detects a new landmark, Schwalbe's line, and measures the anterior chamber angle in the HD-OCT images. The distortion caused by refraction is corrected by dewarping the HD-OCT images, and three biometric measurements are defined to quantitatively assess the anterior chamber angle. The proposed algorithm was tested on 40 HD-OCT images of the eye and provided accurate measurements in about 1 second.

Treatment of sternal wound infection with vacuum-assisted closure.

Science.gov (United States)

Dezfuli, Bobby; Li, Chin-Shang; Young, J Nilas; Wong, Michael S

2013-02-01

Previous work has demonstrated the efficacy of vacuum-assisted closure (VAC) in the treatment of poststernotomy local wound infections, compared to historical treatment protocol. The negative pressure has been found to protect wounds against contamination, prevent wound fluid retention, increase blood flow, and increase rates of granulation tissue formation. For this study, a retrospective analysis compared patients receiving VAC as definitive treatment versus bridging to delayed flap closure. Sixteen patients developed sternal wound infections after cardiac surgeries at the authors' institution from 2006 to 2008. Data was gathered regarding patient comorbidities, treatment method, and outcome. Study objectives included assessment of risk factors that warranted secondary surgicalclosure and examination of long-term followup where VAC was thedefinitive treatment modality. Group A (n = 12) had VAC as the final treatment modality. Group B (n = 4) required myocutaneous flap closure. One patient in Group B passed away prior to flap surgery. Both groups had similar risk factors, except Group B had a higher risk of body mass index (BMI) > 35 that was near statistically significant (P = 0.085; odds ratio = 0.0, 95% CI = [0.0 - 1.21]). Group A required a shorter hospital stay on average. Long-term follow-up showed the majority of Group A had completely healed sternal wounds 2-3 years from initial cardiac surgery. Vacuum-assisted closure as definitive treatment modality is a successful, first line therapy for local superficial sternal wound infections. When deep infections occur, however, VAC as bridge-to-flap coverage is recommended over attempted secondary healing with VAC. .

Closure system for a spent fuel storage cask

International Nuclear Information System (INIS)

Kessinger, B.A.

1987-01-01

A closure system is described for temporarily sealing a cask base element having a mouth region with first and second steps and for permitting the cask base element to be permanently sealed, the closure system comprising: a primary cover having a bottom side with a first peripheral region configured for placement on the first step and having a top side with a second peripheral region, an upwardly open annular recess being provided in the primary cover at the secondary peripheral region; first means disposed between the first peripheral region and the first step for creating a mechanical seal to seal the cash base element at least temporarily; a generally hand-shaped element which is disposed in the annular recess and which has first and second edges and a curved cross section, the first edge being sealingly affixed to the primary cover and the second edge being sealingly affixed to the cash base element only if the cash base element is to be permanently sealed; a secondary cover having a bottom side with a peripheral region configured for placement on the second step; and second means disposed between the peripheral region of the secondary cover and the second step for creating an additional mechanical seal to seal the cast base element at least temporarily

Vacuum assisted closure in vascular surgery.

Science.gov (United States)

Beno, M; Martin, J; Sager, P

2011-01-01

Vacuum assisted closure (VAC-therapy) is a well established method in nearly all surgical disciplines. The aim is to present the efficiency of vacuum assisted closure in the treatment of acute and chronic wounds in patients admitted in the department of vascular surgery. Within the year 2008 there were 59 patients (44 men, 15 women) treated with VAC therapy in our Department of Vascular surgery (Landshut, Germany). VAC was used 22x (37.28 %) in therapy of ulcus cruris (venous, arterial, mixed genesis), 15x (25.42%) in patients with diabetic foot syndrome, 12x (20.33%) in secondary healing wounds and infected wounds, 5x (8.47%) in wounds after several injuries and soft skin tissue infections and 5x (8.47%) in wound infections connected with vascular graft infections after vascular revascularization. VAC therapy seems to be very effective in the management of patients with venous ulcers, especially after a proper surgical treatment (100%), patients with soft skin tissue infections (100%) and secondary healing wounds (100%) especially in combination with MESH-Grafting. In patients with diabetic foot syndrome (80%) and peripheral arterial occlusive disease (72.7%), an evaluation of peripheral blood perfusion and revascularization prior to VAC therapy is often necessary. Although VAC was used 5x in the therapy of infected vascular grafts, successful preservation of infected graft material was observed in only one case (infection of PTFE femoro-popliteal bypass graft). Vacuum assisted closure in vascular surgery proved to be simple and efficient method in therapy of acute and chronic wounds. The efficiency of VAC systems in therapy of infected graft material after revascularization needs further studies (Tab. 3, Ref. 10).

Predicting beta-turns and their types using predicted backbone dihedral angles and secondary structures.

Science.gov (United States)

Kountouris, Petros; Hirst, Jonathan D

2010-07-31

Beta-turns are secondary structure elements usually classified as coil. Their prediction is important, because of their role in protein folding and their frequent occurrence in protein chains. We have developed a novel method that predicts beta-turns and their types using information from multiple sequence alignments, predicted secondary structures and, for the first time, predicted dihedral angles. Our method uses support vector machines, a supervised classification technique, and is trained and tested on three established datasets of 426, 547 and 823 protein chains. We achieve a Matthews correlation coefficient of up to 0.49, when predicting the location of beta-turns, the highest reported value to date. Moreover, the additional dihedral information improves the prediction of beta-turn types I, II, IV, VIII and "non-specific", achieving correlation coefficients up to 0.39, 0.33, 0.27, 0.14 and 0.38, respectively. Our results are more accurate than other methods. We have created an accurate predictor of beta-turns and their types. Our method, called DEBT, is available online at http://comp.chem.nottingham.ac.uk/debt/.

Efficacy of laser peripheral iridoplasty and iridotomy on medically refractory patients with acute primary angle closure: a three year outcome

Institute of Scientific and Technical Information of China (English)

FU Jing; QING Guo-ping; WANG Ning-li; WANG Huai-zhou

2013-01-01

Background Argon laser peripheral iridoplasty (ALPI) is proved to be effective in lowering intraocular pressure (IOP) of patients with mild acute primary angle closure (APAC).It is unclear whether this laser treatment is equally efficient in managing patients with severe APAC.This study aimed to evaluate the IOP-lowering efficacy of ALPI and laser peripheral iridotomy (LPI) on patients with refractory APAC,who have previously responded poorly to intensive medical therapy.Methods Thirty-six patients (8 men and 28 women) were identified as medically refractory APAC,who still had ocular pain,red eye,hazy cornea,closed anterior chamber (AC) angle,and IOP of not less than 21 mmHg after two days or more of anti-glaucoma medication.All enrolled patients underwent ophthalmologic examinations including measurement of visual acuity (VA),best corrected VA (BCVA),IOP,biomicroscopy,and gonioscopy followed by ALPI immediately in the APAC eye and LPI in both eyes.Results All patients were affected unilaterally,with average age of (54.6±11.7) (range,37.0-75.0) years old.The mean IOP value of the affected eyes dropped from (31.6±7.7) (range,21.0-39.0) mmHg at enrollment to (18.4±8.7) (range,10.0-27.0) mmHg 2 hours after ALPI.At follow-up day 7,the mean IOP value maintained at (14.8±4.2) (range,9.0-21.0)mmHg,which was significantly different (P=0.000) compared with baseline.The average decrease of IOP in the APAC eyes was (16.8±7.4) (range,12.0-21.0) mmHg.At follow-up three years later,the mean IOP of the APAC eyes stabilized at (16.3±3.2) (range,9.0-20.0) mmHg with at least 180° of AC angle opened.Conclusion ALPI and LPI lower the IOP of medically refractory cases of APAC though they have responded poorly to anti-glaucoma medication.

The open abdomen and temporary abdominal closure systems--historical evolution and systematic review.

Science.gov (United States)

Quyn, A J; Johnston, C; Hall, D; Chambers, A; Arapova, N; Ogston, S; Amin, A I

2012-08-01

Several techniques for temporary abdominal closure have been developed. We systematically review the literature on temporary abdominal closure to ascertain whether the method can be tailored to the indication. Medline, Embase, the Cochrane Central Register of Controlled Trials and relevant meeting abstracts until December 2009 were searched using the following headings: open abdomen, laparostomy, VAC (vacuum assisted closure), TNP (topical negative pressure), fascial closure, temporary abdominal closure, fascial dehiscence and deep wound dehiscence. The data were analysed by closure technique and aetiology. The primary end-points included delayed fascial closure and in-hospital mortality. The secondary end-points were intra-abdominal complications. The search identified 106 papers for inclusion. The techniques described were VAC (38 series), mesh/sheet (30 series), packing (15 series), Wittmann patch (eight series), Bogotá bag (six series), dynamic retention sutures (three series), zipper (15 series), skin only and locking device (one series each). The highest facial closure rates were seen with the Wittmann patch (78%), dynamic retention sutures (71%) and VAC (61%). Temporary abdominal closure has evolved from simple packing to VAC based systems. In the absence of sepsis Wittmann patch and VAC offered the best outcome. In its presence VAC had the highest delayed primary closure and the lowest mortality rates. However, due to data heterogeneity only limited conclusions can be drawn from this analysis. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

Closure requirements

International Nuclear Information System (INIS)

Hutchinson, I.P.G.; Ellison, R.D.

1992-01-01

Closure of a waste management unit can be either permanent or temporary. Permanent closure may be due to: economic factors which make it uneconomical to mine the remaining minerals; depletion of mineral resources; physical site constraints that preclude further mining and beneficiation; environmental, regulatory or other requirements that make it uneconomical to continue to develop the resources. Temporary closure can occur for a period of several months to several years, and may be caused by factors such as: periods of high rainfall or snowfall which prevent mining and waste disposal; economic circumstances which temporarily make it uneconomical to mine the target mineral; labor problems requiring a cessation of operations for a period of time; construction activities that are required to upgrade project components such as the process facilities and waste management units; and mine or process plant failures that require extensive repairs. Permanent closure of a mine waste management unit involves the provision of durable surface containment features to protect the waters of the State in the long-term. Temporary closure may involve activities that range from ongoing maintenance of the existing facilities to the installation of several permanent closure features in order to reduce ongoing maintenance. This paper deals with the permanent closure features

Case report: imaging and treatment of ophthalmic manifestations in oculodentodigital dysplasia.

Science.gov (United States)

Mosaed, Sameh; Jacobsen, Bradley H; Lin, Ken Young

2016-01-07

Diagnostic and surgical management of severe chronic angle- closure glaucoma secondary to ciliary body cysts can be difficult to manage in a patient with oculodentodigital dysplasia. A 6-year old girl with oculodentodigital dysplasia, with progressive chronic angle- closure glaucoma secondary to ciliary body cysts presented to our clinic. The initial examination revealed counting fingers vision in the left eye. Intraocular pressure (IOP), as assessed by tonopen, was 31 mm Hg. Ultrasound biomicroscopy revealed ciliary body cysts in the left eye, and gonioscopy confirmed chronic angle closure. A tube shunt was placed to control the elevated IOP. A year after her tube shunt placement in the left eye, ultrasound biomiscropy was performed on her right eye and showed no ciliary body cysts. Gonioscopy in the right eye revealed an open angle to the ciliary body band. Subsequent serial gonioscopy every 3 months showed gradual narrowing of the right eye angle and finally three-and-a-half years after tube placement of the left eye, her right eye IOP became uncontrolled with medications alone and a tube shunt was similarly placed in the right eye. Intraoperative ultrasound biomicroscopy performed at the time of the right eye tube shunt revealed extensive ciliary body cysts in the right eye. Her IOP in both eyes have been well controlled since the placement of tube shunts. This is one of the first reported cases of severe chronic angle- closure glaucoma secondary to ciliary body cysts in a patient with oculodentodigital dysplasia. We believe that early screening for ciliary body cysts is important in patients with oculodentodigital dysplasia.

Economic value of angling on the Colorado River at Lees Ferry: Using secondary data to estimate the influence of seasonality

Science.gov (United States)

Bair, Lucas S.; Rogowski, David L.; Neher, Christopher

2016-01-01

Glen Canyon Dam (GCD) on the Colorado River in northern Arizona provides water storage, flood control, and power system benefits to approximately 40 million people who rely on water and energy resources in the Colorado River basin. Downstream resources (e.g., angling, whitewater floating) in Glen Canyon National Recreation Area (GCNRA) and Grand Canyon National Park are impacted by the operation of GCD. The GCD Adaptive Management Program was established in 1997 to monitor and research the effects of dam operations on the downstream environment. We utilized secondary survey data and an individual observation travel cost model to estimate the net economic benefit of angling in GCNRA for each season and each type of angler. As expected, the demand for angling decreased with increasing travel cost; the annual value of angling at Lees Ferry totaled US$2.7 million at 2014 visitation levels. Demand for angling was also affected by season, with per-trip values of $210 in the summer, $237 in the spring, $261 in the fall, and $399 in the winter. This information provides insight into the ways in which anglers are potentially impacted by seasonal GCD operations and adaptive management experiments aimed at improving downstream resource conditions.

The clinical effects of closure of the hernia gap after laparoscopic ventral hernia repair:

DEFF Research Database (Denmark)

Christoffersen, Mette W; Westen, Mikkel; Assadzadeh, Sami

2014-01-01

randomised controlled trials. The primary purpose of this paper is to compare early post-operative activity-related pain in patients undergoing laparoscopic ventral hernia repair with closure of the gap with patients undergoing standard laparoscopic ventral hernia repair (non-closure of the gap). Secondary...... outcomes are patient-rated cosmesis and hernia-specific quality of life. METHODS: A randomised, controlled, double-blinded study is planned. Based on power calculation, we will include 40 patients in each arm. Patients undergoing elective laparoscopic umbilical, epigastric or umbilical trocar-site hernia...... repair at Hvidovre Hospital and Herlev Hospital, Denmark, are invited to participate. CONCLUSION: The gap closure technique may induce more post-operative pain than the non-closure repair, but it may also be superior with regard to other important surgical outcomes. No studies have previously...

Hormonal regulation of floret closure of rice (Oryza sativa.

Directory of Open Access Journals (Sweden)

Youming Huang

Full Text Available Plant hormones play important roles in regulating every aspect of growth, development, and metabolism of plants. We are interested in understanding hormonal regulation of floret opening and closure in plants. This is a particularly important problem for hybrid rice because regulation of flowering time is vitally important in hybrid rice seed production. However, little was known about the effects of plant hormones on rice flowering. We have shown that jasmonate and methyl jasmonate play significant roles in promoting rice floret opening. In this study, we investigated the effects of auxins including indole-3-acidic acid (IAA, indole-3-butyric acid (IBA, 1-naphthalene-acetic acid (NAA, 2,4-dichlorophenoxy acetic acid (2,4-D and 3,6-dichloro-2-methoxybenzoic acid (DIC and abscisic acid (ABA on floret closure of four fertile and three sterile varieties of rice. The results from field studies in three growing seasons in 2013-2015 showed that the percentages of closed florets were significantly lower in plants treated with IAA, IBA, 2,4-D, DIC and NAA and that the durations of floret opening were significantly longer in plants treated with the same auxins. The auxins exhibited time- and concentration-dependant effects on floret closure. ABA displayed opposite effects of auxins because it increased the percentages of floret closure and decreased the length of floret opening of rice varieties. The degree of auxin-inhibiting and ABA-promoting effects on floret closure was varied somewhat but not significantly different among the rice varieties. Endogenous IAA levels were the highest in florets collected shortly before opening followed by a sharp decline in florets with maximal angles of opening and a significant jump of IAA levels shortly after floret closure in both fertile and sterile rice plants. ABA levels showed an opposite trend in the same samples. Our results showed that auxins delayed but ABA promoted the closure of rice floret regardless of

Hormonal regulation of floret closure of rice (Oryza sativa)

Science.gov (United States)

Huang, Youming; Zeng, Xiaochun

2018-01-01

Plant hormones play important roles in regulating every aspect of growth, development, and metabolism of plants. We are interested in understanding hormonal regulation of floret opening and closure in plants. This is a particularly important problem for hybrid rice because regulation of flowering time is vitally important in hybrid rice seed production. However, little was known about the effects of plant hormones on rice flowering. We have shown that jasmonate and methyl jasmonate play significant roles in promoting rice floret opening. In this study, we investigated the effects of auxins including indole-3-acidic acid (IAA), indole-3-butyric acid (IBA), 1-naphthalene-acetic acid (NAA), 2,4-dichlorophenoxy acetic acid (2,4-D) and 3,6-dichloro-2-methoxybenzoic acid (DIC) and abscisic acid (ABA) on floret closure of four fertile and three sterile varieties of rice. The results from field studies in three growing seasons in 2013–2015 showed that the percentages of closed florets were significantly lower in plants treated with IAA, IBA, 2,4-D, DIC and NAA and that the durations of floret opening were significantly longer in plants treated with the same auxins. The auxins exhibited time- and concentration-dependant effects on floret closure. ABA displayed opposite effects of auxins because it increased the percentages of floret closure and decreased the length of floret opening of rice varieties. The degree of auxin-inhibiting and ABA-promoting effects on floret closure was varied somewhat but not significantly different among the rice varieties. Endogenous IAA levels were the highest in florets collected shortly before opening followed by a sharp decline in florets with maximal angles of opening and a significant jump of IAA levels shortly after floret closure in both fertile and sterile rice plants. ABA levels showed an opposite trend in the same samples. Our results showed that auxins delayed but ABA promoted the closure of rice floret regardless of the varieties

Uncertainty Quantification of Turbulence Model Closure Coefficients for Transonic Wall-Bounded Flows

Science.gov (United States)

Schaefer, John; West, Thomas; Hosder, Serhat; Rumsey, Christopher; Carlson, Jan-Renee; Kleb, William

2015-01-01

The goal of this work was to quantify the uncertainty and sensitivity of commonly used turbulence models in Reynolds-Averaged Navier-Stokes codes due to uncertainty in the values of closure coefficients for transonic, wall-bounded flows and to rank the contribution of each coefficient to uncertainty in various output flow quantities of interest. Specifically, uncertainty quantification of turbulence model closure coefficients was performed for transonic flow over an axisymmetric bump at zero degrees angle of attack and the RAE 2822 transonic airfoil at a lift coefficient of 0.744. Three turbulence models were considered: the Spalart-Allmaras Model, Wilcox (2006) k-w Model, and the Menter Shear-Stress Trans- port Model. The FUN3D code developed by NASA Langley Research Center was used as the flow solver. The uncertainty quantification analysis employed stochastic expansions based on non-intrusive polynomial chaos as an efficient means of uncertainty propagation. Several integrated and point-quantities are considered as uncertain outputs for both CFD problems. All closure coefficients were treated as epistemic uncertain variables represented with intervals. Sobol indices were used to rank the relative contributions of each closure coefficient to the total uncertainty in the output quantities of interest. This study identified a number of closure coefficients for each turbulence model for which more information will reduce the amount of uncertainty in the output significantly for transonic, wall-bounded flows.

Trabectome surgery for primary and secondary open angle glaucomas.

Science.gov (United States)

Jordan, Jens F; Wecker, Thomas; van Oterendorp, Christian; Anton, Alexandra; Reinhard, Thomas; Boehringer, Daniel; Neuburger, Matthias

2013-12-01

In most forms of open angle glaucoma, the trabecular meshwork is the main barrier for aqueous humor outflow, causing elevated intraocular pressure (IOP). The Trabectome is a minimal invasive device for the surgical treatment of open angle glaucoma, particularly eliminating the juxtacanalicular meshwork. This study was conducted to compare the effectiveness and complication profile among different glaucoma subgroups. Single center prospective observational study. There were 557 consecutive eyes of 487 patients included in this study. Trabectome surgery was performed either alone or in combination with cataract surgery. Intraoperative and postoperative complications were documented systematically. Main outcome measures were IOP reduction over time and the preoperative and postoperative number of IOP-lowering medications. Due to subgroup sizes, only data from eyes with primary open angle glaucoma and pseudoexfoliation glaucoma were processed for statistical analysis. For the 261 eyes classified as primary open angle glaucoma, preoperative IOP was 24 ± 5.5 mmHg (mean ± SD) under 2.1 ± 1.3 IOP-lowering medications. After a mean follow-up of 204 ± 238 days, IOP was reduced to 18 ± 6.1 mmHg, and medication was reduced to 1.2 ± 1.1. For the 173 eyes classified as pseudoexfoliation glaucoma, after a mean follow-up of 200 ± 278 days, IOP was reduced from 25 ± 5.9 mmHg to 18 ± 8.2 mmHg, and medication was reduced from 2.0 ± 1.2 to 1.1 ± 1.1. A Cox proportional hazards model hinted forward superiority of the combined surgery cases (Trabectome + Phaco + intraocular lens) in comparison to Trabectome surgery only in phakic or pseudophakic eyes. No serious complications were observed. Minimal invasive glaucoma surgery with the Trabectome seems to be safe and effective. The subgroup analysis of different kinds of open angle glaucomas presented in this study may help in first-line patient selection. The lack of ocular surface alterations makes it a valuable addition to

Biometric gonioscopy and the effects of age, race, and sex on the anterior chamber angle

Science.gov (United States)

Congdon, N G; Foster, P J; Wamsley, S; Gutmark, J; Nolan, W; Seah, S K; Johnson, G J; Broman, A T

2002-01-01

Aim: To utilise a novel method for making measurements in the anterior chamber in order to compare the anterior chamber angles of people of European, African, and east Asian descent aged 40 years and over. Methods: A cross sectional study on 15 people of each sex from each decade from the 40s to the 70s, from each of three racial groups—black, white, and Chinese Singaporeans. Biometric gonioscopy (BG) utilises a slit lamp mounted reticule to make measurements from the apparent iris insertion to Schwalbe's line through a Goldmann one mirror goniolens. The main outcome measures were BG measurements of the anterior chamber angle as detailed above. Results: There was no significant difference in angle measurement between black, white, and Chinese races in this study. However, at younger ages people of Chinese race appeared to have deeper angles than white or black people, whereas the angles of older Chinese were significantly narrower (p = 0.004 for the difference in slope of BG by age between Chinese and both black and white people). Conclusion: The failure to detect a difference in angle measurements between these groups was surprising, given the much higher prevalence of angle closure among Chinese. It appears that the overall apparent similarity of BG means between Chinese and Western populations may mask very different trends with age. The apparently more rapid decline in angle width measurements with age among Chinese may be due to the higher prevalence of cataract or “creeping angle closure.” However, longitudinal inferences from cross sectional data are problematic, and this may represent a cohort phenomenon caused by the increasing prevalence of myopia in the younger Singaporean population. PMID:11801496

Secondary electron emission from textured surfaces

Science.gov (United States)

Huerta, C. E.; Patino, M. I.; Wirz, R. E.

2018-04-01

In this work, a Monte Carlo model is used to investigate electron induced secondary electron emission for varying effects of complex surfaces by using simple geometric constructs. Geometries used in the model include: vertical fibers for velvet-like surfaces, tapered pillars for carpet-like surfaces, and a cage-like configuration of interlaced horizontal and vertical fibers for nano-structured fuzz. The model accurately captures the secondary electron emission yield dependence on incidence angle. The model shows that unlike other structured surfaces previously studied, tungsten fuzz exhibits secondary electron emission yield that is independent of primary electron incidence angle, due to the prevalence of horizontally-oriented fibers in the fuzz geometry. This is confirmed with new data presented herein of the secondary electron emission yield of tungsten fuzz at incidence angles from 0-60°.

Predicting Peri-Device Leakage of Left Atrial Appendage Device Closure Using Novel Three-Dimensional Geometric CT Analysis.

Science.gov (United States)

Chung, Hyemoon; Jeon, Byunghwan; Chang, Hyuk-Jae; Han, Dongjin; Shim, Hackjoon; Cho, In Jeong; Shim, Chi Young; Hong, Geu-Ru; Kim, Jung-Sun; Jang, Yangsoo; Chung, Namsik

2015-12-01

After left atrial appendage (LAA) device closure, peri-device leakage into the LAA persists due to incomplete occlusion. We hypothesized that pre-procedural three-dimensional (3D) geometric analysis of the interatrial septum (IAS) and LAA orifice can predict this leakage. We investigated the predictive parameters of LAA device closure obtained from baseline cardiac computerized tomography (CT) using a novel 3D analysis system. We conducted a retrospective study of 22 patients who underwent LAA device closure. We defined peri-device leakage as the presence of a Doppler signal inside the LAA after device deployment (group 2, n = 5) compared with patients without peri-device leakage (group 1, n = 17). Conventional parameters were measured by cardiac CT. Angles θ and φ were defined between the IAS plane and the line, linking the LAA orifice center and foramen ovale. Group 2 exhibited significantly better left atrial (LA) function than group 1 (p = 0.031). Pre-procedural θ was also larger in this group (41.9° vs. 52.3°, p = 0.019). The LAA cauliflower-type morphology was more common in group 2. Overall, the patients' LA reserve significantly decreased after the procedure (21.7 mm(3) vs. 17.8 mm(3), p = 0.035). However, we observed no significant interval changes in pre- and post-procedural values of θ and φ in either group (all p > 0.05). Angles between the IAS and LAA orifice might be a novel anatomical parameter for predicting peri-device leakage after LAA device closure. In addition, 3D CT analysis of the LA and LAA orifice could be used to identify clinically favorable candidates for LAA device closure.

Road Closures

Data.gov (United States)

Montgomery County of Maryland — This is an up to date map of current road closures in Montgomery County.This dataset is updated every few minutes from the Department of Transportation road closure...

Cosmic ray zenith angle distribution at low geomagnetic latitude

Energy Technology Data Exchange (ETDEWEB)

Aragon, G [Instituto de Astronomia y Fisica del Espacio, Buenos Aires, Argentina; Gagliardini, A; Ghielmetti, H S

1977-12-01

The intensity of secondary charged cosmic rays at different zenith angles was measured by narrow angle Geiger-Mueller telescopes up to an atmospheric depth of 2 g cm/sup -2/. The angular distribution observed at high altitudes is nearly flat at small angles around the vertical and suggests that the particle intensity peaks at large zenith angles, close to the horizon.

Interferometric Imaging Directly with Closure Phases and Closure Amplitudes

Science.gov (United States)

Chael, Andrew A.; Johnson, Michael D.; Bouman, Katherine L.; Blackburn, Lindy L.; Akiyama, Kazunori; Narayan, Ramesh

2018-04-01

Interferometric imaging now achieves angular resolutions as fine as ∼10 μas, probing scales that are inaccessible to single telescopes. Traditional synthesis imaging methods require calibrated visibilities; however, interferometric calibration is challenging, especially at high frequencies. Nevertheless, most studies present only a single image of their data after a process of “self-calibration,” an iterative procedure where the initial image and calibration assumptions can significantly influence the final image. We present a method for efficient interferometric imaging directly using only closure amplitudes and closure phases, which are immune to station-based calibration errors. Closure-only imaging provides results that are as noncommittal as possible and allows for reconstructing an image independently from separate amplitude and phase self-calibration. While closure-only imaging eliminates some image information (e.g., the total image flux density and the image centroid), this information can be recovered through a small number of additional constraints. We demonstrate that closure-only imaging can produce high-fidelity results, even for sparse arrays such as the Event Horizon Telescope, and that the resulting images are independent of the level of systematic amplitude error. We apply closure imaging to VLBA and ALMA data and show that it is capable of matching or exceeding the performance of traditional self-calibration and CLEAN for these data sets.

Closure of giant omphaloceles by the abdominal wall component separation technique in infants.

NARCIS (Netherlands)

Eijck, F.C. van; Blaauw, I. de; Bleichrodt, R.P.; Rieu, P.N.M.A.; Staak, F.H.J.M. van der; Wijnen, M.H.W.A.; Wijnen, R.M.H.

2008-01-01

BACKGROUND/PURPOSE: Several techniques have been described to repair giant omphaloceles. There is no procedure considered to be the criterion standard worldwide. The aim of the present prospective study was to analyze the early and late results of secondary closure of giant omphaloceles using the

Transient effects in SIMS analysis of Si with Cs sup + at high incidence angles Secondary ion yield variations

CERN Document Server

Heide, P A W

2002-01-01

Secondary ion mass spectrometry (SIMS) depth profile analysis of Si wafers using 1 keV Cs sup + primary ions at large incidence angles (80 deg. ) is plagued by unusually strong transient effects (variations in both sputter and ion yields). Analysis of a native oxide terminated Si wafer with and without the aid of an O sub 2 leak, and an Ar sup + pre-sputtered wafer revealed correlations between the implanted Cs content and various secondary ion intensities consistent with that expected from a resonance charge transfer process (that assumed by the electron tunneling model). Cs concentrations were defined through X-ray photoelectron spectroscopy of the sputtered surface from SIMS profiles terminated within the transient region. These scaled with the surface roughening occurring under these conditions and can be explained as resulting from the associated drop in sputter rates. An O induced transient effect from the native oxide was also identified. Characterization of these effects allowed the reconstruction of ...

Dependence of secondary electron emission on the incident angle and the energy of primary electrons bombarding bowl-structured beryllium surfaces

International Nuclear Information System (INIS)

Kawata, Jun; Ohya, Kaoru.

1994-01-01

A Monte Carlo simulation of the secondary electron emission from beryllium is combined with a model of bowl structure for surface roughness, for analyzing the difference between the electron emissions for normal and oblique incidences. At normal incidence, with increasing the roughness parameter H/W, the primary energy E pm at which the maximum electron yield occurs becomes higher, and at more than the E pm , the decrease in the yield is slower; where H and W are the depth and width of the bowl structure, respectively. The dispersion of incident angle to the microscopic surface causes a small increase in the yield at oblique incidence, whereas the blocking of primary electrons from bombarding the bottom of the structure causes an opposite trend. The strong anisotropy in the polar angular distribution with respect to the azimuthal angle is calculated at oblique incidence. (author)

Closure The Definitive Guide

CERN Document Server

Bolin, Michael

2010-01-01

If you're ready to use Closure to build rich web applications with JavaScript, this hands-on guide has precisely what you need to learn this suite of tools in depth. Closure makes it easy for experienced JavaScript developers to write and maintain large and complex codebases -- as Google has demonstrated by using Closure with Gmail, Google Docs, and Google Maps. Author and Closure contributor Michael Bolin has included numerous code examples and best practices, as well as valuable information not available publicly until now. You'll learn all about Closure's Library, Compiler, Templates, tes

Containment closure time following the loss of shutdown cooling event of YGN Units 3 and 4

International Nuclear Information System (INIS)

Seul, Kwang Won; Bang, Young Seok; Kim, Hho Jung

1999-01-01

The YGN Units 3 and 4 plant conditions during shutdown operation were reviewed to identify the possible event scenarios following the loss of shutdown cooling (SDC) event. For the five cases of typical reactor coolant system (RCS) configurations under the worst event sequence, such as unavailable secondary cooling and no RCS inventory makeup, the thermal hydraulic analyses were performed using the RELAP5/MOS3.2 code to investigate the plant behavior following the event. The thermal hydraulic analyses include the estimation of time to boil, time to core uncovery, and time to core heat up to determine the containment closure time to prevent the uncontrolled release of fission products to atmosphere. The result indicates that the containment closure is recommended to be achieved within 42 minutes after the loss of SDC for the steam generator (SG) inlet plenum manway open case or the large cold leg open case under the worst event sequence. The containment closure time is significantly dependent on the elevation and size of the opening and the SG secondary water level condition. It is also found that the containment closure needs to be initiated before the boiling time to ensure the survivability of the workers in the containment. These results will provide using information to operators to cope with the loss of SDC event. (Author). 15 refs., 3 tabs., 7 figs

A proposed simple method for measurement in the anterior chamber angle: biometric gonioscopy.

Science.gov (United States)

Congdon, N G; Spaeth, G L; Augsburger, J; Klancnik, J; Patel, K; Hunter, D G

1999-11-01

To design a system of gonioscopy that will allow greater interobserver reliability and more clearly defined screening cutoffs for angle closure than current systems while being simple to teach and technologically appropriate for use in rural Asia, where the prevalence of angle-closure glaucoma is highest. Clinic-based validation and interobserver reliability trial. Study 1: 21 patients 18 years of age and older recruited from a university-based specialty glaucoma clinic; study 2: 32 patients 18 years of age and older recruited from the same clinic. In study 1, all participants underwent conventional gonioscopy by an experienced observer (GLS) using the Spaeth system and in the same eye also underwent Scheimpflug photography, ultrasonographic measurement of anterior chamber depth and axial length, automatic refraction, and biometric gonioscopy with measurement of the distance from iris insertion to Schwalbe's line using a reticule based in the slit-lamp ocular. In study 2, all participants underwent both conventional gonioscopy and biometric gonioscopy by an experienced gonioscopist (NGC) and a medical student with no previous training in gonioscopy (JK). Study 1: The association between biometric gonioscopy and conventional gonioscopy, Scheimpflug photography, and other factors known to correlate with the configuration of the angle. Study 2: Interobserver agreement using biometric gonioscopy compared to that obtained with conventional gonioscopy. In study 1, there was an independent, monotonic, statistically significant relationship between biometric gonioscopy and both Spaeth angle (P = 0.001, t test) and Spaeth insertion (P = 0.008, t test) grades. Biometric gonioscopy correctly identified six of six patients with occludable angles according to Spaeth criteria. Biometric gonioscopic grade was also significantly associated with the anterior chamber angle as measured by Scheimpflug photography (P = 0.005, t test). In study 2, the intraclass correlation coefficient

Glaucoma associated with the management of rhegmatogenous retinal detachment

Directory of Open Access Journals (Sweden)

Mangouritsas G

2013-04-01

Full Text Available George Mangouritsas, Spyridon Mourtzoukos, Dimitra M Portaliou, Vassilios I Georgopoulos, Anastasia Dimopoulou, Elias Feretis Eye Clinic, General Hospital "Hellenic Red Cross", Athens, Greece Abstract: Transient or permanent elevation of intraocular pressure (IOP is a common complication following vitreoretinal surgery. Usually secondary glaucoma, which develops after scleral buckling procedures, or pars plana vitrectomy for repair of rhegmatogenous retinal detachment, is of multifactorial origin. It is essential, for appropriate management, to detect the cause of outflow obstruction. An exacerbation of preexisting open-angle glaucoma or a steroid-induced elevation of IOP should also be considered. Scleral buckling may be complicated by congestion and anterior rotation of the ciliary body resulting in secondary angle closure, which can usually resolve with medical therapy. The use of intravitreal gases may also induce secondary angle-closure with or without pupillary block. Aspiration of a quantity of the intraocular gas may be indicated. Secondary glaucoma can also develop after intravitreal injection of silicone oil due to pupillary block, inflammation, synechial angle closure, or migration of emulsified silicone oil in the anterior chamber and obstruction of the aqueous outflow pathway. In most eyes medical therapy is successful in controlling IOP; however, silicone oil removal with or without concurrent glaucoma surgery may also be required. Diode laser transscleral cyclophotocoagulation and glaucoma drainage devices constitute useful treatment modalities for long-term IOP control. Cooperation between vitreoretinal and glaucoma specialists is necessary to achieve successful management. Keywords: retinal detachment, intraocular pressure elevation, glaucoma, vitrectomy, intravitreal gas, silicone oil

Effectiveness of vacuum-assisted closure (VAC) therapy in the healing of chronic diabetic foot ulcers.

Science.gov (United States)

Nather, Aziz; Chionh, Siok Bee; Han, Audrey Y Y; Chan, Pauline P L; Nambiar, Ajay

2010-05-01

This is the fi rst prospective study done locally to determine the effectiveness of vacuum-assisted closure (VAC) therapy in the healing of chronic diabetic foot ulcers. An electronic vacuum pump was used to apply controlled negative pressure evenly across the wound surface. Changes in wound dimension, presence of wound granulation and infection status of diabetic foot ulcers in 11 consecutive patients with diabetes were followed over the course of VAC therapy. Healing was achieved in all wounds. Nine wounds were closed by split-skin grafting and 2 by secondary closure. The average length of treatment with VAC therapy was 23.3 days. Ten wounds showed reduction in wound size. All wounds were satisfactorily granulated and cleared of bacterial infection at the end of VAC therapy. VAC therapy was useful in the treatment of diabetic foot infection and ulcers, which after debridement, may present with exposed tendon, fascia and/or bone. These included ray amputation wounds, wounds post-debridement for necrotising fasciitis, wounds post-drainage for abscess, a heel ulcer and a sole ulcer. It was able to prepare ulcers well for closure via split-skin grafting or secondary closure in good time. This reduced cost of VAC therapy, as therapy was not prolonged to attain greater reduction in wound area. VAC therapy also provides a sterile, more controlled resting environment to large, exudating wound surfaces. Large diabetic foot ulcers were thus made more manageable.

Patent foramen ovale closure versus medical therapy after cryptogenic stroke: An updated meta-analysis of all randomized clinical trials.

Science.gov (United States)

Kheiri, Babikir; Abdalla, Ahmed; Osman, Mohammed; Ahmed, Sahar; Hassan, Mustafa; Bachuwa, Ghassan

2018-03-07

Cryptogenic strokes can be attributed to paradoxical emboli through patent foramen ovale (PFO). However, the effectiveness of PFO closure in preventing recurrent stroke is uncertain and the results of previous randomized clinical trials (RCTs) have been inconclusive. Hence, this study provides an updated meta-analysis of all RCTs comparing PFO closure with medical therapy for secondary prevention of cryptogenic stroke. All RCTs were identified by a comprehensive literature search of PubMed, Embase, the Cochrane Collaboration Central Register of Controlled Trials, Scopus, and Clinicaltrials.gov. The primary outcome was recurrent ischemic stroke and secondary outcomes were transient ischemic attack (TIA), all-cause mortality, new-onset atrial fibrillation (AF), serious adverse events, and major bleeding. 5 RCTs with 3440 participants were included in the present study (1829 patients underwent PFO closure and 1611 were treated medically). Pooled analysis showed a statistically significant reduction in the rate of recurrent stroke with PFO closure in comparison to medical therapy (OR 0.41; 95% CI 0.19-0.90; p = 0.03). However, there were no statistically significant reductions of recurrent TIAs (OR 0.77; 95% CI 0.51-1.14; p = 0.19) or all-cause mortality (OR 0.76; 95% CI 0.35-1.65; p = 0.48). The risk of developing new-onset AF was increased significantly with PFO closure (OR 4.74; 95% CI 2.33-9.61; p Patent foramen ovale closure in adults with recent cryptogenic stroke was associated with a lower rate of recurrent strokes in comparison with medical therapy alone.

Delayed closure of the palatal defect using buccal inversion and palatal rotation flaps after maxillectomy.

Science.gov (United States)

Jung, Seunggon; Kook, Min-Suk; Park, Hong-Ju; Oh, Hee-Kyun

2013-03-01

Maxillectomy leaves oronasal and oroantral defects that result in functional impairment of mastication, deglutition, and speech. Many treatment options are suggested and tried including the palatal flap as local flap. Although palatal flaps have been used to repair various oral cavity defects, they have certain limitations due to the dimensions. The amount and location of the palatal tissues available are important for palatal repair. Secondary intentional healing after maxillectomy will allow the epithelialization of the defect margin adjacent to remained palate, and there will be more mucosa that is available for closure of the defect. We delayed the closure of the palatal defect, while the patient underwent prosthetic treatment for functional recovery in 5 maxillectomy patients. Delayed closure of palatal defect with local flap was done at 10.8 ± 7.9 months after the maxillectomy. While delayed closure in hemimaxillectomy patients left postoperative fistula, it provided separation of the oral cavity and nasal/sinus cavity and adequate surface for prosthesis in partial maxillectomy patients.

Evaluation of Two Energy Balance Closure Parametrizations

Science.gov (United States)

Eder, Fabian; De Roo, Frederik; Kohnert, Katrin; Desjardins, Raymond L.; Schmid, Hans Peter; Mauder, Matthias

2014-05-01

A general lack of energy balance closure indicates that tower-based eddy-covariance (EC) measurements underestimate turbulent heat fluxes, which calls for robust correction schemes. Two parametrization approaches that can be found in the literature were tested using data from the Canadian Twin Otter research aircraft and from tower-based measurements of the German Terrestrial Environmental Observatories (TERENO) programme. Our analysis shows that the approach of Huang et al. (Boundary-Layer Meteorol 127:273-292, 2008), based on large-eddy simulation, is not applicable to typical near-surface flux measurements because it was developed for heights above the surface layer and over homogeneous terrain. The biggest shortcoming of this parametrization is that the grid resolution of the model was too coarse so that the surface layer, where EC measurements are usually made, is not properly resolved. The empirical approach of Panin and Bernhofer (Izvestiya Atmos Oceanic Phys 44:701-716, 2008) considers landscape-level roughness heterogeneities that induce secondary circulations and at least gives a qualitative estimate of the energy balance closure. However, it does not consider any feature of landscape-scale heterogeneity other than surface roughness, such as surface temperature, surface moisture or topography. The failures of both approaches might indicate that the influence of mesoscale structures is not a sufficient explanation for the energy balance closure problem. However, our analysis of different wind-direction sectors shows that the upwind landscape-scale heterogeneity indeed influences the energy balance closure determined from tower flux data. We also analyzed the aircraft measurements with respect to the partitioning of the "missing energy" between sensible and latent heat fluxes and we could confirm the assumption of scalar similarity only for Bowen ratios 1.

Professional Closure Beyond State Authorization

Directory of Open Access Journals (Sweden)

Gitte Sommer Harrits

2014-03-01

Full Text Available For decades, the Weberian approach to the study of professions has been strong, emphasizing state authorization and market monopolies as constituting what is considered a profession. Originally, however, the Weberian conception of closure, or the ways in which a profession is constituted and made separate, was broader. This article suggests a revision of the closure concept, integrating insights from Pierre Bourdieu, and conceptualizing professional closure as the intersection of social, symbolic and legal closure. Based on this revision, this article demonstrates how to apply such a concept in empirical studies. This is done by exploring social, symbolic and legal closure across sixteen professional degree programs. The analyses show a tendency for some overlap between different forms of closure, with a somewhat divergent pattern for legal closure. Results support the argument that we need to study these processes as an intersection of different sources of closure, including capital, lifestyles and discourse

Tight closure and vanishing theorems

International Nuclear Information System (INIS)

Smith, K.E.

2001-01-01

Tight closure has become a thriving branch of commutative algebra since it was first introduced by Mel Hochster and Craig Huneke in 1986. Over the past few years, it has become increasingly clear that tight closure has deep connections with complex algebraic geometry as well, especially with those areas of algebraic geometry where vanishing theorems play a starring role. The purpose of these lectures is to introduce tight closure and to explain some of these connections with algebraic geometry. Tight closure is basically a technique for harnessing the power of the Frobenius map. The use of the Frobenius map to prove theorems about complex algebraic varieties is a familiar technique in algebraic geometry, so it should perhaps come as no surprise that tight closure is applicable to algebraic geometry. On the other hand, it seems that so far we are only seeing the tip of a large and very beautiful iceberg in terms of tight closure's interpretation and applications to algebraic geometry. Interestingly, although tight closure is a 'characteristic p' tool, many of the problems where tight closure has proved useful have also yielded to analytic (L2) techniques. Despite some striking parallels, there had been no specific result directly linking tight closure and L∼ techniques. Recently, however, the equivalence of an ideal central to the theory of tight closure was shown to be equivalent to a certain 'multiplier ideal' first defined using L2 methods. Presumably, deeper connections will continue to emerge. There are two main types of problems for which tight closure has been helpful: in identifying nice structure and in establishing uniform behavior. The original algebraic applications of tight closure include, for example, a quick proof of the Hochster-Roberts theorem on the Cohen-Macaulayness of rings of invariants, and also a refined version of the Brianqon-Skoda theorem on the uniform behaviour of integral closures of powers of ideals. More recent, geometric

40 CFR 264.228 - Closure and post-closure care.

Science.gov (United States)

2010-07-01

... remaining wastes to a bearing capacity sufficient to support final cover; and (iii) Cover the surface....112 must include both a plan for complying with paragraph (a)(1) of this section and a contingent plan... practicably removed at closure; and (ii) The owner or operator must prepare a contingent post-closure plan...

RCRA corrective action and closure

International Nuclear Information System (INIS)

1995-02-01

This information brief explains how RCRA corrective action and closure processes affect one another. It examines the similarities and differences between corrective action and closure, regulators' interests in RCRA facilities undergoing closure, and how the need to perform corrective action affects the closure of DOE's permitted facilities and interim status facilities

Post-operative analgesic requirement in non-closure and closure of peritoneum during open appendectomy

International Nuclear Information System (INIS)

Khan, A.W.; Maqsood, R.; Saleem, M.M.

2017-01-01

To compare the mean post-operative analgesic requirement in non-closure and closure of peritoneum during open appendectomy. Study Design: Randomized controlled trial. Place and Duration of Study: Department of General Surgery Combined Military Hospital Quetta, from 1st August 2014 to 30th April 2015. Material and Methods: A total of 60 patients were included in this study and were divided into two groups of 30 each. Patients in group A underwent open appendectomy with closure of peritoneum while patients in group B had non-closure of peritoneum during the same procedure. Post-operatively, pain severity was assessed on visual analogue scale (VAS) numeric pain distress scale. On presence of VAS numeric pain distress scale between 5 to 7, intramuscular (IM) diclofenac sodium was given and on score >7, intravascular (IV) tramadol was given. The final outcome was measured at day 0 and day 1. Results: Pain score and analgesic requirements were significantly less in non-closure group than closure group on day 0 and day 1, showing statistically significant difference between the two groups. Conclusion: Mean post-operative analgesic requirement is significantly less in non-closure group as compared to closure group during open appendectomy. (author)

Primary closure after carotid endarterectomy is not inferior to other closure techniques.

Science.gov (United States)

Avgerinos, Efthymios D; Chaer, Rabih A; Naddaf, Abdallah; El-Shazly, Omar M; Marone, Luke; Makaroun, Michel S

2016-09-01

Primary closure after carotid endarterectomy (CEA) has been much maligned as an inferior technique with worse outcomes than in patch closure. Our purpose was to compare perioperative and long-term results of different CEA closure techniques in a large institutional experience. A consecutive cohort of CEAs between January 1, 2000, and December 31, 2010, was retrospectively analyzed. Closure technique was used to divide patients into three groups: primary longitudinal arteriotomy closure (PRC), patch closure (PAC), and eversion closure (EVC). End points were perioperative events, long-term strokes, and restenosis ≥70%. Multivariate regression models were used to assess the effect of baseline predictors. There were 1737 CEA cases (bilateral, 143; mean age, 71.4 ± 9.3 years; 56.2% men; 35.3% symptomatic) performed during the study period with a mean clinical follow-up of 49.8 ± 36.4 months (range, 0-155 months). More men had primary closure, but other demographic and baseline symptoms were similar between groups. Half the patients had PAC, with the rest evenly distributed between PRC and EVC. The rate of nerve injury was 2.7%, the rate of reintervention for hematoma was 1.5%, and the length of hospital stay was 2.4 ± 3.0 days, with no significant differences among groups. The combined stroke and death rate was 2.5% overall and 3.9% and 1.7% in the symptomatic and asymptomatic cohort, respectively. Stroke and death rates were similar between groups: PRC, 11 (2.7%); PAC, 19 (2.2%); EVC, 13 (2.9%). Multivariate analysis showed baseline symptomatic disease (odds ratio, 2.4; P = .007) and heart failure (odds ratio, 3.1; P = .003) as predictors of perioperative stroke and death, but not the type of closure. Cox regression analysis demonstrated, among other risk factors, no statin use (hazard ratio, 2.1; P = .008) as a predictor of ipsilateral stroke and severe (glomerular filtration rate <30 mL/min/1.73 m(2)) renal insufficiency (hazard ratio, 2.6; P�

Comparison of Subcuticular Suture Materials in Cesarean Skin Closure

Directory of Open Access Journals (Sweden)

Pınar Solmaz Hasdemir

2015-01-01

Full Text Available Aim. Comparison of the rate of wound complications, pain, and patient satisfaction based on used subcuticular suture material. Methods. A total of 250 consecutive women undergoing primary and repeat cesarean section with low transverse incision were prospectively included. The primary outcome was wound complication rate including infection, dehiscence, hematoma, and hypertrophic scar formation within a 6-week period after operation. Secondary outcomes were skin closure time, the need for use of additional analgesic agent, pain score on numeric rating scale, cosmetic score, and patient scar satisfaction scale. Results. Absorbable polyglactin was used in 108 patients and nonabsorbable polypropylene was used in 142 patients. Wound complication rates were similar in primary and repeat cesarean groups based on the type of suture material. Skin closure time is longer in nonabsorbable suture material group in both primary and repeat cesarean groups. There was no difference between groups in terms of postoperative pain, need for additional analgesic use, late phase pain, and itching at the scar. Although the cosmetic results tended to be better in the nonabsorbable group in primary surgery patients, there was no significant difference in the visual satisfaction of the patients. Conclusions. Absorbable and nonabsorbable suture materials are comparable in cesarean section operation skin closure.

Retention Load Values of Telescopic Crowns Made of Y-TZP and CoCr with Y-TZP Secondary Crowns: Impact of Different Taper Angles

Directory of Open Access Journals (Sweden)

Susanne Merk

2016-05-01

Full Text Available This study aimed to examine and compare the retention load values (RL of different telescopic crown assemblies (Y-TZP and CoCr primary crowns with electroformed and Y-TZP secondary crowns each with three different taper angles (0°, 1° and 2°. Thirty Y-TZP primary crowns with electroformed gold copings (Z/G group and Y-TZP secondary crowns (Z/Z group and 30 CoCr primary crowns with electroformed gold copings (C/G group and Y-TZP secondary crowns (C/Z group, each with taper angles of 0°, 1° and 2°, were fabricated, respectively. With the exception of the electroformed gold copings, all specimens were Computer-Aided-Design/Computer-Aided-Manufacturing (CAD/CAM-milled, then sintered and afterwards manually adapted. In order to stabilize the gold copings, they were fixed in a tertiary structure. The secondary crowns were constructed with a hook, which ensured self-alignment with an upper chain. Afterwards, 20 pull-off test cycles were performed in a universal testing machine under artificial saliva and after weighing the secondary crowns with a 5 kg object for 20 s. Data were analyzed by one-way and two-way Analysis of Variance (ANOVA. C/Z with 1° showed higher (p = 0.009 RL than 0° and 2° tapers. C/G at 1° also showed higher (p = 0.001 RL than at tapers of 0° and 2°. Z/G and C/G at 0° showed lower RL than Z/Z and C/Z (p < 0.001. Primary crowns had no impact on the 0° group. Z/G showed lower RL as compared to C/Z within the 1° group (p = 0.007 and Z/Z in the 2° group (p = 0.006. The primary crown material had no influence on RL. Electroformed copings showed lower RL. Further investigations for 1° as well as for the long-term performance after thermomechanical aging are necessary.

TOPOGRAPHIC CHANGES OF THE MACULA AFTER CLOSURE OF IDIOPATHIC MACULAR HOLE.

Science.gov (United States)

Pak, Kang Yeun; Park, Keun Heung; Kim, Kyong Ho; Park, Sung Who; Byon, Ik Soo; Kim, Hyun Woong; Chung, In Young; Lee, Joo Eun; Lee, Sang Joon; Lee, Ji Eun

2017-04-01

To investigate retinal displacement in the macula after surgical closure of idiopathic macular hole and to identify factors correlated with displacement. This retrospective multicenter study included 73 eyes of 73 patients having idiopathic macular hole. A custom program was developed to compare the position of the retinal vessels in the macula between preoperative and postoperative photographs. En face images of a 6 mm × 6 mm optical coherence tomography volume scans were registered to calculate the scale. A grid comprising 16 sectors in 2 rings (inner; 2-4 mm and outer; 4-6 mm) was superimposed. The displacement of the retinal vessels was measured as a vector value by comparing the location of the retinal vessels in each sector. The correlation between displacement and various clinical parameters was analyzed. The average displacement was 57.2 μm at an angle of -3.3° (nasal and slightly inferior). Displacement was larger in the inner ring (79.2 μm) than in the outer ring (35.3 μm, P macula was displaced centripetally, nasally, and slightly inferiorly after surgical closure of idiopathic macular hole. Hole closure, contraction of the nerve fiber layer, and gravity are the suggested mechanisms of macular displacement caused by internal limiting membrane peeling.

Experience with wound VAC and delayed primary closure of contaminated soft tissue injuries in Iraq.

Science.gov (United States)

Leininger, Brian E; Rasmussen, Todd E; Smith, David L; Jenkins, Donald H; Coppola, Christopher

2006-11-01

Wartime missile injuries are frequently high-energy wounds that devitalize and contaminate tissue, with high risk for infection and wound complications. Debridement, irrigation, and closure by secondary intention are fundamental principles for the management of these injuries. However, closure by secondary intention was impractical in Iraqi patients. Therefore, wounds were closed definitively before discharge in all Iraqi patients treated for such injures at our hospital. A novel wound management protocol was developed to facilitate this practice, and patient outcomes were tracked. This article describes that protocol and discusses the outcomes in a series of 88 wounds managed with it. High-energy injuries were treated with rapid aggressive debridement and pulsatile lavage, then covered with negative pressure (vacuum-assisted closure [VAC]) dressings. Patients underwent serial operative irrigation and debridement until wounds appeared clean to gross inspection, at which time they were closed primarily. Patient treatment and outcome data were recorded in a prospectively updated database. Treatment and outcomes data from September 2004 through May 2005 were analyzed retrospectively. There were 88 high-energy soft tissue wounds identified in 77 patients. Surprisingly, for this cohort of patients the wound infection rate was 0% and the overall wound complication rate was 0%. This series of 88 cases is the first report of the use of a negative pressure dressing (wound VAC) as part of the definitive management of high-energy soft tissue wounds in a deployed wartime environment. Our experience with these patients suggests that conventional wound management doctrine may be improved with the wound VAC, resulting in earlier more reliable primary closure of wartime injuries.

High prevalence of narrow angles among Chinese-American glaucoma and glaucoma suspect patients.

Science.gov (United States)

Seider, Michael I; Pekmezci, Melike; Han, Ying; Sandhu, Simi; Kwok, Shiu Y; Lee, Roland Y; Lin, Shan C

2009-01-01

To evaluate the prevalence of gonioscopically narrow angles in a Chinese-American population with glaucoma or glaucoma suspicion. Charts from all Chinese-American patients seen in a comprehensive ophthalmology clinic in the Chinatown district of San Francisco in 2002 were reviewed. One eye from each patient with glaucoma or glaucoma suspicion that met inclusion criteria was included (n=108). Data were collected for sex, age, race (self-declared), refraction (spherical equivalent), intraocular pressure, gonioscopy, and vertical cup-to-disk ratio. Sixty percent (n=65) of Chinese-American eyes with glaucoma or glaucoma suspicion had gonioscopically narrow angles (Shaffer grade or = 0.071). In a multivariate model including age, sex, and refraction as predictors of angle grade (open or narrow), only age was a significant predictor of angle grade (P=0.004). A large proportion of Chinese-Americans in our study population with glaucoma or glaucoma suspicion had gonioscopically narrow angles. In multivariate analysis, patients with narrow angles were older than those with open angles but did not differ from them in terms of sex or refraction. Continued evaluation of angle closure glaucoma risk among Chinese-Americans is needed.

Excision and primary closure of pilonidal sinus disease: worthwhile option with an acceptable recurrence rate.

LENUS (Irish Health Repository)

Gilani, S N S

2012-01-31

BACKGROUND: Treatment of pilonidal sinus disease is controversial. Many claim policy of marsupialisation and healing by secondary intention. This is demanding in terms of nursing care and time lost from work. AIMS: To examine outcome of excision and primary closure of chronic pilonidal disease on recurrence rate and patient\\'s daily activities. PATIENTS AND METHODS: One hundred and fourteen consecutive elective patients who had excision and primary closure of pilonidal sinus disease were reviewed. The demographic data and the post-operative outcome were studied. RESULTS: The recurrence of pilonidal sinus was noted in 9% of patients, wound breakdown occasioning delayed healing in 9%, patients able to drive by day 16 on average. The mean time to return to work was 20.5 days; duration of analgesia, 2.4 days; and duration of antibiotic treatment, 4.7 days. CONCLUSION: Excision and primary closure of chronic pilonidal sinus has low recurrence rate with early return to activities. Primary closure appears to be a cost-effective option for uncomplicated pilonidal sinus disease.

Patent Foramen Ovale Closure in the Setting of Cryptogenic Stroke: A Meta-Analysis of Five Randomized Trials.

Science.gov (United States)

Garg, Lohit; Haleem, Affan; Varade, Shweta; Sivakumar, Keithan; Shah, Mahek; Patel, Brijesh; Agarwal, Manyoo; Agrawal, Sahil; Leary, Megan; Kluck, Bryan

2018-05-24

The clinical benefit of patent foramen ovale (PFO) closure after cryptogenic stroke has been a topic of debate for decades. Recently, 3 randomized controlled trials of PFO closure in patients with cryptogenic stroke demonstrated a significantly reduced risk of recurrent stroke compared with standard medical therapy alone. This meta-analysis was performed to clarify the efficacy of PFO closure for future stroke prevention in this population. A systematic literature search was undertaken. Published pooled data from 5 large randomized clinical trials (CLOSE, RESPECT, Gore REDUCE, CLOSURE I, and PC) were combined and then subsequently analyzed. Enrolled patients with cryptogenic stroke were assigned to receive standard medical care or to undergo endovascular PFO closure, with a primary outcome of reduction in stroke recurrence rate. Secondary outcomes included rates of transient ischemic attack (TIA), composite outcome of stroke, TIA, and death from all causes, and rates of atrial fibrillation events. We analyzed data for 3412 patients. Transcatheter PFO closure resulted in a statistically significant reduced rate of recurrent stroke, compared with medication alone. Patients undergoing closure were 58% less likely to have another stroke. The number needed to treat with PFO closure to reduce recurrent stroke for 1 patient was 40. Endovascular PFO closure was associated with a reduced risk of recurrent stroke in patients with a prior cryptogenic cerebral infarct. Although the absolute stroke reduction was small, these findings are clinically significant, given the young age of this patient population and the patients' lifetime risk of recurrent stroke. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Propensity Score-Based Analysis of Percutaneous Closure Versus Medical Therapy in Patients With Cryptogenic Stroke and Patent Foramen Ovale: The IPSYS Registry (Italian Project on Stroke in Young Adults).

Science.gov (United States)

Pezzini, Alessandro; Grassi, Mario; Lodigiani, Corrado; Patella, Rosalba; Gandolfo, Carlo; Zini, Andrea; DeLodovici, Maria Luisa; Paciaroni, Maurizio; Del Sette, Massimo; Toriello, Antonella; Musolino, Rossella; Calabrò, Rocco Salvatore; Bovi, Paolo; Adami, Alessandro; Silvestrelli, Giorgio; Sessa, Maria; Cavallini, Anna; Marcheselli, Simona; Marco Bonifati, Domenico; Checcarelli, Nicoletta; Tancredi, Lucia; Chiti, Alberto; Del Zotto, Elisabetta; Tomelleri, Giampaolo; Spalloni, Alessandra; Giorli, Elisa; Costa, Paolo; Giacalone, Giacomo; Ferrazzi, Paola; Poli, Loris; Morotti, Andrea; Piras, Valeria; Rasura, Maurizia; Simone, Anna Maria; Gamba, Massimo; Cerrato, Paolo; Zedde, Maria Luisa; Micieli, Giuseppe; Melis, Maurizio; Massucco, Davide; Guido, Davide; De Giuli, Valeria; Bonaiti, Silvia; D'Amore, Cataldo; La Starza, Sara; Iacoviello, Licia; Padovani, Alessandro

2016-09-01

We sought to compare the benefit of percutaneous closure to that of medical therapy alone for the secondary prevention of embolism in patients with patent foramen ovale (PFO) and otherwise unexplained ischemic stroke, in a propensity scored study. Between 2000 and 2012, we selected consecutive first-ever ischemic stroke patients aged 18 to 45 years with PFO and no other cause of brain ischemia, as part of the IPSYS registry (Italian Project on Stroke in Young Adults), who underwent either percutaneous PFO closure or medical therapy for comparative analysis. Primary end point was a composite of ischemic stroke, transient ischemic attack, or peripheral embolism. Secondary end point was brain ischemia. Five hundred and twenty-one patients qualified for the analysis. The primary end point occurred in 15 patients treated with percutaneous PFO closure (7.3%) versus 33 patients medically treated (10.5%; hazard ratio, 0.72; 95% confidence interval, 0.39-1.32; P=0.285). The rates of the secondary end point brain ischemia were also similar in the 2 treatment groups (6.3% in the PFO closure group versus 10.2% in the medically treated group; hazard ratio, 0.64; 95% confidence interval, 0.33-1.21; P=0.168). Closure provided a benefit in patients aged 18 to 36 years (hazard ratio, 0.19; 95% confidence interval, 0.04-0.81; P=0.026) and in those with a substantial right-to-left shunt size (hazard ratio, 0.19; 95% confidence interval, 0.05-0.68; P=0.011). PFO closure seems as effective as medical therapy for secondary prevention of cryptogenic ischemic stroke. Whether device treatment might be more effective in selected cases, such as in patients younger than 37 years and in those with a substantial right-to-left shunt size, deserves further investigation. © 2016 American Heart Association, Inc.

Tubular closure device

International Nuclear Information System (INIS)

Klahn, F.C.; Nolan, J.H.; Wills, C.

1982-01-01

This invention relates to a closure mechanism for closing openings such as the bore of a conduit and for releasably securing members within the bore. More particularly, this invention relates to a closure mechanism for tubular irradiation surveillance specimen assembly holders used in nuclear reactors

[Periprocedural and late complications after percutaneous closure of patent foramen ovale: a single centre experience].

Science.gov (United States)

Węglarz, Przemysław; Konarska Kuszewska, Ewa; Spisak Borowska, Katarzyna; Machowski, Jerzy; Drzewiecka-Gerber, Agnieszka; Kuszewski, Piotr; Jackson, Christopher L; Opala, Grzegorz; Trusz Gluza, Maria

2012-01-01

Patent foramen ovale (PFO) is a potential risk factor for ischaemic stroke in young individuals. An interventional method of secondary stroke prevention in PFO patients is its percutaneous closure. To assess safety and effectiveness (i.e. lack of residual shunt) of percutaneous PFO closure in patients with history of cryptogenic cerebrovascular event. 149 patients (56 men/93 women), aged 39 ± 12 years, underwent percutaneous PFO closure. The implantation was performed under local anaesthesia, guided by trans-oesophageal echocardiography (TEE) and fluoroscopy. Follow-up trans-thoracic echocardiography (TTE) was performed at 1 month and follow-up TEE at 6-months. In cases of residual shunt, additional TEE was performed after ensuing 6 months. Effective PFO closure (no residual shunt) was achieved in 91.3% patients at 6 months and 95.3% patients at 12 months. In 2 patients transient atrial fibrillation was observed during the procedure. In 2 patients, a puncture site haematoma developed and in 1 patient superficial thrombophlebitis was noted. In 1 patient a small pericardial effusion was observed, which resolved at day 3 post-procedurally, after administration of non-steroidal anti-inflammatory drugs. Percutaneous PFO closure seems to be a safe procedure when performed in a centre with adequate expertise with regard to these procedures.

CIRSE Vascular Closure Device Registry

NARCIS (Netherlands)

Reekers, Jim A.; Müller-Hülsbeck, Stefan; Libicher, Martin; Atar, Eli; Trentmann, Jens; Goffette, Pierre; Borggrefe, Jan; Zeleňák, Kamil; Hooijboer, Pieter; Belli, Anna-Maria

2011-01-01

Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. The CIRSE registry of closure devices

Vacuum-assisted closure to aid wound healing in foot and ankle surgery.

Science.gov (United States)

Mendonca, Derick A; Cosker, Tom; Makwana, Nilesh K

2005-09-01

Although vacuum-assisted closure (VAC) is a well-established technique in other surgical specialties, its use has not been established in the foot and ankle. The aims of this study were to determine if vacuum-assisted closure therapy (VAC) helps assist closure in diabetic foot ulcers and wounds secondary to peripheral vascular disease, if it helps debride wounds, and if it prevents the need for further surgery. We retrospectively reviewed 15 patients (18 wounds or ulcers) with primary diagnoses of diabetes (10 patients), chronic osteomyelitis (two patients), peripheral vascular disease (two patients), and spina bifida (one patient). Eleven of the 15 patients had serious comorbidities, such as peripheral neuropathy, renal failure, and wound dehiscence. All wounds were surgically debrided before VAC therapy was applied according to the manufacturer's instructions. The main outcome measures were time to satisfactory wound closure, changes in the wound surface area, and the need for further surgery. Satisfactory healing was achieved in 13 of the 18 wounds or ulcers at an average of 2.5 months. VAC therapy failed in five patients (five class III ulcers), three of whom required below-knee amputations. Wound or ulcer size decreased from an average of 7.41 cm(2) before treatment to an average of 1.58 cm(2) after treatment. VAC therapy is a useful adjunct to the standard treatment of chronic wound or ulcers in patients with diabetes or peripheral vascular disease. Its use in foot and ankle surgery leads to a quicker wound closure and, in most patients, avoids the need for further surgery.

Recurrent Stroke after Transcatheter PFO Closure in Cryptogenic Stroke or Tia: Long-Term Follow-Up

Directory of Open Access Journals (Sweden)

Elisabetta Mariucci

2017-01-01

Full Text Available Background. There are few data on the mechanism of recurrent neurological events after transcatheter closure of patent foramen ovale (PFO in cryptogenic stroke or TIA. Methods. We retrospectively reviewed PFO closure procedures for the secondary prevention of cryptogenic stroke/TIA performed between 1999 and 2014 in Bologna, Italy. Results. Written questionnaires were completed by 402 patients. Mean follow-up was 7 ± 3 years. Stroke recurred in 3.2% (0.5/100 patients-year and TIA in 2.7% (0.4/100 patients-year. Ninety-two percent of recurrent strokes were not cryptogenic. Recurrent stroke was noncardioembolic in 69% of patients, AF related in 15% of patients, device related in 1 patient, and cryptogenic in 1 patient. AF was diagnosed after the procedure in 21 patients (5.2%. Multivariate Cox’s proportion hazard model identified age ≥ 55 years at the time of closure (OR 3.16, p=0.007 and RoPE score < 7 (OR 3.21, p=0.03 as predictors of recurrent neurological events. Conclusion. Recurrent neurological events after PFO closure are rare, usually noncryptogenic and associated with conventional vascular risk factors or AF related. Patients older than 55 years of age and those with a RoPE score < 7 are likely to get less benefit from PFO closure. After transcatheter PFO closure, lifelong strict vascular risk factor control is warranted.

Secondary emission coefficient dependence on the angle of incidence of primary electrons on CsI and LiF layers. [0. 9 to 3 keV, mechanism

Energy Technology Data Exchange (ETDEWEB)

Shabel' nikova, A E; Yasnopol' skii, N L

1976-08-01

The angular dependence was studied of the secondary emission coefficient sigma for CsI and LiF dielectrics which have large sigma in conditions of normal incidence of primary electrons. Measurements were taken down to the angle of 85 deg for energies of primary electrons between 0.9 and 3 keV. In the whole range of angles a nonmonotonic angular dependence sigma is observed. The dependence shows itself particularly clearly for CsI at large energies of primary electrons. Such a behaviour is due to the decrease in the depth of yield of inelastically reflected electrons and to the increase in the inelastic reflection coefficient of the substance.

HIGH LEVEL WASTE TANK CLOSURE PROJECT AT THE IDAHO NATIONAL ENGINEERING AND ENVIRONMENTAL LABORATORY

International Nuclear Information System (INIS)

Quigley, K.D.; Wessman, D.

2003-01-01

The Department of Energy, Idaho Operations Office (DOE-ID) is in the process of closing two underground high-level waste (HLW) storage tanks at the Idaho National Engineering and Environmental Laboratory (INEEL) to meet Resource Conservation and Recovery Act (RCRA) regulations and Department of Energy orders. Closure of these two tanks is scheduled for 2004 as the first phase in closure of the eleven 1.14 million liter (300,000 gallon) tanks currently in service at the Idaho Nuclear Technology and Engineering Center (INTEC). The INTEC Tank Farm Facility (TFF) Closure sequence consists of multiple steps to be accomplished through the existing tank riser access points. Currently, the tank risers contain steam and process waste lines associated with the steam jets, corrosion coupons, and liquid level indicators. As necessary, this equipment will be removed from the risers to allow adequate space for closure equipment and activities. The basic tank closure sequence is as follows: Empty the tank to the residual heel using the existing jets; Video and sample the heel; Replace steam jets with new jet at a lower position in the tank, and remove additional material; Flush tank, piping and secondary containment with demineralized water; Video and sample the heel; Evaluate decontamination effectiveness; Displace the residual heel with multiple placements of grout; and Grout piping, vaults and remaining tank volume. Design, development, and deployment of a remotely operated tank cleaning system were completed in June 2002. The system incorporates many commercially available components, which have been adapted for application in cleaning high-level waste tanks. The system is cost-effective since it also utilizes existing waste transfer technology (steam jets), to remove tank heel solids from the tank bottoms during the cleaning operations. Remotely operated directional spray nozzles, automatic rotating wash balls, video monitoring equipment, decontamination spray-rings, and

Observations on early and delayed colostomy closure.

Science.gov (United States)

Tade, A O; Salami, B A; Ayoade, B A

2011-06-01

Traditional treatment of a variety of colorectal pathologies had included a diverting colostomy that was closed eight or more weeks later during a readmission. The aim of this retrospective study was to determine the outcomes of early colostomy closure and delayed colostomy closure in patients with temporary colostomies following traumatic and non-traumatic colorectal pathologies. In this study early colostomy closure was the closure of a colostomy within three weeks of its construction, while delayed colostomy closure referred to closure after 3 weeks. Complete records of the 37 adult patients who had temporary colostomy constructed and closed between Jan. 1997 December 2003 for various colorectal pathologies were studied. Fourteen patients had early colostomy closure while 23 had delayed closure. In the early colostomy closure group there were 10 men and 4 women. The mean age of the patients was 28yr with a range of 18-65yr. Colostomies were closed 9-18 days after initial colostomy construction. There was no mortality. Morbidity rate 28.6% (4 out of 14). There were two faecal fistulas (14.3%). Twenty-three patients had delayed colostomy closure 8 weeks to 18 months after initial colostomy construction. These were patients unfit for early surgery after initial colostomy construction because of carcinoma, significant weight loss, or sepsis. There was no mortality. Morbidity rate was 26.1%. There were 3 faecal fistulas (13.2%). Outcomes following early colostomy closure and delayed closure were comparable. Patients fit for surgery should have early closure whilst patients who may have compromised health should have delayed closure.

Sternal exploration or closure

Science.gov (United States)

VAC - vacuum-assisted closure - sternal wound; Sternal dehiscence; Sternal infection ... in the wound to look for signs of infection Remove dead or infected ... use a VAC (vacuum-assisted closure) dressing. It is a negative ...

Advanced pigment dispersion glaucoma secondary to phakic intraocular collamer lens implant.

Science.gov (United States)

Ye, Clara; Patel, Cajal K; Momont, Anna C; Liu, Yao

2018-06-01

We report a case of pigment dispersion glaucoma secondary to uncomplicated phakic intraocular collamer lens (ICL) (Visian ICL™, Staar Inc., Monrovia, CA) implant that resulted in advanced visual field loss. A 50-year-old man presented for routine follow-up status post bilateral phakic intraocular collamer lens (ICL) placement 8 years earlier. He was incidentally found to have a decline in visual acuity from an anterior subcapsular cataract and elevated intraocular pressure (IOP) in the left eye. There were signs of pigment dispersion and no evidence of angle closure. Diffuse optic nerve thinning was consistent with advanced glaucomatous visual field defects. Pigment dispersion was also present in the patient's right eye, but without elevated IOP or visual field defects. The patient was treated with topical glaucoma medications and the phakic ICL in the left eye was removed concurrently with cataract surgery to prevent further visual field loss. Pigment dispersion glaucoma is a serious adverse outcome after phakic ICL implantation and regular post-operative monitoring may prevent advanced visual field loss.

Full closure strategic analysis.

Science.gov (United States)

2014-07-01

The full closure strategic analysis was conducted to create a decision process whereby full roadway : closures for construction and maintenance activities can be evaluated and approved or denied by CDOT : Traffic personnel. The study reviewed current...

Crack closure, a literature study

Science.gov (United States)

Holmgren, M.

1993-08-01

In this report crack closure is treated. The state of the art is reviewed. Different empirical formulas for determining the crack closure are compared with each other, and their benefits are discussed. Experimental techniques for determining the crack closure stress are discussed, and some results from fatigue tests are also reported. Experimental data from the literature are reported.

Surgical peripheral iridectomy via a clear-cornea phacoemulsification incision for pupillary block following cataract surgery in acute angle closure.

Science.gov (United States)

Fang, Aiwu; Wang, Peijuan; He, Rui; Qu, Jia

2018-05-18

To describe a technique of surgical peripheral iridectomy via a clear-cornea tunnel incision to prevent or treat pupillary block following phacoemulsification. Description of technique and retrospective description results in 20 eyes of 20 patients with acute angle closure with coexisting visually significant cataract undergoing phacoemulsification considered at risk of postoperative papillary block as well as two pseudo-phakic eyes with acute postoperative pupillary-block. Following phacoemulsification and insertion of an intraocular lens, a needle with a bent tip was inserted behind the iris through the corneal tunnel incision. A blunt iris repositor was introduced through the paracentesis and placed above the iris to exert posterior pressure and create a puncture. The size of the puncture was enlarged using scissors. For postoperative pupillary block the same technique was carried out through the existing incisions created for phacoemulsification. Peripheral iridectomy was successfully created in all 22 eyes. At a mean follow-up of 18.77 ± 9.72 months, none of the iridectomies closed or required enlargement. Two eyes had mild intraoperative bleeding and one eye a small Descemet's detachment that did not require intervention. No clinically significant complications were observed. Visual acuity and IOP improved or was maintained in all patients. The incidence of pupillary block in our hospital was 0.09% overall, 0.6% in diabetics and 3.5% in those with diabetic retinopathy. This technique of peripheral iridectomy via the cornea tunnel incision can be safely used during phacoemulsification in eyes at high risk of pupillary block or in the treatment of acute postoperative pupillary-block after cataract surgery. The technique is likely to be especially useful in brown iris, or if a laser is not available.

Scalp Wound Closure with K wires: An alternative easier method to scalp wound closure.

Science.gov (United States)

Ramesh, S; Ajik, S

2012-12-01

Scalp defects and lacerations present a reconstructive challenge to plastic surgeons. Many methods have been described from the use of skin grafting to rotation flaps. Here we present a method of closure of a contaminated scalp wound with the use of Kirschner wires. In our case, closure of scalp laceration was made possible with the use of 1.4 Kirschner wires and cable tie/ zip tie fasteners. The duration to closure of wound was 10 days. In reconstructing the scalp defect, this method was found to adhere to principles of scalp reconstruction. There were no post operative complications found from the procedure. On initial application on the edge of the wound, tension applied caused the K wires to cut through the wound edge. On replacement of K wires 1cm away from wound edge the procedure was not plagued by any further complication. In conclusion we find scalp closure with Kirschner wires are a simple and effective method for scalp wound closure.

Revisit to Grad's Closure and Development of Physically Motivated Closure for Phenomenological High-Order Moment Model

International Nuclear Information System (INIS)

Myong, R. S.; Nagdewe, S. P.

2011-01-01

The Grad's closure for the high-order moment equation is revisited and, by extending his theory, a physically motivated closure is developed for the one-dimensional velocity shear gas flow. The closure is based on the physical argument of the relative importance of various terms appearing in the moment equation. Also, the closure is derived such that the resulting theory may be inclusive of the well established linear theory (Navier-Stokes-Fourier) as limiting case near local thermal equilibrium.

Relationship between retinal lattice degeneration and open angle glaucoma.

Science.gov (United States)

Rahimi, Mansour

2005-01-01

Patients with retinal disorders may develop glaucoma of both a primary and secondary type. Pigment may contribute to trabecular obstruction in some patients with open-angle glaucoma. Lattice degeneration of the retina in its typical form is a sharply demarcated, circumferentially oriented, degenerative process with significant alterations of retinal pigmentation. The association between myopia, open angle glaucoma and pigment dispersion is striking. Therefore, it could be postulated that there is significant prevalence of open angle glaucoma in patients with retinal lattice degeneration, especially in combination with myopia.

Simulation study of radial dose due to the irradiation of a swift heavy ion aiming to advance the treatment planning system for heavy particle cancer therapy: The effect of emission angles of secondary electrons

Energy Technology Data Exchange (ETDEWEB)

Moribayashi, Kengo, E-mail: moribayashi.kengo@jaea.go.jp

2015-12-15

A radial dose simulation model has been proposed in order to advance the treatment planning system for heavy particle cancer therapy. Here, the radial dose is the dose due to the irradiation of a heavy ion as a function of distances from this ion path. The model proposed here may overcome weak points of paradigms that are employed to produce the conventional radial dose distributions. To provide the radial dose with higher accuracy, this paper has discussed the relationship between the emission angles of secondary electrons and the radial dose. It is found that the effect of emission angles becomes stronger on the radial dose with increasing energies of the secondary electrons.

Closure of Myelomeningocele Defects Using a Limberg Flap or Direct Repair

Directory of Open Access Journals (Sweden)

Jung-Hwan Shim

2016-01-01

Full Text Available BackgroundThe global prevalence of myelomeningocele has been reported to be 0.8–1 per 1,000 live births. Early closure of the defect is considered to be the standard of care. Various surgical methods have been reported, such as primary skin closure, local skin flaps, musculocutaneous flaps, and skin grafts. The aim of this study was to describe the clinical characteristics of myelomeningocele defects and present the surgical outcomes of recent cases of myelomeningocele at our institution.MethodsPatients who underwent surgical closure of myelomeningocele at our institution from January 2004 to December 2013 were included in this study. A retrospective chart review of their medical records was performed, and comorbidities, defect size, location, surgical procedures, complications, and the final results were analyzed.ResultsA total of 14 patients underwent surgical closure for myelomeningocele defects. Twelve cases were closed with direct skin repair, while two cases required local skin flaps to cover the skin defects. Three cases of infection occurred, requiring incision and either drainage or removal of allogenic materials. One case of partial flap necrosis occurred, requiring secondary revision using a rotational flap and a full-thickness skin graft. Despite these complications, all wounds eventually healed completely.ConclusionsMost myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local flaps may be used to cover the defect. Complications such as wound dehiscence and partial flap necrosis occurred in this study; however, all such complications were successfully managed with simple ancillary procedures.

High Prevalence of Narrow Angles among Chinese-American Glaucoma and Glaucoma Suspect Patients

Science.gov (United States)

Seider, Michael I; Pekmezci, Melike; Han, Ying; Sandhu, Simi; Kwok, Shiu Y; Lee, Roland Y; Lin, Shan C

2009-01-01

Purpose To evaluate the prevalence of gonioscopically narrow angles in a Chinese-American population with glaucoma or glaucoma suspicion. Patients and Methods Charts from all Chinese-American patients seen in a comprehensive ophthalmology clinic in the Chinatown district of San Francisco in 2002 were reviewed. One eye from each patient with glaucoma or glaucoma suspicion that met inclusion criteria was included (n=108). Data was collected for gender, age, race (self-declared), refraction (spherical equivalent), intraocular pressure (IOP), gonioscopy and vertical cup-to-disk ratio (CDR). Results Sixty percent (n=65) of Chinese-American eyes with glaucoma or glaucoma suspicion had gonioscopically narrow angles (Shaffer grade ≤2 in three or more quadrants). Those with narrow angles were significantly older (P=0.004) than their open angle counterparts, but the two groups did not differ in terms of gender, refraction, IOP or CDR (all, P≥0.071). In a multivariate model including age, gender and refraction as predictors of angle grade (open or narrow), only age was a significant predictor of angle grade (P=0.004). Conclusions A large proportion of Chinese-Americans in our study population with glaucoma or glaucoma suspicion had gonioscopically narrow angles. In multivariate analysis, patients with narrow angles were older than those with open angles but did not differ from them in terms of gender or refraction. Continued evaluation of angle closure glaucoma risk among Chinese-Americans is needed. PMID:19826385

Nevada Test Site closure program

International Nuclear Information System (INIS)

Shenk, D.P.

1994-08-01

This report is a summary of the history, design and development, procurement, fabrication, installation and operation of the closures used as containment devices on underground nuclear tests at the Nevada Test Site. It also addresses the closure program mothball and start-up procedures. The Closure Program Document Index and equipment inventories, included as appendices, serve as location directories for future document reference and equipment use

Evaluation of a novel trocar-site closure and comparison with a standard Carter-Thomason closure device.

Science.gov (United States)

del Junco, Michael; Okhunov, Zhamshid; Juncal, Samuel; Yoon, Renai; Landman, Jaime

2014-07-01

The aim of this study was to evaluate and compare a novel trocars-site closure device, the WECK EFx™ Endo Fascial Closure System (EFx) with the Carter-Thomason CloseSure System® (CT) for the closure of laparoscopic trocar site defects created by a 12-mm dilating trocar. We created standardized laparoscopic trocars-site abdominal wall defects in cadaver models using a standard 12-mm laparoscopic dilating trocar. Trocar defects were closed in a randomized fashion using one of the two closure systems. We recorded time and number of attempts needed for complete defect closure. In addition, we recorded the ability to maintain pneumoperitoneum, endoscopic visualization, safety, security, and facility based on the surgeon's subjective evaluations. We compared outcomes for the EFx and CT closure systems. We created 72 standardized laparoscopic trocars-site abdominal wall defects. The mean time needed for complete defect closure was 98.53 seconds (±28.9) for the EFx compared with 133.61 seconds (±54.61) for the CT (Psafety were 2.92 for EFx vs 2.19 for CT (Pvs 1.83 for EFx and CT, respectively (Pvs 2.33 for CT (P=0.022). No significant difference was observed between the EFx and the CT systems for endoscopic visualization (2.28 vs 2.50, P=0.080). In this in vitro cadaver trial, the EFx was superior in terms of time needed to complete defect closure, safety, and facility. CT was superior in terms of maintenance of pneumoperitoneum. Both systems were equal in the number of attempts needed to complete the defect closure and endoscopic visualization.

Percutaneous closure of patent foramen ovale in patients with presumed paradoxical embolism: periprocedural results and midterm risk of recurrent neurologic events.

Science.gov (United States)

Balbi, Manrico; Casalino, Laura; Gnecco, Giovanni; Bezante, Gian Paolo; Pongiglione, Giacomo; Marasini, Maurizio; Del Sette, Massimo; Barsotti, Antonio

2008-08-01

To report our data on selected patients with previous paradoxical embolism who underwent transcatheter patent foramen ovale (PFO) closure. Between July 2001 and July 2007, percutaneous PFO closure was performed on 128 patients (65 women, mean age: 46 +/- 12.8 years). Patent foramen ovale closure was recommended for secondary prevention in patients with previous transient ischemic attacks (52.5%), stroke (46%), or peripheral embolism (1.5%). Implantation was successful in all patients, and at the end of intervention, complete PFO closure was achieved in 70.3% of them. There were no "major" complications (ie, deaths, device embolization or thrombosis, need for cardiac surgery). The overall incidence of complications (mostly hemorrhagic) was 7%. The mean follow-up period was 32 months. Complete closure had been achieved in 78.4% and in 82.5% of patients at the third month of transesophageal echocardiography examination and at the sixth month of transcranial Doppler examination, respectively. There were no recurrent thromboembolic events during the follow-up period. Percutaneous closure of PFO is a feasible procedure, but it is not a risk-free technique. However, in correctly selected patients (ie, large PFO and those at risk for neurologic relapse), nearly complete PFO closure seems to provide protection from future neurologic ischaemic events at midterm follow-up.

Occupancy estimation and the closure assumption

Science.gov (United States)

Rota, Christopher T.; Fletcher, Robert J.; Dorazio, Robert M.; Betts, Matthew G.

2009-01-01

1. Recent advances in occupancy estimation that adjust for imperfect detection have provided substantial improvements over traditional approaches and are receiving considerable use in applied ecology. To estimate and adjust for detectability, occupancy modelling requires multiple surveys at a site and requires the assumption of 'closure' between surveys, i.e. no changes in occupancy between surveys. Violations of this assumption could bias parameter estimates; however, little work has assessed model sensitivity to violations of this assumption or how commonly such violations occur in nature. 2. We apply a modelling procedure that can test for closure to two avian point-count data sets in Montana and New Hampshire, USA, that exemplify time-scales at which closure is often assumed. These data sets illustrate different sampling designs that allow testing for closure but are currently rarely employed in field investigations. Using a simulation study, we then evaluate the sensitivity of parameter estimates to changes in site occupancy and evaluate a power analysis developed for sampling designs that is aimed at limiting the likelihood of closure. 3. Application of our approach to point-count data indicates that habitats may frequently be open to changes in site occupancy at time-scales typical of many occupancy investigations, with 71% and 100% of species investigated in Montana and New Hampshire respectively, showing violation of closure across time periods of 3 weeks and 8 days respectively. 4. Simulations suggest that models assuming closure are sensitive to changes in occupancy. Power analyses further suggest that the modelling procedure we apply can effectively test for closure. 5. Synthesis and applications. Our demonstration that sites may be open to changes in site occupancy over time-scales typical of many occupancy investigations, combined with the sensitivity of models to violations of the closure assumption, highlights the importance of properly addressing

Eyelid closure at death

Directory of Open Access Journals (Sweden)

A D Macleod

2009-01-01

Full Text Available Aim: To observe the incidence of full or partial eyelid closure at death. Materials and Methods: The presence of ptosis was recorded in 100 consecutive hospice patient deaths. Results: Majority (63% of the patients died with their eyes fully closed, however, 37% had bilateral ptosis at death, with incomplete eye closure. In this study, central nervous system tumor involvement and/or acute hepatic encephalopathy appeared to be pre-mortem risk factors of bilateral ptosis at death. Conclusion: Organicity and not psychogenicity is, therefore, the likely etiology of failure of full eyelid closure at death.

Closure and Sealing Design Calculation

International Nuclear Information System (INIS)

T. Lahnalampi; J. Case

2005-01-01

The purpose of the ''Closure and Sealing Design Calculation'' is to illustrate closure and sealing methods for sealing shafts, ramps, and identify boreholes that require sealing in order to limit the potential of water infiltration. In addition, this calculation will provide a description of the magma that can reduce the consequences of an igneous event intersecting the repository. This calculation will also include a listing of the project requirements related to closure and sealing. The scope of this calculation is to: summarize applicable project requirements and codes relating to backfilling nonemplacement openings, removal of uncommitted materials from the subsurface, installation of drip shields, and erecting monuments; compile an inventory of boreholes that are found in the area of the subsurface repository; describe the magma bulkhead feature and location; and include figures for the proposed shaft and ramp seals. The objective of this calculation is to: categorize the boreholes for sealing by depth and proximity to the subsurface repository; develop drawing figures which show the location and geometry for the magma bulkhead; include the shaft seal figures and a proposed construction sequence; and include the ramp seal figure and a proposed construction sequence. The intent of this closure and sealing calculation is to support the License Application by providing a description of the closure and sealing methods for the Safety Analysis Report. The closure and sealing calculation will also provide input for Post Closure Activities by describing the location of the magma bulkhead. This calculation is limited to describing the final configuration of the sealing and backfill systems for the underground area. The methods and procedures used to place the backfill and remove uncommitted materials (such as concrete) from the repository and detailed design of the magma bulkhead will be the subject of separate analyses or calculations. Post-closure monitoring will not

Scope and closures

CERN Document Server

Simpson, Kyle

2014-01-01

No matter how much experience you have with JavaScript, odds are you don’t fully understand the language. This concise yet in-depth guide takes you inside scope and closures, two core concepts you need to know to become a more efficient and effective JavaScript programmer. You’ll learn how and why they work, and how an understanding of closures can be a powerful part of your development skillset.

Comparison of factors associated with occludable angle between american Caucasians and ethnic Chinese.

Science.gov (United States)

Wang, Ye Elaine; Li, Yingjie; Wang, Dandan; He, Mingguang; Lin, Shan

2013-11-21

To determine if factors associated with gonioscopy-determined occludable angle among American Caucasians are similar to those found in ethnic Chinese. This is a prospective cross-sectional study with 120 American Caucasian, 116 American Chinese, and 116 mainland Chinese subjects. All three groups were matched for sex and age (40-80 years). Gonioscopy was performed for each subject (occludable angles = posterior trabecular meshwork not visible for ≥2 quadrants). Anterior segment optical coherence tomography and customized software was used to measure anterior segment biometry and iris parameters, including anterior chamber depth/width (ACD, ACW), lens vault (LV), and iris thickness/area/curvature. In both Chinese and Caucasians, eyes with occludable angles had smaller ACD and ACW, and larger LV and iris curvature than eyes with open angles (all P gonioscopy-determined occludable angle was significantly associated with LV, iris area, and sex (all P < 0.03) in Chinese; and with LV, ACD, iris thickness, age, and sex (all P < 0.04) in Caucasians. Several factors associated with occludable angle differed between Caucasians and Chinese, suggesting potentially different mechanisms in occludable angle development in the two racial groups. This is the first study to demonstrate that lens vault is an important anterior segment optical coherence tomography parameter in the screening for angle closure in Caucasians. In addition, iris thickness was a significant predictor for occludable angles in Caucasians but was not in ethnic Chinese.

100-D Ponds closure plan. Revision 1

International Nuclear Information System (INIS)

Petersen, S.W.

1997-09-01

The 100-D Ponds is a Treatment, Storage, and Disposal (TSD) unit on the Hanford Facility that received both dangerous and nonregulated waste. This Closure Plan (Rev. 1) for the 100-D Ponds TSD unit consists of a RCRA Part A Dangerous Waste Permit Application (Rev. 3), a RCRA Closure Plan, and supporting information contained in the appendices to the plan. The closure plan consists of eight chapters containing facility description, process information, waste characteristics, and groundwater monitoring data. There are also chapters containing the closure strategy and performance standards. The strategy for the closure of the 100-D Ponds TSD unit is clean closure. Appendices A and B of the closure plan demonstrate that soil and groundwater beneath 100-D Ponds are below cleanup limits. All dangerous wastes or dangerous waste constituents or residues associated with the operation of the ponds have been removed, therefore, human health and the environment are protected. Discharges to the 100-D Ponds, which are located in the 100-DR-1 operable unit, were discontinued in June 1994. Contaminated sediment was removed from the ponds in August 1996. Subsequent sampling and analysis demonstrated that there is no contamination remaining in the ponds, therefore, this closure plan is a demonstration of clean closure

Does the Angle of the Nail Matter for Pertrochanteric Fracture Reduction? Matching Nail Angle and Native Neck-Shaft Angle.

Science.gov (United States)

Parry, Joshua A; Barrett, Ian; Schoch, Bradley; Yuan, Brandon; Cass, Joseph; Cross, William

2018-04-01

To determine whether fixation of pertrochanteric hip fractures with cephalomedullary nails (CMNs) with a neck-shaft angle (NSA) less than the native NSA affects reduction and lag screw cutout. Retrospective comparative study. Level I trauma center. Patients treated with a CMN for unstable pertrochanteric femur fractures (OTA/AO 31-A2.2 and 31-A2.3) between 2005 and 2014. CMN fixation. NSA reduction and lag screw cutout. Patients fixed with a nail angle less than their native NSA were less likely to have good reductions [17% vs. 60%, 95% confidence interval (CI), -63% to -18%; P = 0.0005], secondary to more varus reductions (41% vs. 10%, 95% CI, 9%-46%; P = 0.01) and more fractures with ≥4 mm of displacement (63% vs. 35%, 95% CI, 3%-49%; P = 0.03). The cutout was not associated with the use of a nail angle less than the native NSA (60% vs. 76%, 95% CI, -56% to 18%; P = 0.5), varus reductions (60% vs. 32%, 95% CI, -13% to 62%; P = 0.3), or poor reductions (20% vs. 17%, 95% CI, -24% to 44%; P = 1.0). The fixation of unstable pertrochanteric hip fractures with a nail angle less than the native NSA was associated with more varus reductions and fracture displacement but did not affect the lag screw cutout. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Buccinator sandwich pushback: a new technique for treatment of secondary velopharyngeal incompetence.

Science.gov (United States)

Hill, C; Hayden, C; Riaz, M; Leonard, A G

2004-05-01

A small percentage of patients have inadequate velopharyngeal closure, or secondary velopharyngeal incompetence, following primary palatoplasty. Use of the buccinator musculomucosal flap has been described for primary palate repair with lengthening, but its use in secondary palate lengthening for the correction of insufficient velopharyngeal closure has not been described. This study presents the results of a series of patients who had correction of secondary velopharyngeal incompetence using bilateral buccinator musculomucosal flaps used as a sandwich. In this prospective study between 1995 and 1998, a group of 16 patients with insufficient velopharyngeal closure as determined by speech assessment and videoradiography were selected. Nasopharyngoscopy was carried out in addition in a number of cases. Case selection was a result of these investigations and clinical examination in which the major factor in velopharyngeal insufficiency was determined to be short palatal length. The patients underwent palate lengthening using bilateral buccinator musculomucosal flaps as a sandwich. All patients were assessed 6 months postoperatively. The operative technique, postoperative course, and recorded postoperative complications including partial/total flap necrosis and residual velopharyngeal insufficiency were evaluated. Preoperative and postoperative speech samples were rated by an independent speech therapist. Ninety-three percent (15 of 16) had a significant improvement in velopharyngeal insufficiency, and 14 patients had no hypernasality postoperatively. Both cases of persistent mild hypernasality had had a recognized postoperative complication. The sandwich pushback technique for the correction of persistent velopharyngeal incompetence was successful in achieving good speech results.

Closure for spent-fuel transport and storage containers

International Nuclear Information System (INIS)

Ahner, S.; Knackstedt, H.G.; Srostlik, P.

1980-01-01

The container has a transport closure and a shielding closure. This shielding closure consists of two pieces (double closure system), which can be fartened to one another like a bayonet fixing. A central motion of rotation is enough to open the closure. It can be done remote-controlled as well as manually. (DG) [de

Echocardiographic predictors of coil vs device closure in patients undergoing percutaneous patent ductus arteriosus closure.

Science.gov (United States)

Roushdy, Alaa; Abd El Razek, Yasmeen; Mamdouh Tawfik, Ahmed

2018-01-01

To determine anatomic and hemodynamic echocardiographic predictors for patent ductus arteriosus (PDA) device vs coil closure. Seventy-six patients who were referred for elective transcatheter PDA closure were enrolled in the study. All patients underwent full echocardiogram including measurement of the PDA pulmonary end diameter, color flow width and extent, peak and end-diastolic Doppler gradients across the duct, diastolic flow reversal, left atrial dimensions and volume, left ventricular sphericity index, and volumes. The study group was subdivided into 2 subgroups based on the mode of PDA closure whether by coil (n = 42) or device (n = 34). Using univariate analysis there was a highly significant difference between the 2 groups as regard the pulmonary end diameter measured in both the suprasternal and parasternal short-axis views as well as the color flow width and color flow extent (P closure group had statistically significant higher end-systolic and end-diastolic volumes indexed, left atrial volume, and diastolic flow reversal. Receiver operating characteristic curve analysis showed a pulmonary end diameter cutoff point from the suprasternal view > 2.5 mm and from parasternal short-axis view > 2.61 mm to have the highest balanced sensitivity and specificity to predict the likelihood for device closure (AUC 0.971 and 0.979 respectively). The pulmonary end diameter measured from the suprasternal view was the most independent predictor of device closure. The selection between PDA coil or device closure can be done on the basis of multiple anatomic and hemodynamic echocardiographic variables. © 2017 Wiley Periodicals, Inc.

Numerical simulation of the effects of variation of angle of attack and sweep angle on vortex breakdown over delta wings

Science.gov (United States)

Ekaterinaris, J. A.; Schiff, Lewis B.

1990-01-01

In the present investigation of the vortical flowfield structure over delta wings at high angles of attack, three-dimensional Navier-Stokes numerical simulations were conducted to predict the complex leeward flowfield characteristics; these encompass leading-edge separation, secondary separation, and vortex breakdown. Attention is given to the effect on solution accuracy of circumferential grid-resolution variations in the vicinity of the wing leading edge, and well as to the effect of turbulence modeling on the solutions. When a critical angle-of-attack was reached, bubble-type vortex breakdown was found. With further angle-of-attack increase, a change from bubble-type to spiral-type vortex breakdown was predicted by the numerical solution.

Association of lens vault with narrow angles among different ethnic groups.

Science.gov (United States)

Lee, Roland Y; Huang, Guofu; Cui, Qi N; He, Mingguang; Porco, Travis C; Lin, Shan C

2012-06-01

eyes. With the exception of the comparison between African-Americans and Caucasian-Americans, differences in lens vault measurements among the racial groups with open angle were statistically insignificant. Our data suggest that other factors may play a greater role in predisposing Asian races to angle closure.

Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis

Directory of Open Access Journals (Sweden)

Yu Chen

2014-01-01

Full Text Available Up to the present, the optimal time to close an open abdomen remains controversial. This study was designed to evaluate whether early fascial abdominal closure had advantages over delayed approach for open abdomen populations. Medline, Embase, and Cochrane Library were searched until April 2013. Search terms included “open abdomen,” “abdominal compartment syndrome,” “laparostomy,” “celiotomy,” “abdominal closure,” “primary,” “delayed,” “permanent,” “fascial closure,” and “definitive closure.” Open abdomen was defined as “fail to close abdominal fascia after a laparotomy.” Mortality, complications, and length of stay were compared between early and delayed fascial closure. In total, 3125 patients were included for final analysis, and 1942 (62% patients successfully achieved early fascial closure. Vacuum assisted fascial closure had no impact on pooled fascial closure rate. Compared with delayed abdominal closure, early fascial closure significantly reduced mortality (12.3% versus 24.8%, RR, 0.53, P<0.0001 and complication incidence (RR, 0.68, P<0.0001. The mean interval from open abdomen to definitive closure ranged from 2.2 to 14.6 days in early fascial closure groups, but from 32.5 to 300 days in delayed closure groups. This study confirmed clinical advantages of early fascial closure over delayed approach in treatment of patients with open abdomen.

Surgical treatment of chronic sacrococcygeal pilonidal sinus. Open method versus primary closure

International Nuclear Information System (INIS)

Kareem, Tayeb S.

2006-01-01

Objective was to study the comparison between the primary closure and open technique after excision of chronic sacrococcygeal pilonidal sinus. A randomized study was designed and 77 patients with chronic sacrococcygeal pilonidal sinus were included in this study. This study took place in Rizgary Teaching Hospital, Erbil, Kurdistan, Iraq, from January 1997 to August 2003. The patients were separated into 2 groups; Group A (37 patients) were treated by open method (excision and healing by secondary intention) and Group B (40 patients) for whom primary midline suturing was performed after excision of the pilonidal sinus. The follow up ranged from 1.5-5.5 years (mean 4.16) was through outpatient visits. The Student t test was applied for statistical analysis for the operating time, hospital-stay, time off from work and wound healing time; and the results show extremely significant differences between the 2 groups (p<0.0001). The statistical analysis of the total number of postoperative complications of both techniques showed a significant difference (p=0.0401), while the differences were insignificant for each complication when analyzed separately. Excision and primary closure for chronic sacrococcygeal pilonidal sinus is superior to excision and healing by secondary intention. We believe that primary midline suturing is a useful method for management of chronic sacrococcygeal pilonidal sinus. (author)

Tools for Closure Project and Contract Management: Development of the Rocky Flats Integrated Closure Project Baseline

International Nuclear Information System (INIS)

Gelles, C. M.; Sheppard, F. R.

2002-01-01

This paper details the development of the Rocky Flats Integrated Closure Project Baseline - an innovative project management effort undertaken to ensure proactive management of the Rocky Flats Closure Contract in support of the Department's goal for achieving the safe closure of the Rocky Flats Environmental Technology Site (RFETS) in December 2006. The accelerated closure of RFETS is one of the most prominent projects within the Department of Energy (DOE) Environmental Management program. As the first major former weapons plant to be remediated and closed, it is a first-of-kind effort requiring the resolution of multiple complex technical and institutional challenges. Most significantly, the closure of RFETS is dependent upon the shipment of all special nuclear material and wastes to other DOE sites. The Department is actively working to strengthen project management across programs, and there is increasing external interest in this progress. The development of the Rocky Flats Integrated Closure Project Baseline represents a groundbreaking and cooperative effort to formalize the management of such a complex project across multiple sites and organizations. It is original in both scope and process, however it provides a useful precedent for the other ongoing project management efforts within the Environmental Management program

Vacuum-assisted closure in the treatment of extensive lymphangiomas in children.

Science.gov (United States)

Katz, Michael S; Finck, Christine M; Schwartz, Marshall Z; Moront, Matthew L; Prasad, Rajeev; Timmapuri, Shaheen J; Arthur, L Grier

2012-02-01

The management of lymphangiomas in children is a complex problem with frequent recurrence and infection. Vacuum-assisted closure (VAC) devices have been shown to accelerate the healing of open wounds. We hypothesized that VAC therapy might decrease complications after resection of lymphangiomas. A retrospective review was performed on 13 children (August 2005 to April 2010) who were patients undergoing lymphangioma resection with postoperative VAC therapy. Patient demographics, size and location of the lymphangioma, VAC duration and number of changes, hospital stay, complications, need for further surgery, and length of follow-up were recorded. Thirteen children (mean age, 8 years; mean weight, 34 kg) underwent 15 operations for lymphangiomas followed by postoperative VAC therapy. Locations included the head and neck, thorax and abdomen, and lower extremity. The mean VAC duration was 19 days, and they underwent a mean of 2.6 VAC changes. Six children had operative closure of the wound at a mean of 15 days postoperative. The remaining patients underwent closure by secondary intention. There were no recurrences. Complications included VAC device malfunctions requiring intervention and wound infections. Mean follow-up was 289 days. Postoperative VAC therapy for the treatment of lymphangiomas can be an effective adjunct to surgical treatment by decreasing risks of recurrence and infection. Copyright © 2012 Elsevier Inc. All rights reserved.

50 CFR 648.161 - Closures.

Science.gov (United States)

2010-10-01

... Bluefish Fishery § 648.161 Closures. (a) EEZ closure. NMFS shall close the EEZ to fishing for bluefish by... dealer permit holders that no commercial quota is available for landing bluefish in that state. ...

Percutaneous Closure of Patent Foramen Ovale in Patients With Migraine: The PREMIUM Trial.

Science.gov (United States)

Tobis, Jonathan M; Charles, Andrew; Silberstein, Stephen D; Sorensen, Sherman; Maini, Brijeshwar; Horwitz, Phillip A; Gurley, John C

2017-12-05

Migraine is a prevalent and disabling disorder. Patent foramen ovale (PFO) has been associated with migraine, but its role in the disorder remains poorly understood. This study examined the efficacy of percutaneous PFO closure as a therapy for migraine with or without aura. The PREMIUM (Prospective, Randomized Investigation to Evaluate Incidence of Headache Reduction in Subjects With Migraine and PFO Using the AMPLATZER PFO Occluder to Medical Management) was a double-blind study investigating migraine characteristics over 1 year in subjects randomized to medical therapy with a sham procedure (right heart catheterization) versus medical therapy and PFO closure with the Amplatzer PFO Occluder device (St. Jude Medical, St. Paul, Minnesota). Subjects had 6 to 14 days of migraine per month, had failed at least 3 migraine preventive medications, and had significant right-to-left shunt defined by transcranial Doppler. Primary endpoints were responder rate defined as 50% reduction in migraine attacks and adverse events. Secondary endpoints included reduction in migraine days and efficacy in patients with versus without aura. Of 1,653 subjects consented, 230 were enrolled. There was no difference in responder rate in the PFO closure (45 of 117) versus control (33 of 103) groups. One serious adverse event (transient atrial fibrillation) occurred in 205 subjects who underwent PFO closure. Subjects in the PFO closure group had a significantly greater reduction in headache days (-3.4 vs. -2.0 days/month, p = 0.025). Complete migraine remission for 1 year occurred in 10 patients (8.5%) in the treatment group versus 1 (1%) in the control group (p = 0.01). PFO closure did not meet the primary endpoint of reduction in responder rate in patients with frequent migraine. (Prospective, Randomized Investigation to Evaluate Incidence of Headache Reduction in Subjects With Migraine and PFO Using the AMPLATZER PFO Occluder to Medical Management [PREMIUM]; NCT00355056). Copyright

Catheter closure of patent foramen ovale in patients with cryptogenic cerebrovascular accidents: initial experiences in Japan.

Science.gov (United States)

Kijima, Yasufumi; Akagi, Teiji; Nakagawa, Koji; Taniguchi, Manabu; Ueoka, Akira; Deguchi, Kentaro; Toh, Norihisa; Oe, Hiroki; Kusano, Kengo; Sano, Shunji; Ito, Hiroshi

2014-01-01

Although numerous studies have shown an association between a patent foramen ovale (PFO) and cryptogenic cerebrovascular accidents (CVA), there has been no definitive control study that demonstrated the benefit of percutaneous device closure of a PFO compared to medical therapy in patients with CVA. Additionally, few clinical data exist for Japanese patients in this field. We demonstrate the initial experiences in catheter closure of a PFO as secondary prevention of CVA in Japan. Catheter closure of a PFO was attempted in 7 patients who were diagnosed with cryptogenic CVA. Mean age at the procedure was 54 ± 19 years. The presence of spontaneous interatrial right-to-left shunts was demonstrated by transesophageal contrast echocardiography without Valsalva maneuver in all of the patients. Amplatzer Cribriform device (n = 4) or Amplatzer PFO Occluder (n = 3) was used for the procedure and was successfully deployed. Device-related complications were not observed at the time of the procedure or during the follow-up period (mean period of 16 ± 9 months). Catheter closure of a PFO could be safely performed with Amplatzer Cribriform or Amplatzer PFO Occluder. This procedure may contribute to prevention of recurrent cryptogenic CVA in Japanese patients.

Hanford Patrol Academy Demolition Sites Closure Plan

International Nuclear Information System (INIS)

1992-11-01

From 1975 to 1991 the Hanford Patrol Academy Demolition Sites (HPADS) were used for demolition events. These demolition events were a form of thermal treatment for spent or abandoned chemical waste. Because the HPADS will no longer be used for this thermal activity, the sites will be closed. Closure will be conducted pursuant to the requirements of the Washington State Department of Ecology (Ecology) Dangerous Waste Regulations, Washington Administrative Code (WAC) 173-303-610 and 40 CFR 270.1. Closure also will satisfy closure requirements of WAC 173-303-680 and for the thermal treatment closure requirements of 40 CFR 265.381. This closure plan presents a description of the HPADS, the history of the waste treated, and the approach that will be followed to close the HPADS. Because dangerous waste does not include the source, special nuclear, and by-product material components of mixed waste, radionuclides are not within the scope of WAC 173-303 or of this closure plan. The information on radionuclides is provided only for general knowledge where appropriate. Only dangerous constituents derived from HPADS operations will be addressed in this closure plan in accordance with WAC 173-303-610(2)(b)(i). The HPADS are actually two distinct soil closure areas within the Hanford Patrol Academy training area

Interventional Closure of a Patent Ductus Arteriosus Using an Amplatz Canine Duct Occluder in an Alpaca Cria.

Science.gov (United States)

Chapel, E C; Lozier, J; Lakritz, J; Schober, K E

2017-07-01

A 6-month old female alpaca cria presented to The Ohio State University for evaluation of a cardiac murmur. Echocardiography revealed a left-to-right shunting patent ductus arteriosus, a restrictive left-to-right shunting perimembranous ventricular septal defect, and secondary moderate left atrial and ventricular dilation. Aortic root angiography demonstrated a type IIA patent ductus arteriosus (PDA). Interventional closure of the PDA was successfully performed, without complication, using an Amplatz canine duct occluder. This case report describes the materials and methods used for interventional closure of a PDA in an alpaca cria. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

ASD Closure in Structural Heart Disease.

Science.gov (United States)

Wiktor, Dominik M; Carroll, John D

2018-04-17

While the safety and efficacy of percutaneous ASD closure has been established, new data have recently emerged regarding the negative impact of residual iatrogenic ASD (iASD) following left heart structural interventions. Additionally, new devices with potential advantages have recently been studied. We will review here the potential indications for closure of iASD along with new generation closure devices and potential late complications requiring long-term follow-up. With the expansion of left-heart structural interventions and large-bore transseptal access, there has been growing experience gained with management of residual iASD. Some recently published reports have implicated residual iASD after these procedures as a potential source of diminished clinical outcomes and mortality. Additionally, recent trials investigating new generation closure devices as well as expanding knowledge regarding late complications of percutaneous ASD closure have been published. While percutaneous ASD closure is no longer a novel approach to managing septal defects, there are several contemporary issues related to residual iASD following large-bore transseptal access and new generation devices which serve as an impetus for this review. Ongoing attention to potential late complications and decreasing their incidence with ongoing study is clearly needed.

32 CFR 989.25 - Base closure and realignment.

Science.gov (United States)

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Base closure and realignment. 989.25 Section 989... PROTECTION ENVIRONMENTAL IMPACT ANALYSIS PROCESS (EIAP) § 989.25 Base closure and realignment. Base closure or realignment may entail special requirements for environmental analysis. The permanent base closure...

Factors Associated with the Retinal Nerve Fiber Layer Loss after Acute Primary Angle Closure: A Prospective EDI-OCT Study.

Directory of Open Access Journals (Sweden)

Eun Ji Lee

Full Text Available To determine the factors associated with retinal nerve fiber layer (RNFL loss in eyes with acute primary angle-closure (APAC, particularly focusing on the influence of the change in the anterior lamina cribrosa surface depth (LCD.After the initial presentation, 30 eyes with unilateral APAC were followed up at the following specific time points over a 12-month period: 1 week, 1~2 months, 2~3 months, 5~6 months, and 11~12 months. These follow-ups involved intraocular pressure measurements, enhanced depth-imaging spectral-domain optical coherence tomography (SD-OCT scanning of the optic disc, and measurements of the circumpapillary RNFL thickness. The prelaminar tissue thickness (PLT and LCD were determined in the SD-OCT images obtained at each follow-up visit.Repeated measures analysis of variance revealed a significant pattern of decrease in the global RNFL thickness, PLT, and LCD (all p<0.001. The global RNFL thickness decreased continuously throughout the follow-up period, while the PLT decreased until 5~6 months and did not change thereafter. The LCD reduced until 2~3 months and then also remained steady. Multivariable regression analysis revealed that symptoms with a longer duration before receiving laser peripheral iridotomy (LI (p = 0.049 and a larger LCD reduction (p = 0.034 were significant factors associated with the conversion to an abnormal RNFL thickness defined using OCT normative data.Early short-term decreases in the PLT and LCD and overall long-term decrease in the peripapillary RNFL were observed during a 12-month follow-up after an APAC episode. A longer duration of symptoms before receiving LI treatment and larger LCD reduction during follow-up were associated with the progressive RNFL loss. The LCD reduction may indicate a prior presence of significant pressure-induced stress that had been imposed on the optic nerve head at the time of APAC episode. Glaucomatous progression should be suspected in eyes showing LCD reduction

Nasal closure for the treatment of epistaxis secondary to hereditary hemorrhagic telangiectasia.

Science.gov (United States)

Sena Esteves, Sara; Cardoso, Carla; Silva, Ana; Abrunhosa, José; Almeida E Sousa, Cecília

Hereditary hemorrhagic telangiectasia (HHT), also known by the eponym Osler-Weber-Rendu syndrome, is an autosomal dominant disorder characterised by the presence of multiple arteriovenous malformations (AVMs) affecting multiple organs. Many procedures have been used for epistaxis control in patients with this disorder. The objective of this study was to report the treatment of severe HHT-related epistaxiswith the modified Young's procedure. We describe the treatment of 4 patients with severe blood-transfusion-dependent epistaxis who underwent a modified Young's procedure in a tertiary hospital. The nasal closure was bilateral and complete in all cases. All patients were followed for 12 months or longer. The procedure was well tolerated and complete cessation of bleeding was achieved in all the patients. Young's technique is a safe surgical procedure, well tolerated by patients with severe epistaxis and HHT. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

Advanced pigment dispersion glaucoma secondary to phakic intraocular collamer lens implant

Directory of Open Access Journals (Sweden)

Clara Ye

2018-06-01

Full Text Available Purpose: We report a case of pigment dispersion glaucoma secondary to uncomplicated phakic intraocular collamer lens (ICL (Visian ICL™, Staar Inc., Monrovia, CA implant that resulted in advanced visual field loss. Observations: A 50-year-old man presented for routine follow-up status post bilateral phakic intraocular collamer lens (ICL placement 8 years earlier. He was incidentally found to have a decline in visual acuity from an anterior subcapsular cataract and elevated intraocular pressure (IOP in the left eye. There were signs of pigment dispersion and no evidence of angle closure. Diffuse optic nerve thinning was consistent with advanced glaucomatous visual field defects. Pigment dispersion was also present in the patient's right eye, but without elevated IOP or visual field defects. The patient was treated with topical glaucoma medications and the phakic ICL in the left eye was removed concurrently with cataract surgery to prevent further visual field loss. Conclusions and importance: Pigment dispersion glaucoma is a serious adverse outcome after phakic ICL implantation and regular post-operative monitoring may prevent advanced visual field loss. Keywords: Phakic intraocular lens, Intraocular collamer lens, Pigment dispersion, Glaucoma

Patent ductus arteriosus closure using an Amplatzer™ ventricular septal defect closure device

Science.gov (United States)

Fernando, Rajeev; Koranne, Ketan; Loyalka, Pranav; Kar, Biswajit; Gregoric, Igor

2013-01-01

The ductus arteriosus originates from the persistence of the distal portion of the left sixth aortic arch. It connects the descending aorta (immediately distal to the left subclavian artery) to the roof of the main pulmonary artery, near the origin of the left pulmonary artery. Persistence of the duct beyond 48 h after birth is abnormal and results in patent ductus arteriosus (PDA). PDA is rare in adults because it is usually discovered and treated in childhood. Mechanical closure remains the definitive therapy because the patency of ductus arteriosus may lead to multiple complications, depending on the size and flow through the ductus. PDA closure is indicated in patients with symptoms and evidence of left heart enlargement, and in patients with elevated pulmonary pressures when reversal is possible. Transcatheter closure is the preferred technique in adults because it avoids sternotomy, reduces the length of hospital stay and is associated with fewer complications compared with surgery. First demonstrated in 1967, both the technique and the occluder devices used have since evolved. However, designing an ideal PDA occluder has been a challenge due to the variability in size, shape and orientation of PDAs. The present article describes a case involving a 35-year-old woman who presented to the Center for Advanced Heart Failure (Houston, USA) with congestive heart failure due to a large PDA, which was successfully occluded using an Amplatzer (St Jude Medical, USA) muscular ventricular septal defect closure device. The wider waist and dual-retention discs of these ventricular septal defect closure devices may be important factors to consider in the future development of devices for the occlusion of large PDAs. PMID:24294051

Use of a furosemide drip does not improve earlier primary fascial closure in the open abdomen

Directory of Open Access Journals (Sweden)

Leland H Webb

2012-01-01

Full Text Available Background: The furosemide drip (FD, in addition to improving volume overload respiratory failure, has been used to decrease fluid in attempts to decrease intra-abdominal and abdominal wall volumes to facilitate fascial closure. The purpose of this study is to evaluate the FD and the associated rate of primary fascial closure following trauma damage control laparotomy (DCL. Materials and Methods: From January 2004 to September 2008, a retrospective review from a single institution Trauma Registry of the American College of Surgeons dataset was performed. All DCLs greater than 24 h who had a length of stay for 3 or more days were identified. The study group (FD+ and control group (FD- were compared. Demographic data including age, sex, probability of survival, red blood cell transfusions, initial lactate, and mortality were collected. Primary outcomes included primary fascial closure and primary fascial closure within 7 days. Secondary outcomes included total ventilator days and LOS. Results: A total of 139 patients met inclusion criteria: 25 FD+ and 114 FD-. The 25 FD+ patients received the drug at a median 4 days post DCL. Demographic differences between the groups were not significantly different, except that initial lactate was higher for FD- (1.7 vs 4.0; P=0.03. No differences were noted between groups regarding successful primary fascial closure (FD+ 68.4% vs FD- 64.0%; P=0.669, or closure within 7 days (FD+13.2% vs FD- 28.0%; P=0.066 of original DCL. FD+ patients suffered more open abdomen days (4 [2-7] vs 2 [1-4]; P=0.001. FD+ did not demonstrate an association with primary fascial closure [Odds ratio (OR 1.5, 95% confidence interval (CI 0.260-8.307; P=0.663]. FD+ patients had more ventilator days and longer Intensive Care Unit (ICU/hospital LOS (P<0.01. Conclusion: FD use may remove excess volume; however, forced diuresis with an FD is not associated with an increased rate of primary closure after DCL. Further studies are warranted to

Evaluation of the Momentum Closure Schemes in MPAS-Ocean

Science.gov (United States)

Zhao, Shimei; Liu, Yudi; Liu, Wei

2018-04-01

In order to compare and evaluate the performances of the Laplacian viscosity closure, the biharmonic viscosity closure, and the Leith closure momentum schemes in the MPAS-Ocean model, a variety of physical quantities, such as the relative reference potential energy (RPE) change, the RPE time change rate (RPETCR), the grid Reynolds number, the root mean square (RMS) of kinetic energy, and the spectra of kinetic energy and enstrophy, are calculated on the basis of results of a 3D baroclinic periodic channel. Results indicate that: 1) The RPETCR demonstrates a saturation phenomenon in baroclinic eddy tests. The critical grid Reynolds number corresponding to RPETCR saturation differs between the three closures: the largest value is in the biharmonic viscosity closure, followed by that in the Laplacian viscosity closure, and that in the Leith closure is the smallest. 2) All three closures can effectively suppress spurious dianeutral mixing by reducing the grid Reynolds number under sub-saturation conditions of the RPETCR, but they can also damage certain physical processes. Generally, the damage to the rotation process is greater than that to the advection process. 3) The dissipation in the biharmonic viscosity closure is strongly dependent on scales. Most dissipation concentrates on small scales, and the energy of small-scale eddies is often transferred to large-scale kinetic energy. The viscous dissipation in the Laplacian viscosity closure is the strongest on various scales, followed by that in the Leith closure. Note that part of the small-scale kinetic energy is also transferred to large-scale kinetic energy in the Leith closure. 4) The characteristic length scale L and the dimensionless parameter D in the Leith closure are inherently coupled. The RPETCR is inversely proportional to the product of D and L. When the product of D and L is constant, both the simulated RPETCR and the inhibition of spurious dianeutral mixing are the same in all tests using the Leith

Deviation from an inverse cosine dependence of kinetic secondary electron emission for angle of incidence at keV energy

International Nuclear Information System (INIS)

Ohya, Kaoru; Kawata, Jun; Mori, Ichiro

1989-01-01

Incident angle dependence of kinetic secondary electron emission from metals resulting from incidence of keV ions is investigated by computer simulation with the TRIM Monte Carlo program of ion scattering in matter. The results show large deviations from the inverse cosine dependence, which derives from high-energy approximation, because of a series of elastic collisions of incident ions with metal atoms. In the keV energy region, the elastic collisions have two different effects on the angular dependence for relatively high-energy light ions and for low-energy heavy ions: they result in over- and under-inverse-cosine dependences, respectively. The properties are observed even with an experiment of the keV-neutral incidence on a contaminated surface. In addition, the effects of the thin oxide layer and roughness on the surface are examined with simplified models. (author)

A radiographic study of growth plate closure compared with age in the Korean native goat

International Nuclear Information System (INIS)

Choi, H.J.; Shin, H.J.; Kang, S.K.; Cho, J.K.; Chang, D.W.; Lee, Y.W.; Jeong, S.M.; Park, S.J.; Shin, S.T.; Lee, H.C.

2006-01-01

This study was performed to assess the growth plate closure time with aging in the Korean native goat. Radiographs of proximal and distal epiphysis of humerus, radius, ulna, femur and tibia were obtained at 2, 3, 4, 5, 6, 7, 8, 9, 11, 12, 13, 14, 17, 18, 20, 21, 30, 43 and 52 weeks after birth in 30 Korean native goats. The secondary ossification centers were scrutinized and assessed the maturity process on the basis of the criteria (stage 0 to 10). The secondary ossification centers of proximal and distal epiphysis of humerus, radius, femur and tibia and proximal ulna epiphysis appeared immediately after birth

Metabolomics by Proton High-Resolution Magic-Angle-Spinning Nuclear Magnetic Resonance of Tomato Plants Treated with Two Secondary Metabolites Isolated from Trichoderma.

Science.gov (United States)

Mazzei, Pierluigi; Vinale, Francesco; Woo, Sheridan Lois; Pascale, Alberto; Lorito, Matteo; Piccolo, Alessandro

2016-05-11

Trichoderma fungi release 6-pentyl-2H-pyran-2-one (1) and harzianic acid (2) secondary metabolites to improve plant growth and health protection. We isolated metabolites 1 and 2 from Trichoderma strains, whose different concentrations were used to treat seeds of Solanum lycopersicum. The metabolic profile in the resulting 15 day old tomato leaves was studied by high-resolution magic-angle-spinning nuclear magnetic resonance (HRMAS NMR) spectroscopy directly on the whole samples without any preliminary extraction. Principal component analysis (PCA) of HRMAS NMR showed significantly enhanced acetylcholine and γ-aminobutyric acid (GABA) content accompanied by variable amount of amino acids in samples treated with both Trichoderma secondary metabolites. Seed germination rates, seedling fresh weight, and the metabolome of tomato leaves were also dependent upon doses of metabolites 1 and 2 treatments. HRMAS NMR spectroscopy was proven to represent a rapid and reliable technique for evaluating specific changes in the metabolome of plant leaves and calibrating the best concentration of bioactive compounds required to stimulate plant growth.

40 CFR 264.178 - Closure.

Science.gov (United States)

2010-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Use and Management of Containers § 264.178 Closure. At closure, all hazardous waste and hazardous waste residues must be removed...

Peripheral laser iridoplasty opens angle in plateau iris by thinning the cross-sectional tissues

Directory of Open Access Journals (Sweden)

Liu J

2013-09-01

Full Text Available Ji Liu,1,2 Tania Lamba,1 David A Belyea1 1Department of Ophthalmology, The George Washington University, Washington DC, USA; 2Yale Eye Center, Yale University, New Haven, CT, USA Abstract: Plateau iris syndrome has been described as persistent angle narrowing or occlusion with intraocular pressure elevation after peripheral iridotomy due to the abnormal plateau iris configuration. Argon laser peripheral iridoplasty (ALPI is an effective adjunct procedure to treat plateau iris syndrome. Classic theory suggests that the laser causes the contraction of the far peripheral iris stroma, "pulls" the iris away from the angle, and relieves the iris-angle apposition. We report a case of plateau iris syndrome that was successfully treated with ALPI. Spectral domain optical coherence tomography confirmed the angle was open at areas with laser treatment but remained appositionally closed at untreated areas. Further analysis suggested significant cross-sectional thinning of the iris at laser-treated areas in comparison with untreated areas. The findings indicate that APLI opens the angle, not only by contracting the iris stroma, but also by thinning the iris tissue at the crowded angle. This is consistent with the ALPI technique to aim at the iris as far peripheral as possible. This case also suggests that spectral domain optical coherence tomography is a useful adjunct imaging tool to gonioscopy in assessing the angle condition. Keywords: plateau iris, optic coherence tomography, argon laser peripheral iridoplasty, angle-closure glaucoma

Closure report for N Reactor

International Nuclear Information System (INIS)

1994-01-01

This report has been prepared to satisfy Section 3156(b) of Public Law 101-189 (Reports in Connection with Permanent Closures of Department of Energy Defense Nuclear Facilities), which requires submittal of a Closure Report to Congress by the Secretary of Energy upon the permanent cessation of production operations at a US Department of Energy (DOE) defense nuclear facility (Watkins 1991). This closure report provides: (1) A complete survey of the environmental problems at the facility; (2) Budget quality data indicating the cost of environmental restoration and other remediation and cleanup efforts at the facility; (3) A proposed cleanup schedule

Closure report for N Reactor

Energy Technology Data Exchange (ETDEWEB)

1994-01-01

This report has been prepared to satisfy Section 3156(b) of Public Law 101-189 (Reports in Connection with Permanent Closures of Department of Energy Defense Nuclear Facilities), which requires submittal of a Closure Report to Congress by the Secretary of Energy upon the permanent cessation of production operations at a US Department of Energy (DOE) defense nuclear facility (Watkins 1991). This closure report provides: (1) A complete survey of the environmental problems at the facility; (2) Budget quality data indicating the cost of environmental restoration and other remediation and cleanup efforts at the facility; (3) A proposed cleanup schedule.

Femoral Artery Stenosis Following Percutaneous Closure Using a Starclose Closure Device

International Nuclear Information System (INIS)

Bent, Clare Louise; Kyriakides, Constantinos; Matson, Matthew

2008-01-01

Starclose (Abbott Vascular Devices, Redwood City, CA) is a new arterial closure device that seals a femoral puncture site with an extravascular star-shaped nitinol clip. The clip projects small tines into the arterial wall which fold inward, causing the arterial wall to pucker, producing a purse-string-like seal closing the puncture site. The case history is that of a 76-year-old female patient who underwent day-case percutaneous diagnostic coronary angiography. A Starclose femoral artery closure device was used to achieve hemostasis with subsequent femoral artery stenosis.

9 CFR 318.301 - Containers and closures.

Science.gov (United States)

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Containers and closures. 318.301... Canning and Canned Products § 318.301 Containers and closures. (a) Examination and cleaning of empty containers. (1) Empty containers, closures, and flexible pouch roll stock shall be evaluated by the...

75 FR 29322 - Base Closure and Realignment

Science.gov (United States)

2010-05-25

... DEPARTMENT OF DEFENSE Office of the Secretary Base Closure and Realignment AGENCY: Office of...)(ii) of the Defense Base Closure and Realignment Act of 1990. It provides a partial list of military installations closing or realigning pursuant to the 2005 Base Closure and Realignment (BRAC) Report. It also...

Influence of closure, phenolic levels and microoxygenation on Cabernet Sauvignon wine composition after 5 years' bottle storage.

Science.gov (United States)

Han, Guomin; Ugliano, Maurizio; Currie, Bruce; Vidal, Stéphane; Diéval, Jean-Baptiste; Waterhouse, Andrew L

2015-01-01

Wine aging is generally limited by the amount of oxidation, which is dependent on the amount of oxygen entering via the closure. Cabernet Sauvignon wine is well known for its high concentration of tannin, making it an ideal red wine for aging. The impact of closure type after 5 years' bottle aging has been investigated on a 2007 Cabernet Sauvignon red wine, treated with or without polyvinylpolypyrrolidone (PVPP) and micro-oxygenation (Mox). Two oxygen transfer rate (OTR) conditions (16 and 5 µg per day) into 375 mL bottles were obtained by using different synthetic stoppers. Color was evaluated by UV-visible spectrophotometry, carbonyls by 2,4-dinitrophenylhydrazine derivatization, phenolics by high-performance liquid chromatography and sulfur dioxide by the aspiration method. Closure type strongly influenced color parameters involving SO2 bleaching and some phenolics, particularly quercetin, were affected, but there was little effect on carbonyls other than acetaldehyde. PVPP treatment afforded wines with the lowest levels of phenolics and color density, but highest acetaldehyde. Few effects of Mox could be detected. Closure OTR strongly affects sulfur dioxide levels - the primary antioxidant in wine - in aged wine, but phenolic levels substantially alter the secondary reactions of oxidative aging. © 2014 Society of Chemical Industry.

Influence of timing of delayed hard palate closure on articulation skills in 3-year-old Danish children with unilateral cleft lip and palate

DEFF Research Database (Denmark)

Willadsen, Elisabeth; Boers, Maria; Schöps, Antje

2017-01-01

Background Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. Aims To assess the influence of different timing of hard palate closure in a two-stage procedure on articu......Background Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. Aims To assess the influence of different timing of hard palate closure in a two-stage procedure...... on articulation skills in 3-year-olds born with unilateral cleft lip and palate (UCLP). Secondary aims were to compare results with peers without CP, and to investigate if there are gender differences in articulation skills. Furthermore, burden of treatment was to be estimated in terms of secondary surgery...

Closure Welding of Plutonium Bearing Storage Containers

International Nuclear Information System (INIS)

Cannell, G.R.

2002-01-01

A key element in the Department of Energy (DOE) strategy for the stabilization, packaging and storage of plutonium-bearing materials involves closure welding of DOE-STD-3013 Outer Containers (3013 container). The 3013 container provides the primary barrier and pressure boundary preventing release of plutonium-bearing materials to the environment. The final closure (closure weld) of the 3013 container must be leaktight, structurally sound and meet DOE STD 3013 specified criteria. This paper focuses on the development, qualification and demonstration of the welding process for the closure welding of Hanford PFP 3013 outer containers

Prospective, randomized, controlled trial of polymer cable ties versus standard wire closure of midline sternotomy.

Science.gov (United States)

Marasco, Silvana F; Fuller, Louise; Zimmet, Adam; McGiffin, David; Seitz, Michael; Ch'ng, Stephanie; Gangahanumaiah, Shivanand; Bailey, Michael

2018-04-16

Midline sternotomy remains the most common access incision for cardiac operations. Traditionally, the sternum is closed with stainless steel wires. Wires are well known to stretch and break, however, leading to pain, nonunion, and potential deep sternal wound infection. We hypothesized that biocompatible plastic cable ties would achieve a more rigid sternal fixation, reducing postoperative pain and analgesia requirements. A prospective, randomized study compared the ZIPFIX (De Puy Synthes, West Chester, Pa) sternal closure system (n = 58) with standard stainless steel wires (n = 60). Primary outcomes were pain and analgesia requirements in the early postoperative period. Secondary outcome was sternal movement, as assessed by ultrasound at the postoperative follow-up visit. Groups were well matched in demographic and operative variables. There were no significant differences between groups in postoperative pain, analgesia, or early ventilatory requirements. Patients in the ZIPFIX group had significantly more movement in the sternum and manubrium on ultrasound at 4 weeks. ZIPFIX sternal cable ties provide reliable closure but no demonstrable benefit in this study in pain or analgesic requirements relative to standard wire closure after median sternotomy. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

Fuel channel closure and adapter

International Nuclear Information System (INIS)

Cashen, W.S.

1985-01-01

This invention provides a mechanical closure/actuating ram combination particularly suited for use in sealing the ends of the pressure tubes when a CANDU-type reactor is refueled. It provides a cluster that may be inserted into a fuel channel end fitting to provide at least partial closing off of a pressure tube while permitting the disengagement of the fueling machine and its withdrawal from the closure for other purposes. The invention also provides a ram/closure combination wherein the application of loading force to a deformable sealing disk is regulated by a massive load bar component forming part of the fueling machine and being therefore accessible for maintenance or replacement

Restaurant closures

CERN Document Server

Novae Restauration

2012-01-01

Christmas Restaurant closures Please note that the Restaurant 1 and Restaurant 3 will be closed from Friday, 21 December at 5 p.m. to Sunday, 6 January, inclusive. They will reopen on Monday, 7 January 2013.   Restaurant 2 closure for renovation To meet greater demand and to modernize its infrastructure, Restaurant 2 will be closed from Monday, 17 December. On Monday, 14 January 2013, Sophie Vuetaz’s team will welcome you to a renovated self-service area on the 1st floor. The selections on the ground floor will also be expanded to include pasta and pizza, as well as snacks to eat in or take away. To ensure a continuity of service, we suggest you take your break at Restaurant 1 or Restaurant 3 (Prévessin).

Patent ductus arteriosus closure using an Amplatzer(™) ventricular septal defect closure device.

Science.gov (United States)

Fernando, Rajeev; Koranne, Ketan; Loyalka, Pranav; Kar, Biswajit; Gregoric, Igor

2013-01-01

The ductus arteriosus originates from the persistence of the distal portion of the left sixth aortic arch. It connects the descending aorta (immediately distal to the left subclavian artery) to the roof of the main pulmonary artery, near the origin of the left pulmonary artery. Persistence of the duct beyond 48 h after birth is abnormal and results in patent ductus arteriosus (PDA). PDA is rare in adults because it is usually discovered and treated in childhood. Mechanical closure remains the definitive therapy because the patency of ductus arteriosus may lead to multiple complications, depending on the size and flow through the ductus. PDA closure is indicated in patients with symptoms and evidence of left heart enlargement, and in patients with elevated pulmonary pressures when reversal is possible. Transcatheter closure is the preferred technique in adults because it avoids sternotomy, reduces the length of hospital stay and is associated with fewer complications compared with surgery. First demonstrated in 1967, both the technique and the occluder devices used have since evolved. However, designing an ideal PDA occluder has been a challenge due to the variability in size, shape and orientation of PDAs. The present article describes a case involving a 35-year-old woman who presented to the Center for Advanced Heart Failure (Houston, USA) with congestive heart failure due to a large PDA, which was successfully occluded using an Amplatzer (St Jude Medical, USA) muscular ventricular septal defect closure device. The wider waist and dual-retention discs of these ventricular septal defect closure devices may be important factors to consider in the future development of devices for the occlusion of large PDAs.

Temporary Closure of the Open Abdomen: A Systematic Review on Delayed Primary Fascial Closure in Patients with an Open Abdomen

NARCIS (Netherlands)

Boele van Hensbroek, Pieter; Wind, Jan; Dijkgraaf, Marcel G. W.; Busch, Olivier R. C.; Goslings, J. Carel

2009-01-01

Background This study was designed to systematically review the literature to assess which temporary abdominal closure (TAC) technique is associated with the highest delayed primary fascial closure (FC) rate. In some cases of abdominal trauma or infection, edema or packing precludes fascial closure

Special closures for steel drum shipping containers

International Nuclear Information System (INIS)

Bonzon, L.L.; Otts, J.V.

1976-01-01

The objective of this program was to develop special lid closures for typical, steel drum, radioactive material shipping containers. Previous experience and testing had shown that the existing container was adequate to withstand the required environmental tests for certification, but that the lid and closure were just marginally effective. Specifically, the lid closure failed to consistently maintain a tight seal between the container and the lid after drop tests, thus causing the package contents to be vulnerable in the subsequent fire test. Recognizing the deficiency, the United States Energy Research and Development Administration requested the development of new closure(s) which would: (1) be as strong and resistant to a drop as the bottom of the container; (2) have minimal economic impact on the overall container cost; (3) maximize the use of existing container designs; (4) consider crush loads; and (5) result in less dependence on personnel and loading procedures. Several techniques were evaluated and found to be more effective than the standard closure mechanism. Of these, three new closure techniques were designed, fabricated, and proven to be structurally adequate to provide containment when a 454-kg drum was drop tested from 9.14-m onto an unyielding surface. The three designs were: (1) a 152-mm long lid extension or skirt welded to the standard drum lid, (2) a separate inner lid, with 152-mm long skirt and (3) C-clamps used at the container-lid interface. Based upon structural integrity, economic impact, and minimal design change, the lid extension is the recommended special closure

Plasma rich in growth factors eye drops to treat secondary ocular surface disorders in patients with glaucoma.

Science.gov (United States)

Sánchez-Avila, Ronald M; Merayo-Lloves, Jesus; Fernández, Maria Laura; Rodríguez-Gutiérrez, Luis Alberto; Rodríguez-Calvo, Pedro Pablo; Fernández-Vega Cueto, Andres; Muruzabal, Francisco; Orive, Gorka; Anitua, Eduardo

2018-01-01

To evaluate the efficacy and safety of plasma rich in growth factors (PRGF) eye drops in patients with glaucoma with secondary ocular surface disorders (OSDs) due to surgeries and topical hypotensive drugs use. A retrospective case-series study design was used including six patients (eight eyes) diagnosed with glaucoma who received surgical (nonpenetrating deep sclerectomy and/or trabeculectomy) and medical treatments (hypotensive eye drops) to control intraocular pressure (IOP) and who developed secondary OSDs, unresponsive to conventional treatments. Patients were treated with PRGF eye drops (four times a day). Outcome measures were ocular surface disease index (OSDI), best-corrected visual acuity (BCVA, in logarithm of the minimum angle of resolution), visual analog scale (VAS), frequency and severity of symptoms, and IOP. The safety of the treatment was also evaluated. Six patients (seven eyes with open-angle glaucoma and one eye with uveitic glaucoma) treated with PRGF eye drops were evaluated. Mean age was 71 years (SD=7.2, range 58-79 years). Five were female and one was male. The mean treatment time was 21.8 weeks (SD=9.0, range 12-36 weeks). The mean time to reach closure of the corneal ulcer was 14.5 (SD=5.5) weeks. A statistical significant reduction in OSDI scale (50.6%), VAS frequency (53.1%), VAS severity (42.0%), and a 41.8% improvement in BCVA were observed ( p PRGF eye drops until the end of therapy; the remaining patients did not report any AEs during the follow-up period. In patients with glaucoma and secondary OSDs refractive to conventional treatments, the treatment with PRGF eye drops could be considered a possible therapeutic option, because it demonstrates an improvement in the signs and symptoms of the ocular surface, as well as a better control of the IOP. This is an initial research work that can open doors for future research to confirm these findings.

Some Recent Developments in Turbulence Closure Modeling

Science.gov (United States)

Durbin, Paul A.

2018-01-01

Turbulence closure models are central to a good deal of applied computational fluid dynamical analysis. Closure modeling endures as a productive area of research. This review covers recent developments in elliptic relaxation and elliptic blending models, unified rotation and curvature corrections, transition prediction, hybrid simulation, and data-driven methods. The focus is on closure models in which transport equations are solved for scalar variables, such as the turbulent kinetic energy, a timescale, or a measure of anisotropy. Algebraic constitutive representations are reviewed for their role in relating scalar closures to the Reynolds stress tensor. Seamless and nonzonal methods, which invoke a single closure model, are reviewed, especially detached eddy simulation (DES) and adaptive DES. Other topics surveyed include data-driven modeling and intermittency and laminar fluctuation models for transition prediction. The review concludes with an outlook.

Analysis of Mining-induced Valley Closure Movements

Science.gov (United States)

Zhang, C.; Mitra, R.; Oh, J.; Hebblewhite, B.

2016-05-01

Valley closure movements have been observed for decades in Australia and overseas when underground mining occurred beneath or in close proximity to valleys and other forms of irregular topographies. Valley closure is defined as the inward movements of the valley sides towards the valley centreline. Due to the complexity of the local geology and the interplay between several geological, topographical and mining factors, the underlying mechanisms that actually cause this behaviour are not completely understood. A comprehensive programme of numerical modelling investigations has been carried out to further evaluate and quantify the influence of a number of these mining and geological factors and their inter-relationships. The factors investigated in this paper include longwall positional factors, horizontal stress, panel width, depth of cover and geological structures around the valley. It is found that mining in a series passing beneath the valley dramatically increases valley closure, and mining parallel to valley induces much more closure than other mining orientations. The redistribution of horizontal stress and influence of mining activity have also been recognised as important factors promoting valley closure, and the effect of geological structure around the valley is found to be relatively small. This paper provides further insight into both the valley closure mechanisms and how these mechanisms should be considered in valley closure prediction models.

Biomechanics Strategies for Space Closure in Deep Overbite

Directory of Open Access Journals (Sweden)

Harryanto Wijaya

2013-07-01

Full Text Available Space closure is an interesting aspect of orthodontic treatment related to principles of biomechanics. It should be tailored individually based on patient’s diagnosis and treatment plan. Understanding the space closure biomechanics basis leads to achieve the desired treatment objective. Overbite deepening and losing posterior anchorage are the two most common unwanted side effects in space closure. Conventionally, correction of overbite must be done before space closure resulted in longer treatment. Application of proper space closure biomechanics strategies is necessary to achieve the desired treatment outcome. This cases report aimed to show the space closure biomechanics strategies that effectively control the overbite as well as posterior anchorage in deep overbite patients without increasing treatment time. Two patients who presented with class II division 1 malocclusion were treated with fixed orthodontic appliance. The primary strategies included extraction space closure on segmented arch that employed two-step space closure, namely single canine retraction simultaneously with incisors intrusion followed by enmasse retraction of four incisors by using differential moment concept. These strategies successfully closed the space, corrected deep overbite and controlled posterior anchorage simultaneously so that the treatment time was shortened. Biomechanics strategies that utilized were effective to achieve the desired treatment outcome.

Magnetisable container closure and means for its removal

International Nuclear Information System (INIS)

Barrett, W.I.

1984-01-01

A container has a closed lower end and an open upper end, is made of a non-magnetic material such as aluminium, and has a peripheral groove spaced from the open end. A disc-like closure is of magnetic material such as ferritic steel, has a pair of spring jaws joined to the disc by a joining member such that when the disc of the closure is in position closing the open end of the container, the jaws engage in groove and hold the closure in position. To remove the closure, it is engaged by magnetic means mounted for example on a wall and having a step such that when the container is moved laterally away the closure is retained by the magnetic means aided by the step and thereby the closure becomes removed from the container. (author)

Segmental maxillary distraction with a novel device for closure of a wide alveolar cleft.

Science.gov (United States)

Bousdras, Vasilios A; Liyanage, Chandra; Mars, Michael; Ayliffe, Peter R

2014-01-01

Treatment of a wide alveolar cleft with initial application of segmental distraction osteogenesis is reported, in order to minimise cleft size prior to secondary alveolar bone grafting. The lesser maxillary segment was mobilised with osteotomy at Le Fort I level and, a novel distractor, facilitated horizontal movement of the dental/alveolar segment along the curvature of the maxillary dental arch. Following a latency period of 4 days distraction was applied for 7 days at a rate of 0.5 mm twice daily. Radiographic, ultrasonographic and clinical assessment revealed new bone and soft tissue formation 8 weeks after completion of the distraction phase. Overall the maxillary segment did move minimising the width of the cleft, which allowed successful closure with a secondary alveolar bone graft.

Urethrovaginal fistula closure.

Science.gov (United States)

Clifton, Marisa M; Goldman, Howard B

2017-01-01

In the developed world, urethrovaginal fistulas are most the likely the result of iatrogenic injury. These fistulas are quite rare. Proper surgical repair requires careful dissection and tension-free closure. The objective of this video is to demonstrate the identification and surgical correction of an urethrovaginal fistula. The case presented is of a 59-year-old woman with a history of pelvic organ prolapse and symptomatic stress urinary incontinence who underwent vaginal hysterectomy, anterior colporrhaphy, posterior colporrhaphy, and synthetic sling placement. Postoperatively, she developed a mesh extrusion and underwent sling excision. After removal of her synthetic sling, she began to experience continuous urinary incontinence. Physical examination and cystourethroscopy demonstrated an urethrovaginal fistula at the midurethra. Options were discussed and the patient wished to undergo transvaginal fistula repair. The urethrovaginal fistula was intubated with a Foley catheter. The fistula tract was isolated and removed. The urethra was then closed with multiple tension-free layers. This video demonstrates several techniques for identifying and subsequently repairing an urethrovaginal fistula. Additionally, it demonstrates the importance of tension-free closure. Urethrovaginal fistulas are rare. They should be repaired with careful dissection and tension-free closure.

Self-corrective T-loop design for differential space closure.

Science.gov (United States)

Viecilli, Rodrigo F

2006-01-01

The current approach to measuring T-loop force systems in patients requiring differential anchorage does not consider active unit angulations and steps during space closure. The angulations and steps during movement introduced by rotation can considerably modify the force system acting on the teeth. In this study, geometric modifications were determined during controlled tipping of the 6 anterior teeth, where there was no movement of the posterior teeth, thus configuring a type A anchorage situation. An optimal beta-titanium alloy 0.017 x 0.025-in T-loop spring was designed by using a simulation performed with LOOP software (dHAL Orthodontic Software, Athens, Greece) to allow compensation for anterior unit-position effect on the final force system. The force systems produced by this T-loop spring with and without geometric correction of the brackets have significant differences that should be considered in the segmented arch approach to space closure. The effects of steps, angles, and vertical forces were combined to produce an ideal T-loop design that would provide a more determinate force system. The effects and force systems are estimates based on simplified locations of the centers of resistance, assuming relatively constant behavior of the centers of rotation. These simplifications might differ slightly from what happens in vivo. The finite element method or an accurate spring tester capable of reproducing the geometric corrections should be used to ensure a precise force system.

Closure of shallow underground injection wells

International Nuclear Information System (INIS)

Veil, J.A.; Grunewald, B.

1993-01-01

Shallow injection wells have long been used for disposing liquid wastes. Some of these wells have received hazardous or radioactive wastes. According to US Environmental Protection Agency (EPA) regulations, Class IV wells are those injection wells through which hazardous or radioactive wastes are injected into or above an underground source of drinking water (USDW). These wells must be closed. Generally Class V wells are injection wells through which fluids that do not contain hazardous or radioactive wastes are injected into or above a USDW. Class V wells that are responsible for violations of drinking water regulations or that pose a threat to human health must also be closed. Although EPA regulations require closure of certain types of shallow injection wells, they do not provide specific details on the closure process. This paper describes the regulatory background, DOE requirements, and the steps in a shallow injection well closure process: Identification of wells needing closure; monitoring and disposal of accumulated substances; filling and sealing of wells; and remediation. In addition, the paper describes a major national EPA shallow injection well enforcement initiative, including closure plan guidance for wells used to dispose of wastes from service station operations

Reliability assessment of underground shaft closure

International Nuclear Information System (INIS)

Fossum, A.F.; Munson, D.E.

1994-01-01

The intent of the WIPP, being constructed in the bedded geologic salt deposits of Southeastern New Mexico, is to provide the technological basis for the safe disposal of radioactive Transuranic (TRU) wastes generated by the defense programs of the United States. In determining this technological basis, advanced reliability and structural analysis techniques are used to determine the probability of time-to-closure of a hypothetical underground shaft located in an argillaceous salt formation and filled with compacted crushed salt. Before being filled with crushed salt for sealing, the shaft provides access to an underground facility. Reliable closure of the shaft depends upon the sealing of the shaft through creep closure and recompaction of crushed backfill. Appropriate methods are demonstrated to calculate cumulative distribution functions of the closure based on laboratory determined random variable uncertainty in salt creep properties

Relationship between intraocular pressure and angle configuration: an anterior segment OCT study.

Science.gov (United States)

Chong, Rachel S; Sakata, Lisandro M; Narayanaswamy, Arun K; Ho, Sue-Wei; He, Mingguang; Baskaran, Mani; Wong, Tien Yin; Perera, Shamira A; Aung, Tin

2013-03-05

To assess the relationship between intraocular pressure (IOP) and anterior chamber angle (ACA) configuration as assessed by gonioscopy and anterior segment optical coherence tomography (AS-OCT). A total of 2045 subjects aged 50 years and older, were recruited from a community clinic and underwent AS-OCT, Goldmann applanation tonometry, and gonioscopy. A quadrant was classified as closed on gonioscopy if the posterior trabecular meshwork could not be seen. A closed quadrant on AS-OCT was defined by the presence of any contact between the iris and angle wall anterior to the scleral spur. Customized software (Zhongshan Angle Assessment Program, Guangzhou, China) was used to measure AS-OCT parameters on AS-OCT scans, including anterior chamber depth, area, and volume; iris thickness (IT) and curvature; lens vault; angle opening distance; and trabecular-iris space area. IOP values were adjusted for age, sex, diabetes and hypertension status, body mass index, central corneal thickness, and presence of peripheral anterior synechiae. Mean age of study subjects was 63.2 ± 8.0 years, 52.6% were female, and 89.4% were Chinese. Mean IOP was 14.8 ± 2.4 mm Hg (range 826). IOP (mean ± SE) increased with number of quadrants with gonioscopic angle closure (none: 14.6 ± 0.2; one: 14.7 ± 0.3; two: 15.0 ± 0.3; three: 15.0 ± 0.3; four: 15.6 ± 0.3 mm Hg; P gonioscopy, with increasing IOP.

Comparison of cost-effectiveness and postoperative outcome of device closure and open surgery closure techniques for treatment of patent ductus arteriosus

Directory of Open Access Journals (Sweden)

Alireza Ahmadi

2014-01-01

Full Text Available BACKGROUND: Various devices have been recently employed for percutaneous closure of the patent ductus arteriosus (PDA. Although the high effectiveness of device closure techniques has been clearly determined, a few studies have focused on the cost-effectiveness and also postoperative complications of these procedures in comparison with open surgery. The present study aimed to evaluate the clinical outcome and cost-effectiveness of PDA occlusion by Amplatzer and coil device in comparisong with open surgery. METHODS: In this cross-sectional study, a randomized sample of 201 patients aged 1 month to 16 years (105 patients with device closure and 96 patients with surgical closure was selected. The ratio of total pulmonary blood flow to total systemic blood flow, the Qp/Qs ratio, was measured using a pulmonary artery catheter. The cost analysis included direct medical care costs associated with device implantation and open surgery, as well as professional fees. All costs were calculated in Iranian Rials and then converted to US dollars. RESULTS: There was no statistical difference in mean Qp/Qs ratio before the procedure between the device closure group and the open surgery group (2.1 ± 0.7 versus 1.7 ± 0.6, P = 0.090. The mean measured costs were overall higher in the device closure group than in open closure group (948.87 ± 548.76 US$ versus 743.70 ± 696.91 US$, P < 0.001. This difference remained significant after adjustment for age and gender (Standardized Beta = 0.160, P = 0.031. PDA closure with the Amplatzer ductal occluder (1053.05 ± 525.73 US$ or with Nit-Occlud coils (PFM (912.73 ± 565.94 US$, P < 0.001 was more expensive than that via open surgery. However, the Cook detachable spring coils device closure (605.65 ± 194.62 US$, P = 0.650 had a non-significant cost difference with open surgery. No event was observed in the device closure group regarding in-hospital mortality or morbidity; however, in another group, 2 in-hospital deaths

Numerical approximation of the Boltzmann equation : moment closure

NARCIS (Netherlands)

Abdel Malik, M.R.A.; Brummelen, van E.H.

2012-01-01

This work applies the moment method onto a generic form of kinetic equations to simplify kinetic models of particle systems. This leads to the moment closure problem which is addressed using entropy-based moment closure techniques utilizing entropy minimization. The resulting moment closure system

WASTE PACKAGE OPERATIONS FY99 CLOSURE METHODS REPORT

Energy Technology Data Exchange (ETDEWEB)

M. C. Knapp

1999-09-23

The waste package (WP) closure weld development task is part of a larger engineering development program to develop waste package designs. The purpose of the larger waste package engineering development program is to develop nuclear waste package fabrication and closure methods that the Nuclear Regulatory Commission will find acceptable and will license for disposal of spent nuclear fuel (SNF), non-fuel components, and vitrified high-level waste within a Monitored Geologic Repository (MGR). Within the WP closure development program are several major development tasks, which, in turn, are divided into subtasks. The major tasks include: WP fabrication development, WP closure weld development, nondestructive examination (NDE) development, and remote in-service inspection development. The purpose of this report is to present the objectives, technical information, and work scope relating to the WP closure weld development.and NDE tasks and subtasks and to report results of the closure weld and NDE development programs for fiscal year 1999 (FY-99). The objective of the FY-99 WP closure weld development task was to develop requirements for closure weld surface and volumetric NDE performance demonstrations, investigate alternative NDE inspection techniques, and develop specifications for welding, NDE, and handling system integration. In addition, objectives included fabricating several flat plate mock-ups that could be used for NDE development, stress relief peening, corrosion testing, and residual stress testing.

WASTE PACKAGE OPERATIONS FY-99 CLOSURE METHODS REPORT

International Nuclear Information System (INIS)

M. C. Knapp

1999-01-01

The waste package (WP) closure weld development task is part of a larger engineering development program to develop waste package designs. The purpose of the larger waste package engineering development program is to develop nuclear waste package fabrication and closure methods that the Nuclear Regulatory Commission will find acceptable and will license for disposal of spent nuclear fuel (SNF), non-fuel components, and vitrified high-level waste within a Monitored Geologic Repository (MGR). Within the WP closure development program are several major development tasks, which, in turn, are divided into subtasks. The major tasks include: WP fabrication development, WP closure weld development, nondestructive examination (NDE) development, and remote in-service inspection development. The purpose of this report is to present the objectives, technical information, and work scope relating to the WP closure weld development.and NDE tasks and subtasks and to report results of the closure weld and NDE development programs for fiscal year 1999 (FY-99). The objective of the FY-99 WP closure weld development task was to develop requirements for closure weld surface and volumetric NDE performance demonstrations, investigate alternative NDE inspection techniques, and develop specifications for welding, NDE, and handling system integration. In addition, objectives included fabricating several flat plate mock-ups that could be used for NDE development, stress relief peening, corrosion testing, and residual stress testing

T-tube vs Primary Common Bile Duct Closure

Directory of Open Access Journals (Sweden)

M R Joshi

2010-09-01

Full Text Available INTRODUCTION: Closure of the common bile duct over T-tube after exploration is a widely practiced traditional method. However, its use may give rise to many complications. We do primary closure of common bile duct after exploration. Aim of the study is to see the efficacy and safety of the primary closure. METHODS: Study was carried out to compare the results of both the techniques from 2006 to 2009 in the cases proven to have common bile duct stone with or without the features of obstructive jaundice. Post operative hospital stay and morbidities related to both the groups were recorded and analyzed. RESULTS: There were total 71 cases included in the study. Thirty one in T-tube group and 40 in primary closure group. T-tube was removed in most of the cases after three weeks where as average time of drain removal in primary closure group is 5.79 +/-1.79 days. Incidence of retained stone was equal in each group. Major complication in T-tube group is biliary peritonitis in four patients at the time of T-tube removal whereas none of the patient from primary closure group suffered from such major complication. CONCLUSIONS: Primary closure after the common bile duct exploration is safe and it helps to avoid the morbidities related to T-tube. Keywords: Choledocholithiasis, Primary closure, retained stone, T-tube, Ureterorenoscope.

Techniques for Abdominal Wall Closure after Damage Control Laparotomy: From Temporary Abdominal Closure to Early/Delayed Fascial Closure—A Review

Directory of Open Access Journals (Sweden)

Qian Huang

2016-01-01

Full Text Available Open abdomen (OA has been an effective treatment for abdominal catastrophes in traumatic and general surgery. However, management of patients with OA remains a formidable task for surgeons. The central goal of OA is closure of fascial defect as early as is clinically feasible without precipitating abdominal compartment syndrome. Historically, techniques such as packing, mesh, and vacuum-assisted closure have been developed to assist temporary abdominal closure, and techniques such as components separation, mesh-mediated traction, bridging fascial defect with permanent synthetic mesh, or biologic mesh have also been attempted to achieve early primary fascial closure, either alone or in combined use. The objective of this review is to present the challenges of these techniques for OA with a goal of early primary fascial closure, when the patient’s physiological condition allows.

Uncertainty Quantification of Multi-Phase Closures

Energy Technology Data Exchange (ETDEWEB)

Nadiga, Balasubramanya T. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Baglietto, Emilio [Massachusetts Inst. of Technology (MIT), Cambridge, MA (United States)

2017-10-27

In the ensemble-averaged dispersed phase formulation used for CFD of multiphase ows in nuclear reactor thermohydraulics, closures of interphase transfer of mass, momentum, and energy constitute, by far, the biggest source of error and uncertainty. Reliable estimators of this source of error and uncertainty are currently non-existent. Here, we report on how modern Validation and Uncertainty Quanti cation (VUQ) techniques can be leveraged to not only quantify such errors and uncertainties, but also to uncover (unintended) interactions between closures of di erent phenomena. As such this approach serves as a valuable aide in the research and development of multiphase closures. The joint modeling of lift, drag, wall lubrication, and turbulent dispersion|forces that lead to tranfer of momentum between the liquid and gas phases|is examined in the frame- work of validation of the adiabatic but turbulent experiments of Liu and Banko , 1993. An extensive calibration study is undertaken with a popular combination of closure relations and the popular k-ϵ turbulence model in a Bayesian framework. When a wide range of super cial liquid and gas velocities and void fractions is considered, it is found that this set of closures can be validated against the experimental data only by allowing large variations in the coe cients associated with the closures. We argue that such an extent of variation is a measure of uncertainty induced by the chosen set of closures. We also nd that while mean uid velocity and void fraction pro les are properly t, uctuating uid velocity may or may not be properly t. This aspect needs to be investigated further. The popular set of closures considered contains ad-hoc components and are undesirable from a predictive modeling point of view. Consequently, we next consider improvements that are being developed by the MIT group under CASL and which remove the ad-hoc elements. We use non-intrusive methodologies for sensitivity analysis and calibration (using

HDR-investigations of check valve closure and resultant water hammer effects

International Nuclear Information System (INIS)

Scholl, K.D.

1983-01-01

The presented investigations are based on the Loss of Coolant Accident (LOCA). They concentrate on the first blowdown phase after pipe break of a feedwater line. The effect of such a break is moderated by quick closing check valves, by which the loss of coolant water is reduced and optimal post accident conditions are obtained. Unfortunately the closure of the valve can cause high pressure peaks (water hammer effects) in the feedwater system which potentially could produce safety relevant secondary damage. The system loading by these effects has been analysed. The HDR-Investigation-results led to an improvement of the feedwater system safety by verifying damping measures of quick closing check valves. Pressure peaks obtained with undamped valves in the range of 300 bars, are reduced to zero or a few bars above the normal operation pressure in feedwater systems. For the analytical simulation of valve closure the following dominant acting forces are identified: the blowdown flow resistance of the valve cone and the damping pistong force. The analytical description and quantification of the forces depends on blowdown flow and valve friction parameters. These have been evaluated and are presented for practical use. (orig.)

Factors affecting closure of a temporary stoma.

Science.gov (United States)

Taylor, Claire; Varma, Sarah

2012-01-01

The purpose of the study was to examine time to reversal of a temporary ostomy, reasons for delayed closure, and patient satisfaction with the scheduling of their closure and related hospital care. Cross-sectional, descriptive study. The target population comprised patients who underwent creation of a temporary ostomy and reversal surgery within one National Health System Hospital Trust in the United Kingdom. The population served by this Trust are ethnically and socioeconomically diverse, predominantly living in urban areas around Greater London. Sixty-one persons who met inclusion criteria were identified. A two-step analytical process was undertaken. First, a literature review examining incidence and causes of delayed stoma closure was undertaken. Second, a postal survey of all patients who had had their stoma closed in 2009 was conducted. Respondents were allowed 2 weeks to complete and return the questionnaire. The survey instrument was developed locally and subjected to content validation using ostomy patients, surgical and nursing colleagues. It consisted of 9 questions querying time from original surgery to closure, reasons for delaying closure surgery beyond 12 weeks, and satisfaction with care. Twenty-seven patients returned their questionnaires, indicating they consented to participate; a response rate of 44%. Half of the respondents (n = 14 [52%]) underwent closure surgery within 6 months of stoma formation; the remaining 48% waited more than 6 months (median: 6.5 months, range: 1.5-26 months). Thirteen patients (48%) reported a delay in receiving their stoma closure; the main reason cited was the need for a course of adjuvant postoperative chemotherapy. Three quarters of respondents (22 [74%]) were satisfied with the overall care they received. Findings from this study suggest that stoma closure may be associated with fewest complications if performed before 12 weeks.

CIRSE Vascular Closure Device Registry

International Nuclear Information System (INIS)

Reekers, Jim A.; Müller-Hülsbeck, Stefan; Libicher, Martin; Atar, Eli; Trentmann, Jens; Goffette, Pierre; Borggrefe, Jan; Zeleňák, Kamil; Hooijboer, Pieter; Belli, Anna-Maria

2011-01-01

Purpose: Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. Methods: The CIRSE registry of closure devices with an anchor and a plug started in January 2009 and ended in August 2009. A total of 1,107 patients were included in the registry. Results: Deployment success was 97.2%. Deployment failure specified to access type was 8.8% [95% confidence interval (95% CI) 5.0–14.5] for antegrade access and 1.8% (95% CI 1.1–2.9) for retrograde access (P = 0.001). There was no difference in deployment failure related to local PVD at the access site. Calcification was a reason for deployment failure in only 5.9 cm, and two vessel occlusions. Conclusion: The conclusion of this registry of closure devices with an anchor and a plug is that the use of this device in interventional radiology procedures is safe, with a low incidence of serious access site complications. There seems to be no difference in complications between antegrade and retrograde access and other parameters.

40 CFR 267.143 - Financial assurance for closure.

Science.gov (United States)

2010-07-01

...), utilizing the certificate of insurance for closure specified at 40 CFR 264.151(e). (f) Corporate financial... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Financial assurance for closure. 267... PERMIT Financial Requirements § 267.143 Financial assurance for closure. The owner or operator must...

Tubular closure mechanism

International Nuclear Information System (INIS)

Kalen, D.D.; Mitchem, J.W.

1982-01-01

This invention relates to a closure mechanism for tubular irradiation surveillance specimen assembly holder used in nuclear reactors. The closure mechanism is composed of a latching member which includes a generally circular chamber with a plurality of elongated latches depending therefrom. The latching member circumscribes part of an actuator member which is disposed within the latching member so as to be axially movable. The axial movement of the actuator actuates positioning of the latches between positions in which the latches are locked and secured within the actuator member. Means, capable of being remotely manipulated, are provided to move the actuator in order to position the latches and load the articles within the tube

Design and analysis of PCRV core cavity closure

International Nuclear Information System (INIS)

Lee, T.T.; Schwartz, A.A.; Koopman, D.C.A.

1980-05-01

Design requirements and considerations for a core cavity closure which led to the choice of a concrete closure with a toggle hold-down as the design for the Gas-Cooled Fast Breeder Reactor (GCFR) plant are discussed. A procedure for preliminary stress analysis of the closure by means of a three-dimensional finite element method is described. A limited parametric study using this procedure indicates the adequacy of the present closure design and the significance of radial compression developed as a result of inclined support reaction

40 CFR 265.280 - Closure and post-closure.

Science.gov (United States)

2010-07-01

... contaminants caused by wind erosion; and (4) Compliance with § 265.276 concerning the growth of food-chain... and post-closure care objectives of paragraph (a) of this section: (1) Type and amount of hazardous..., including amount, frequency, and pH of precipitation; (5) Geological and soil profiles and surface and...

Airport Movement Area Closure Planner, Phase I

Data.gov (United States)

National Aeronautics and Space Administration — This SBIR research develops an automation tool improving temporary and permanent runway closure management. The Movement Area Closure Planner (MACP) provides airport...

Left ventricular remodeling and change of systolic function after closure of patent ductus arteriosus in adults: device and surgical closure.

Science.gov (United States)

Jeong, Young-Hoon; Yun, Tae-Jin; Song, Jong-Min; Park, Jung-Jun; Seo, Dong-Man; Koh, Jae-Kon; Lee, Se-Whan; Kim, Mi-Jeong; Kang, Duk-Hyun; Song, Jae-Kwan

2007-09-01

Left ventricular (LV) remodeling and predictors of LV systolic function late after closure of patent ductus arteriosus (PDA) in adults remain to be clearly demonstrated. In 45 patients with PDA, including 28 patients who received successful occlusion using the Amplatzer device (AD group) (AGA, Golden Valley, MN) and 17 patients who received surgical closure (OP group), echocardiography studies were performed before closure and 1 day (AD group) or within 7 days (OP group) after closure, and then were repeated at > or = 6 months (17 +/- 13 months). In both groups, LV ejection fraction (EF) and end-diastolic volume index were significantly decreased immediately after closure, whereas end-systolic volume index did not change. During the long-term follow-up period, end-systolic as well as end-diastolic volume indices decreased significantly in both groups and LV EF recovered compared to the immediate postclosure state. However, LV EF remained low compared to the preclosure state. Five patients (11.1%) including 3 patients in the AD group and 2 patients in the OP group showed persistent late LV systolic dysfunction (EF or = 62% had a sensitivity of 72% and a specificity of 83% for predicting late normal LV EF after closure. Left ventricular EF remains low late after PDA closure compared with preclosure state in adults. Preclosure LV EF is the best index to predict late postclosure LV EF.

Interventional Closure of a Patent Ductus Arteriosus Using an Amplatz Canine Duct Occluder in an Alpaca Cria

OpenAIRE

Chapel, E.C.; Lozier, J.; Lakritz, J.; Schober, K.E.

2017-01-01

A 6?month old female alpaca cria presented to The Ohio State University for evaluation of a cardiac murmur. Echocardiography revealed a left?to?right shunting patent ductus arteriosus, a restrictive left?to?right shunting perimembranous ventricular septal defect, and secondary moderate left atrial and ventricular dilation. Aortic root angiography demonstrated a type IIA patent ductus arteriosus (PDA). Interventional closure of the PDA was successfully performed, without complication, using an...

Single-site neural tube closure in human embryos revisited.

Science.gov (United States)

de Bakker, Bernadette S; Driessen, Stan; Boukens, Bastiaan J D; van den Hoff, Maurice J B; Oostra, Roelof-Jan

2017-10-01

Since the multi-site closure theory was first proposed in 1991 as explanation for the preferential localizations of neural tube defects, the closure of the neural tube has been debated. Although the multi-site closure theory is much cited in clinical literature, single-site closure is most apparent in literature concerning embryology. Inspired by Victor Hamburgers (1900-2001) statement that "our real teacher has been and still is the embryo, who is, incidentally, the only teacher who is always right", we decided to critically review both theories of neural tube closure. To verify the theories of closure, we studied serial histological sections of 10 mouse embryos between 8.5 and 9.5 days of gestation and 18 human embryos of the Carnegie collection between Carnegie stage 9 (19-21 days) and 13 (28-32 days). Neural tube closure was histologically defined by the neuroepithelial remodeling of the two adjoining neural fold tips in the midline. We did not observe multiple fusion sites in neither mouse nor human embryos. A meta-analysis of case reports on neural tube defects showed that defects can occur at any level of the neural axis. Our data indicate that the human neural tube fuses at a single site and, therefore, we propose to reinstate the single-site closure theory for neural tube closure. We showed that neural tube defects are not restricted to a specific location, thereby refuting the reasoning underlying the multi-site closure theory. Clin. Anat. 30:988-999, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Moment Closure for the Stochastic Logistic Model

National Research Council Canada - National Science Library

Singh, Abhyudai; Hespanha, Joao P

2006-01-01

..., which we refer to as the moment closure function. In this paper, a systematic procedure for constructing moment closure functions of arbitrary order is presented for the stochastic logistic model...

Comparison of cost-effectiveness and postoperative outcome of device closure and open surgery closure techniques for treatment of patent ductus arteriosus.

Science.gov (United States)

Ahmadi, Alireza; Sabri, Mohammadreza; Bigdelian, Hamid; Dehghan, Bahar; Gharipour, Mojgan

2014-01-01

Various devices have been recently employed for percutaneous closure of the patent ductus arteriosus (PDA). Although the high effectiveness of device closure techniques has been clearly determined, a few studies have focused on the cost-effectiveness and also postoperative complications of these procedures in comparison with open surgery. The present study aimed to evaluate the clinical outcome and cost-effectiveness of PDA occlusion by Amplatzer and coil device in comparisong with open surgery. In this cross-sectional study, a randomized sample of 201 patients aged 1 month to 16 years (105 patients with device closure and 96 patients with surgical closure) was selected. The ratio of total pulmonary blood flow to total systemic blood flow, the Qp/Qs ratio, was measured using a pulmonary artery catheter. The cost analysis included direct medical care costs associated with device implantation and open surgery, as well as professional fees. All costs were calculated in Iranian Rials and then converted to US dollars. There was no statistical difference in mean Qp/Qs ratio before the procedure between the device closure group and the open surgery group (2.1 ± 0.7 versus 1.7 ± 0.6, P = 0.090). The mean measured costs were overall higher in the device closure group than in open closure group (948.87 ± 548.76 US$ versus 743.70 ± 696.91 US$, P gender (Standardized Beta = 0.160, P = 0.031). PDA closure with the Amplatzer ductal occluder (1053.05 ± 525.73 US$) or with Nit-Occlud coils (PFM) (912.73 ± 565.94 US$, P < 0.001) was more expensive than that via open surgery. However, the Cook detachable spring coils device closure (605.65 ± 194.62 US$, P = 0.650) had a non-significant cost difference with open surgery. No event was observed in the device closure group regarding in-hospital mortality or morbidity; however, in another group, 2 in-hospital deaths occurred, two patients experienced pneumonia and seizure, and one suffered electrolyte abnormalities including

Mass extraction container closure integrity physical testing method development for parenteral container closure systems.

Science.gov (United States)

Yoon, Seung-Yil; Sagi, Hemi; Goldhammer, Craig; Li, Lei

2012-01-01

Container closure integrity (CCI) is a critical factor to ensure that product sterility is maintained over its entire shelf life. Assuring the CCI during container closure (C/C) system qualification, routine manufacturing and stability is important. FDA guidance also encourages industry to develop a CCI physical testing method in lieu of sterility testing in a stability program. A mass extraction system has been developed to check CCI for a variety of container closure systems such as vials, syringes, and cartridges. Various types of defects (e.g., glass micropipette, laser drill, wire) were created and used to demonstrate a detection limit. Leakage, detected as mass flow in this study, changes as a function of defect length and diameter. Therefore, the morphology of defects has been examined in detail with fluid theories. This study demonstrated that a mass extraction system was able to distinguish between intact samples and samples with 2 μm defects reliably when the defect was exposed to air, water, placebo, or drug product (3 mg/mL concentration) solution. Also, it has been verified that the method was robust, and capable of determining the acceptance limit using 3σ for syringes and 6σ for vials. Sterile products must maintain their sterility over their entire shelf life. Container closure systems such as those found in syringes and vials provide a seal between rubber and glass containers. This seal must be ensured to maintain product sterility. A mass extraction system has been developed to check container closure integrity for a variety of container closure systems such as vials, syringes, and cartridges. In order to demonstrate the method's capability, various types of defects (e.g., glass micropipette, laser drill, wire) were created in syringes and vials and were tested. This study demonstrated that a mass extraction system was able to distinguish between intact samples and samples with 2 μm defects reliably when the defect was exposed to air, water

105-DR Large Sodium Fire Facility closure activities evaluation report

International Nuclear Information System (INIS)

Adler, J.G.

1996-01-01

This report evaluates the closure activities at the 105-DR Large Sodium Fire Facility. The closure activities discussed include: the closure activities for the structures, equipment, soil, and gravel scrubber; decontamination methods; materials made available for recycling or reuse; and waste management. The evaluation compares these activities to the regulatory requirements and closure plan requirements. The report concludes that the areas identified in the closure plan can be clean closed

Storage shaft definitive closure plug and method

International Nuclear Information System (INIS)

Dardaine, M.

1992-01-01

A definitive closure plug system for radioactive waste storage at any deepness, is presented. The inherent weight of the closure materials is used to set in the plug: these materials display an inclined sliding surface in such a way that when the closure material rests on a stable surface of the shaft storage materials, the relative sliding of the different materials tends to spread them towards the shaft internal wall so as to completely occlude the shaft

Transcatheter coil occluder for closure of ventricular septal defect (a report of 4 cases)

International Nuclear Information System (INIS)

Gao Wei; Zhou Aiqing; Yu Zhiqing; Li Fen; Zhong Yumin; Zhang Yuqi; Huang Meirong; Sun Kun

2005-01-01

Objective: To explore the indication, methodology and complication of transcatheter coil closure of ventricular septal defect (VSD) in children. Methods: Transcatheter closure of perimembranous VSD with coils was performed in 4 cases from 2003 to 2005. The Duct-Occlude (pfm) and detachable coil (Cook) were chosen for embolization depending on the results of the left ventricular angiogram. The coil size was generally about 1-4 mm larger than the diameter of VSD. Follow up was carried out with echocardiography, ultrasound and clinical examination. Results: The defect diameters of the four cases were 2.0 mm, 2.7 mm, 2.5 mm and 1.5 mm respectively. The Duct-Occlude were successfully implanted in 3 cases of perimembranous VSD with the same type coil (OD[mm]7-3-6, windings 5-3-4) for each. One detachable coil (Cook) (5 x 5) was implanted in the remaining case. All cases had trivial residual shunt immediately after implantation which disappeared 24 hours later. Follow-up for 2 months to one year showed no coil displacement and secondary bacterial arteritis. No tricuspid and aortic regurgitation, no emboli, no endocarditis, and no arrhythmia were found. Conclusions: Coil closure of some small VSD with membranate part pseudo-ventricular aneurysm has good efficacy with the advantages of simple operation, less metal content and mini-invasion also applicable for infants. (authors)

Iridotomy with red krypton laser.

Science.gov (United States)

Yassur, Y; David, R; Rosenblatt, I; Marmour, U

1986-01-01

Iridotomy with red krypton laser instead of blue-green argon laser was performed on 68 eyes with various types of angle-closure glaucoma. Patent iridotomy was obtained in all the eyes, mostly in one working session. In eight eyes secondary closure by pigment needed reopening with a few applications at the iridotomy site. There were no immediate or late complications of importance, the main advantage of the technique being the avoidance of the corneal epithelial and endothelial burns which commonly occur during argon laser iridotomy, particularly when the anterior chamber is shallow. PMID:3964628

The potential migration effect of rural hospital closures

DEFF Research Database (Denmark)

Sørensen, Jens Fyhn Lykke

2008-01-01

to out-migration, although the hypothetical way of questioning leaves uncertainty about the actual scale of out-migration. Child families appear to be the most likely out-migrants. Elderly people may be hardest hit by a hospital closure, being most reliant on health care and least inclined to move away.......Rural hospital closures are high on the current health care agenda in Denmark. One raised concern is that rural hospital closures may further decrease population numbers in rural areas, as closures may induce some residents to move away from affected areas, i.e. closer to health care services...

304 Concretion facility closure plan

International Nuclear Information System (INIS)

1990-04-01

The Hanford Site, located northwest of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials. The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. Recyclable scrap uranium Zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/Zircaloy-2 alloy, and Zircaloy-2 chips and fines were secured in concrete billets in the 304 Concretion Facility, located in the 300 Area. The beryllium/Zircaloy-2 alloy and Zircaloy-2 chips and fines are designated as low-level radioactive mixed waste (LLRMW) with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 304 Concretion Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act of 1976 (RCRA). This closure plan presents a description of the facility, the history of materials and wastes managed, and the procedures that will be followed to close the 304 Concretion Facility (304 Facility). Clean closure of the 304 Facility is the proposed method for closure of the facility. Justification for this proposal is presented. 15 refs., 22 figs., 4 tabs

CIRSE Vascular Closure Device Registry

Science.gov (United States)

Müller-Hülsbeck, Stefan; Libicher, Martin; Atar, Eli; Trentmann, Jens; Goffette, Pierre; Borggrefe, Jan; Zeleňák, Kamil; Hooijboer, Pieter; Belli, Anna-Maria

2010-01-01

Purpose Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. Methods The CIRSE registry of closure devices with an anchor and a plug started in January 2009 and ended in August 2009. A total of 1,107 patients were included in the registry. Results Deployment success was 97.2%. Deployment failure specified to access type was 8.8% [95% confidence interval (95% CI) 5.0–14.5] for antegrade access and 1.8% (95% CI 1.1–2.9) for retrograde access (P = 0.001). There was no difference in deployment failure related to local PVD at the access site. Calcification was a reason for deployment failure in only 5.9 cm, and two vessel occlusions. Conclusion The conclusion of this registry of closure devices with an anchor and a plug is that the use of this device in interventional radiology procedures is safe, with a low incidence of serious access site complications. There seems to be no difference in complications between antegrade and retrograde access and other parameters. PMID:20981425

200 West Ash Pit Demolition Site closure plan

International Nuclear Information System (INIS)

1992-11-01

The Hanford Facility is owned by the US Government and operated by the US Department of Energy, Richland Field Office. Dangerous waste and mixed waste (containing both radioactive and dangerous components) are managed and produced on the Hanford Facility. Westinghouse Hanford Company is a major contractor to the US Department of Energy, Richland Field Office and serves as cooperator of the 200 West Ash Pit Demolition Site, the unit addressed in this closure plan. The 200 West Ash Pit Demolition Site Closure Plan consists of a Part A Permit Application (Revision 3) and a closure plan. An explanation of the Part A Permit Application revision is provided at the beginning of the Part A section. The closure plan consists of nine chapters and three appendices. This 200 West Ash Pit Demolition Site Closure Plan submittal contains information current as of October 15, 1992

Deep learning methods for protein torsion angle prediction.

Science.gov (United States)

Li, Haiou; Hou, Jie; Adhikari, Badri; Lyu, Qiang; Cheng, Jianlin

2017-09-18

Deep learning is one of the most powerful machine learning methods that has achieved the state-of-the-art performance in many domains. Since deep learning was introduced to the field of bioinformatics in 2012, it has achieved success in a number of areas such as protein residue-residue contact prediction, secondary structure prediction, and fold recognition. In this work, we developed deep learning methods to improve the prediction of torsion (dihedral) angles of proteins. We design four different deep learning architectures to predict protein torsion angles. The architectures including deep neural network (DNN) and deep restricted Boltzmann machine (DRBN), deep recurrent neural network (DRNN) and deep recurrent restricted Boltzmann machine (DReRBM) since the protein torsion angle prediction is a sequence related problem. In addition to existing protein features, two new features (predicted residue contact number and the error distribution of torsion angles extracted from sequence fragments) are used as input to each of the four deep learning architectures to predict phi and psi angles of protein backbone. The mean absolute error (MAE) of phi and psi angles predicted by DRNN, DReRBM, DRBM and DNN is about 20-21° and 29-30° on an independent dataset. The MAE of phi angle is comparable to the existing methods, but the MAE of psi angle is 29°, 2° lower than the existing methods. On the latest CASP12 targets, our methods also achieved the performance better than or comparable to a state-of-the art method. Our experiment demonstrates that deep learning is a valuable method for predicting protein torsion angles. The deep recurrent network architecture performs slightly better than deep feed-forward architecture, and the predicted residue contact number and the error distribution of torsion angles extracted from sequence fragments are useful features for improving prediction accuracy.

Assessment of consistent two-equation closure for forest flows

DEFF Research Database (Denmark)

Sogachev, Andrey; Cavar, Dalibor; Bechmann, Andreas

of grid turbulence and wall-bounded flow, the closure suggested is also valid for homogeneous shear flows commonly observed inside tall vegetative canopies. The present work assess the plant drag closure by comparing results of two different CFD models against observations derived over the forested area...... and can be applied for any twoequation closure. Results derived by different CFD models with k-epsilon and k-omega closure are similar and in good comparison with observations. Overall, numerical results show that the closure performs well, opening new possibilities for application to tasks related...... to the atmospheric boundary layer—where it is important to adequately account for the influences of vegetation....

A successful environmental remediation program closure and post-closure activities (CAPCA) Y-12 Plant, Oak Ridge, Tennessee

International Nuclear Information System (INIS)

Bowers, M.H.

1991-01-01

The Resource Conservation and Recovery Act (RCRA) closure of eleven waste management units at the Department of Energy's (DOE's) Oak Ridge Y-12 Plant is nearing completion. The Oak Ridge Y-12 Plant is managed by Martin Marietta Energy Systems, Inc. for the US Department of Energy under Contract DE-AC05-84OR21400. The Closure and Post Closure Program (CAPCA) has been accomplished on an accelerated schedule through the efforts of a dedicated team from several organizations. This paper relates experience gained from the program that can be of benefit on other DOE environmental remediation projects. Technical design and construction aspects, as well as project management considerations, are discussed

Evaluation of Container Closure System Integrity for Frozen Storage Drug Products.

Science.gov (United States)

Nieto, Alejandra; Roehl, Holger; Brown, Helen; Nikoloff, Jonas; Adler, Michael; Mahler, Hanns-Christian

2016-01-01

Sometimes, drug product for parenteral administration is stored in a frozen state (e.g., -20 °C or -80 °C), particularly during early stages of development of some biotech molecules in order to provide sufficient stability. Shipment of frozen product could potentially be performed in the frozen state, yet possibly at different temperatures, for example, using dry ice (-80 °C). Container closure systems of drug products usually consist of a glass vial, rubber stopper, and an aluminum crimped cap. In the frozen state, the glass transition temperature (Tg) of commonly used rubber stoppers is between -55 and -65 °C. Below their Tg, rubber stoppers are known to lose their elastic properties and become brittle, and thus potentially fail to maintain container closure integrity in the frozen state. Leaks during frozen temperature storage and transportation are likely to be transient, yet, can possibly risk container closure integrity and lead to microbial contamination. After thawing, the rubber stopper is supposed to re-seal the container closure system. Given the transient nature of the possible impact on container closure integrity in the frozen state, typical container closure integrity testing methods (used at room temperature conditions) are unable to evaluate and thus confirm container closure integrity in the frozen state. Here we present the development of a novel method (thermal physical container closure integrity) for direct assessment of container closure integrity by a physical method (physical container closure integrity) at frozen conditions, using a modified He leakage test. In this study, different container closure systems were evaluated with regard to physical container closure integrity in the frozen state to assess the suitability of vial/stopper combinations and were compared to a gas headspace method. In summary, the thermal physical container closure integrity He leakage method was more sensitive in detecting physical container closure

Considerations for closure of low-level radioactive waste engineered disposal facilities

International Nuclear Information System (INIS)

1992-01-01

Proper stabilization and closure of low-level radioactive waste disposal facilities require detailed planning during the early stages of facility development. This report provides considerations for host States, compact regions, and unaffiliated States on stabilization and closure of engineered low-level radioactive waste and mixed waste disposal facilities. A time line for planning closure activities, which identifies closure considerations to be addressed during various stages of a facility's development, is presented. Current Federal regulatory requirements and guidance for closure and post-closure are outlined. Significant differences between host State and Federal closure requirements are identified. Design features used as stabilization measures that support closure, such as waste forms and containers, backfill materials, engineered barrier systems, and site drainage systems, are described. These design features are identified and evaluated in terms of how they promote long-term site stability by minimizing water infiltration, controlling subsidence and surface erosion, and deterring intrusion. Design and construction features critical to successful closure are presented for covers and site drainage. General considerations for stabilization and closure operations are introduced. The role of performance and environmental monitoring during closure is described

Tank closure reducing grout

International Nuclear Information System (INIS)

Caldwell, T.B.

1997-01-01

A reducing grout has been developed for closing high level waste tanks at the Savannah River Site in Aiken, South Carolina. The grout has a low redox potential, which minimizes the mobility of Sr 90 , the radionuclide with the highest dose potential after closure. The grout also has a high pH which reduces the solubility of the plutonium isotopes. The grout has a high compressive strength and low permeability, which enhances its ability to limit the migration of contaminants after closure. The grout was designed and tested by Construction Technology Laboratories, Inc. Placement methods were developed by the Savannah River Site personnel

Socket sclerosis--an obstacle for orthodontic space closure?

Science.gov (United States)

Baumgaertel, Sebastian

2009-07-01

Socket sclerosis is a rare reaction to tooth extraction resulting in high-density bone in the center of the alveolar process, where, under normal circumstances, cancellous bone is to be expected. In an adult orthodontic patient, routine extractions of the mandibular first permanent bicuspids were performed, resulting in socket sclerosis and unsuccessful orthodontic space closure. Orthodontic mini-implants were inserted to augment anchorage and aid in space closure. In the presence of socket sclerosis, conventional orthodontic mechanics failed to close the extraction spaces. However, with absolute anchorage in place, space closure occurred at a nearly normal rate. After treatment, no signs of socket sclerosis were discernible on the periapical radiographs. Socket sclerosis can be an obstacle for orthodontic space closure if traditional mechanics are employed. However, mini-implant-reinforced anchorage can lead to successful space closure, resulting in complete resolution of the sclerotic sites.

Primary closure of equine laryngotomy incisions

DEFF Research Database (Denmark)

Lindegaard, C.; Karlsson, L.; Ekstrøm, Claus Thorn

2016-01-01

incision between January 1995 and June 2012 were reviewed. Horses with a laryngotomy incision closed in three layers for primary healing were included. Descriptive data on healing characteristics and complications of laryngotomy wounds were collected from the medical records and via follow......The objective was to report healing characteristics and complications after primary closure of equine laryngotomies and analyse factors potentially associated with complications. This retrospective case series of the medical records of horses (n = 180) undergoing laryngoplasty and laryngotomy...... after primary closure of equine laryngotomy incisions are infrequent and considered of minimal severity and can be performed safely when paying careful attention to the closure of the cricothyroid membrane....

Detailed design report for an operational phase panel-closure system

International Nuclear Information System (INIS)

1996-01-01

Under contract to Westinghouse Electric Corporation (Westinghouse), Waste Isolation Division (WID), IT Corporation has prepared a detailed design of a panel-closure system for the Waste Isolation Pilot Plant (WIPP). Preparation of this detailed design of an operational-phase closure system is required to support a Resource Conservation and Recovery Act (RCRA) Part B permit application and a non-migration variance petition. This report describes the detailed design for a panel-closure system specific to the WIPP site. The recommended panel-closure system will adequately isolate the waste-emplacement panels for at least 35 years. This report provides detailed design and material engineering specifications for the construction, emplacement, and interface-grouting associated with a panel-closure system at the WIPP repository, which would ensure that an effective panel-closure system is in place for at least 35 years. The panel-closure system provides assurance that the limit for the migration of volatile organic compounds (VOC) will be met at the point of compliance, the WIPP site boundary. This assurance is obtained through the inherent flexibility of the panel-closure system

Percutaneous Transcatheter PDA Device Closure in Infancy

International Nuclear Information System (INIS)

Ullah, M.; Sultan, M.; Akhtar, K.; Sadiq, N.; Akbar, H.

2014-01-01

Objective: To evaluate the results and complications associated with transcatheter closure of patent ductus arteriosus (PDA) in infants. Study Design: Quasi-experimental study. Place and Duration of Study: Paediatric Cardiology Department of Armed Forces Institute of Cardiology / National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, from December 2010 to June 2012. Methodology: Infants undergoing transcatheter device closure of PDA were included. All patients were evaluated by experienced Paediatric Cardiologists with 2-D echocardiography and Doppler before the procedure. Success of closure and complications were recorded. Results: The age of patients varied from 05 - 12 months and 31 (56.4%) were females. Out of the 55 infants, 3 (5.4%) were not offered device closure after aortogram (two large tubular type ducts and one tiny duct, considered unsuitable for device closure); while in 50 (96.1%) patients out of remaining 52, the duct was successfully closed with transcatheter PDA device or coil. In one infant, device deployment resulted in acquired coarctation, necessitating device retrieval by Snare followed by surgical duct interruption and another patient had non-fatal cardiac arrest during device deployment leading to abandonment of procedure and subsequent successful surgical interruption. Local vascular complications occurred in 12 (21.8%) of cases and all were satisfactorily treated. Conclusion: Transcatheter device closure of PDA in infants was an effective procedure in the majority of cases; however, here were considerable number of local access site vascular complications. (author)

3718-F Alkali Metal Treatment and Storage Facility Closure Plan

International Nuclear Information System (INIS)

1991-12-01

Since 1987, Westinghouse Hanford Company has been a major contractor to the U.S. Department of Energy-Richland Operations Office and has served as co-operator of the 3718-F Alkali Metal Treatment and Storage Facility, the waste management unit addressed in this closure plan. The closure plan consists of a Part A Dangerous waste Permit Application and a RCRA Closure Plan. An explanation of the Part A Revision (Revision 1) submitted with this document is provided at the beginning of the Part A section. The closure plan consists of 9 chapters and 5 appendices. The chapters cover: introduction; facility description; process information; waste characteristics; groundwater; closure strategy and performance standards; closure activities; postclosure; and references

3718-F Alkali Metal Treatment and Storage Facility Closure Plan

Energy Technology Data Exchange (ETDEWEB)

None

1991-12-01

Since 1987, Westinghouse Hanford Company has been a major contractor to the U.S. Department of Energy-Richland Operations Office and has served as co-operator of the 3718-F Alkali Metal Treatment and Storage Facility, the waste management unit addressed in this closure plan. The closure plan consists of a Part A Dangerous waste Permit Application and a RCRA Closure Plan. An explanation of the Part A Revision (Revision 1) submitted with this document is provided at the beginning of the Part A section. The closure plan consists of 9 chapters and 5 appendices. The chapters cover: introduction; facility description; process information; waste characteristics; groundwater; closure strategy and performance standards; closure activities; postclosure; and references.

Transcatheter closure of patent ductus arteriosus: past, present and future.

Science.gov (United States)

Baruteau, Alban-Elouen; Hascoët, Sébastien; Baruteau, Julien; Boudjemline, Younes; Lambert, Virginie; Angel, Claude-Yves; Belli, Emre; Petit, Jérôme; Pass, Robert

2014-02-01

This review aims to describe the past history, present techniques and future directions in transcatheter treatment of patent ductus arteriosus (PDA). Transcatheter PDA closure is the standard of care in most cases and PDA closure is indicated in any patient with signs of left ventricular volume overload due to a ductus. In cases of left-to-right PDA with severe pulmonary arterial hypertension, closure may be performed under specific conditions. The management of clinically silent or very tiny PDAs remains highly controversial. Techniques have evolved and the transcatheter approach to PDA closure is now feasible and safe with current devices. Coils and the Amplatzer Duct Occluder are used most frequently for PDA closure worldwide, with a high occlusion rate and few complications. Transcatheter PDA closure in preterm or low-bodyweight infants remains a highly challenging procedure and further device and catheter design development is indicated before transcatheter closure is the treatment of choice in this delicate patient population. The evolution of transcatheter PDA closure from just 40 years ago with 18F sheaths to device delivery via a 3F sheath is remarkable and it is anticipated that further improvements will result in better safety and efficacy of transcatheter PDA closure techniques. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Patent foramen ovale closure using a bioabsorbable closure device: safety and efficacy at 6-month follow-up.

Science.gov (United States)

Van den Branden, Ben J; Post, Martijn C; Plokker, Herbert W; ten Berg, Jurriën M; Suttorp, Maarten J

2010-09-01

The aim of this study was to assess the mid-term safety and efficacy of percutaneous patent foramen ovale (PFO) closure using a bioabsorbable device (BioSTAR, NMT Medical, Boston, Massachusetts). Closure of PFO in patients with cryptogenic stroke has proven to be safe and effective using different types of permanent devices. All consecutive patients who underwent percutaneous PFO closure with the bioabsorbable closure device between November 2007 and January 2009 were included. Residual shunt was assessed using contrast transthoracic echocardiography. Sixty-two patients (55% women, mean age 47.7 ± 11.8 years) underwent PFO closure. The in-hospital complications were a surgical device retrieval in 2 patients (3.2%), device reposition in 1 (1.6%), and a minimal groin hematoma in 6 patients (9.7%). The short-term complications at 1-month follow-up (n = 60) were a transient ischemic attack in the presence of a residual shunt in 1 patient and new supraventricular tachycardia in 7 patients (11.3%). At 6-month follow-up (n = 60), 1 patient without residual shunt developed a transient ischemic attack and 1 developed atrial fibrillation. A mild or moderate residual shunt was noted in 51.7%, 33.9%, and 23.7% after 1-day, 1-month, and 6-month follow-up, respectively. A large shunt was present in 8.3%, 3.4%, and 0% after 1-day, 1-month, and 6-month follow-up. Closure of PFO using the bioabsorbable device is associated with a low complication rate and a low recurrence rate of embolic events. However, a relatively high percentage of mild or moderate residual shunting is still present at 6-month follow-up. Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Patent foramen ovale closure vs medical therapy for stroke prevention: meta-analysis of randomized trials and review of heterogeneity in meta-analyses.

Science.gov (United States)

Udell, Jacob A; Opotowsky, Alexander R; Khairy, Paul; Silversides, Candice K; Gladstone, David J; O'Gara, Patrick T; Landzberg, Michael J

2014-10-01

Patent foramen ovale (PFO) might be a risk factor for unexplained ("cryptogenic") stroke or transient ischemic attack (TIA). We sought to determine the efficacy and safety of transcatheter PFO closure compared with antithrombotic therapy for secondary prevention of cerebrovascular events among patients with cryptogenic stroke. We performed a systematic review and meta-analysis of MedLine and Embase (from inception to March 2013) for randomized controlled trials (RCTs) that compared transcatheter PFO closure with medical therapy in subjects with cryptogenic stroke. Data were independently extracted on trial conduct quality, baseline characteristics, efficacy, and safety events from published articles and appendices. Risk ratios (RRs) and 95% confidence intervals (CIs) for the composite of stroke or TIA, and adverse cardiovascular events including atrial fibrillation/flutter were constructed. Three RCTs of 2303 subjects with previous stroke, TIA, or systemic arterial embolism (mean age, 45.7 years; 47.3% women; mean follow-up, 2.6 years) were included. PFO closure did not significantly reduce the risk of recurrent stroke/TIA (3.7% vs 5.2%; RR, 0.73; 95% CI, 0.50-1.07; P = 0.10); however, an increased risk of incident atrial fibrillation/flutter was detected (3.8% vs 1.0%; RR, 3.67; 95% CI, 1.95-6.89; P < 0.0001). No significant heterogeneity was detected for any end point among subgroups of patients stratified according to age, sex, index cardiovascular event, device type, interatrial shunt size, and presence of an atrial septal aneurysm (all P interactions ≥ 0.09). Meta-analysis of RCTs that assessed transcatheter PFO closure for secondary prevention of cerebrovascular events in subjects with cryptogenic stroke does not demonstrate benefit compared with antithrombotic therapy, and suggests potential risks. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Emergent properties during dorsal closure in Drosophila morphogenesis

International Nuclear Information System (INIS)

Peralta, X G; Toyama, Y; Edwards, G S; Kiehart, D P

2008-01-01

Dorsal closure is an essential stage of Drosophila development that is a model system for research in morphogenesis and biological physics. Dorsal closure involves an orchestrated interplay between gene expression and cell activities that produce shape changes, exert forces and mediate tissue dynamics. We investigate the dynamics of dorsal closure based on confocal microscopic measurements of cell shortening in living embryos. During the mid-stages of dorsal closure we find that there are fluctuations in the width of the leading edge cells but the time-averaged analysis of measurements indicate that there is essentially no net shortening of cells in the bulk of the leading edge, that contraction predominantly occurs at the canthi as part of the process for zipping together the two leading edges of epidermis and that the rate constant for zipping correlates with the rate of movement of the leading edges. We characterize emergent properties that regulate dorsal closure, i.e., a velocity governor and the coordination and synchronization of tissue dynamics

Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: a prospective case-control study.

Science.gov (United States)

Lone, Ali M; Zaroo, Mohd I; Laway, Bashir A; Pala, Nazir A; Bashir, Sheikh A; Rasool, Altaf

2014-01-01

To compare the effectiveness of vacuum-assisted closure (VAC) versus conventional dressings in the healing of diabetic foot ulcerations (DFUs) in terms of healing rate (time to prepare the wound for closure either spontaneously or by surgery), safety, and patient satisfaction. Randomized case-control study enrolling 56 patients, divided into two groups. Group A (patients treated with VAC) and Group B (patients treated with conventional dressings), with an equal number of patients in each group. DFUs were treated until wound closure, either spontaneously, surgically, or until completion of the 8-week period. Granulation tissue appeared in 26 (92.85%) patients by the end of Week 2 in Group A, while it appeared in 15 (53.57%) patients by that time in Group B. 100% granulation was achieved in 21 (77.78%) patients by the end of Week 5 in Group A as compared to only 10 (40%) patients by that time in Group B. Patients in Group A had fewer number of positive blood cultures, secondary amputations and were satisfied with treatment as compared to Group B. VAC appears to be more effective, safe, and patient satisfactory compared to conventional dressings for the treatment of DFUs.

Self-Assembly of Flux-Closure Polygons from Magnetite Nanocubes.

Science.gov (United States)

Szyndler, Megan W; Corn, Robert M

2012-09-06

Well-defined nanoscale flux-closure polygons (nanogons) have been fabricated on hydrophilic surfaces from the face-to-face self-assembly of magnetite nanocubes. Uniform ferrimagnetic magnetite nanocubes (∼86 nm) were synthesized and characterized with a combination of electron microscopy, diffraction, and magnetization measurements. The nanocubes were subsequently cast onto hydrophilic substrates, wherein the cubes lined up face-to-face and formed a variety of polygons due to magnetostatic and hydrophobic interactions. The generated surfaces consist primarily of three- and four-sided nanogons; polygons ranging from two to six sides were also observed. Further examination of the nanogons showed that the constraints of the face-to-face assembly of nanocubes often led to bowed sides, strained cube geometries, and mismatches at the acute angle vertices. Additionally, extra nanocubes were often present at the vertices, suggesting the presence of external magnetostatic fields at the polygon corners. These nanogons are inimitable nanoscale magnetic structures with potential applications in the areas of magnetic memory storage and high-frequency magnetics.

Economic evaluation of closure cap barrier materials study

Energy Technology Data Exchange (ETDEWEB)

Serrato, M.G.; Bhutani, J.S.; Mead, S.M.

1993-09-01

Volume II of the Economic Evaluation of the Closure Cap Barrier Materials, Revision I contains detailed cost estimates for closure cap barrier materials. The cost estimates incorporate the life cycle costs for a generic hazardous waste seepage basin closure cap under the RCRA Post Closure Period of thirty years. The economic evaluation assessed six barrier material categories. Each of these categories consists of several composite cover system configurations, which were used to develop individual cost estimates. The information contained in this report is not intended to be used as a cost estimating manual. This information provides the decision makers with the ability to screen barrier materials, cover system configurations, and identify cost-effective materials for further consideration.

Economic evaluation of closure cap barrier materials study

International Nuclear Information System (INIS)

Serrato, M.G.; Bhutani, J.S.; Mead, S.M.

1993-09-01

Volume II of the Economic Evaluation of the Closure Cap Barrier Materials, Revision I contains detailed cost estimates for closure cap barrier materials. The cost estimates incorporate the life cycle costs for a generic hazardous waste seepage basin closure cap under the RCRA Post Closure Period of thirty years. The economic evaluation assessed six barrier material categories. Each of these categories consists of several composite cover system configurations, which were used to develop individual cost estimates. The information contained in this report is not intended to be used as a cost estimating manual. This information provides the decision makers with the ability to screen barrier materials, cover system configurations, and identify cost-effective materials for further consideration

Key financial ratios can foretell hospital closures.

Science.gov (United States)

Lynn, M L; Wertheim, P

1993-11-01

An analysis of various financial ratios sampled from open and closed hospitals shows that certain leverage, liquidity, capital efficiency, and resource availability ratios can predict hospital closure up to two years in advance of the closure with an accuracy of nearly 75 percent.

Hospital closure: Phoenix, Hydra or Titanic?

Science.gov (United States)

Dunne, T; Davis, S

1996-01-01

Very little has been published about the effects of hospital closure in terms of the service, financial or management issues of the process. Attempts through a case-study format to redress the balance and as such represents the reflections of practitioners who have recently undergone the experience of hospital closure and the often neglected issues arising both during and after the process.

Gas phase detection of the NH-P hydrogen bond and importance of secondary interactions

DEFF Research Database (Denmark)

Møller, Kristian Holten; Hansen, Anne Schou; Kjærgaard, Henrik Grum

2015-01-01

bond compared to secondary interactions. We find that B3LYP favors the hydrogen bond and M06-2X favors the secondary interactions leading to under- and overestimation, respectively, of the hydrogen bond angle relative to a DF-LCCSD(T)-F12a calculated angle. The remaining functionals tested, B3LYP-D3, B......3LYP-D3BJ, CAM-B3LYP, and ωB97X-D, as well as MP2, show comparable contributions from the hydrogen bond and the secondary interactions and are close to DF-LCCSD(T)-F12a results....

Predicting backbone Cα angles and dihedrals from protein sequences by stacked sparse auto-encoder deep neural network.

Science.gov (United States)

Lyons, James; Dehzangi, Abdollah; Heffernan, Rhys; Sharma, Alok; Paliwal, Kuldip; Sattar, Abdul; Zhou, Yaoqi; Yang, Yuedong

2014-10-30

Because a nearly constant distance between two neighbouring Cα atoms, local backbone structure of proteins can be represented accurately by the angle between C(αi-1)-C(αi)-C(αi+1) (θ) and a dihedral angle rotated about the C(αi)-C(αi+1) bond (τ). θ and τ angles, as the representative of structural properties of three to four amino-acid residues, offer a description of backbone conformations that is complementary to φ and ψ angles (single residue) and secondary structures (>3 residues). Here, we report the first machine-learning technique for sequence-based prediction of θ and τ angles. Predicted angles based on an independent test have a mean absolute error of 9° for θ and 34° for τ with a distribution on the θ-τ plane close to that of native values. The average root-mean-square distance of 10-residue fragment structures constructed from predicted θ and τ angles is only 1.9Å from their corresponding native structures. Predicted θ and τ angles are expected to be complementary to predicted ϕ and ψ angles and secondary structures for using in model validation and template-based as well as template-free structure prediction. The deep neural network learning technique is available as an on-line server called Structural Property prediction with Integrated DEep neuRal network (SPIDER) at http://sparks-lab.org. Copyright © 2014 Wiley Periodicals, Inc.

Simulating school closure policies for cost effective pandemic decision making

Directory of Open Access Journals (Sweden)

Araz Ozgur M

2012-06-01

Full Text Available Abstract Background Around the globe, school closures were used sporadically to mitigate the 2009 H1N1 influenza pandemic. However, such closures can detrimentally impact economic and social life. Methods Here, we couple a decision analytic approach with a mathematical model of influenza transmission to estimate the impact of school closures in terms of epidemiological and cost effectiveness. Our method assumes that the transmissibility and the severity of the disease are uncertain, and evaluates several closure and reopening strategies that cover a range of thresholds in school-aged prevalence (SAP and closure durations. Results Assuming a willingness to pay per quality adjusted life-year (QALY threshold equal to the US per capita GDP ($46,000, we found that the cost effectiveness of these strategies is highly dependent on the severity and on a willingness to pay per QALY. For severe pandemics, the preferred strategy couples the earliest closure trigger (0.5% SAP with the longest duration closure (24 weeks considered. For milder pandemics, the preferred strategies also involve the earliest closure trigger, but are shorter duration (12 weeks for low transmission rates and variable length for high transmission rates. Conclusions These findings highlight the importance of obtaining early estimates of pandemic severity and provide guidance to public health decision-makers for effectively tailoring school closures strategies in response to a newly emergent influenza pandemic.

Potential socio-economic consequences of mine closure

Directory of Open Access Journals (Sweden)

Marietjie Ackermann

2018-01-01

Full Text Available Background: Mine closures generally reveal negligence on the part of mining houses, not only in terms of the environment, but also the surrounding mining communities. Aim: This article reflects on the findings of research into the socio-economic consequences of mine closure. The research specifically explored how mineworkers’ dependency on their employment at a mine affects their ability to sustain their livelihood. Setting: The research was conducted at the Orkney Mine and the Grootvlei Mine (Springs. Methods: The research was conducted within a naturalistic domain, guided by a relativist orientation, a constructivist ontology and an interpretivist epistemology. Data were collected by means of document analysis, semi-structured interviews, focus group discussion and unstructured observation. Results: From the research findings, it is evident that mine closures, in general, have a devastating effect on the surrounding mining communities as well as on the employees. Mine closures in the case studies gradually depleted the mining communities’ livelihood assets and resulted in the collapse of their coping strategies and livelihood outcomes. It generally affected the communities’ nutrition, health, education, food security, water, shelter, levels of community participation and personal safety. Conclusion: If not managed efficiently and effectively, mine closures may pose significant challenges to the mining industry, government, the environment, national and local economic prosperity and communities in the peripheral areas of mines. This truly amplifies that mine closure, whether temporary or permanent, is an issue that needs to be addressed with responsibility towards all stakeholders, including the mining community and the labour force.

Top closure for control rod drive for nuclear reactor

International Nuclear Information System (INIS)

Raas, J.H.; Schwartz, J.I.

1978-01-01

A removable top closure and venting assembly for the tubular housing of a control rod drive includes a mounting ring threadably inserted in the upper end of the housing, a fluid-sealing closure member beneath the mounting ring and which is mounted in and coupled to the mounting ring by means of a ball and socket joint, a gas vent defined by interconnecting passages extending through the closure and through the ball and socket joint, and a vent valve accessible from the top of the closure assembly. 3 claims, 2 figures

Transcatheter closure of ventricular septal defect with Occlutech Duct Occluder.

Science.gov (United States)

Atik-Ugan, Sezen; Saltik, Irfan Levent

2018-04-01

Patent ductus arteriosus occluders are used for transcatheter closure of ventricular septal defects, as well as for closure of patent ductus arteriosus. The Occlutech Duct Occluder is a newly introduced device for transcatheter closure of patent ductus arteriosus. Here, we present a case in which the Occlutech Duct Occluder was successfully used on a patient for the closure of a perimembraneous ventricular septal defect.

Seven-year follow-up of percutaneous closure of patent foramen ovale.

Science.gov (United States)

Mirzada, Naqibullah; Ladenvall, Per; Hansson, Per-Olof; Johansson, Magnus Carl; Furenäs, Eva; Eriksson, Peter; Dellborg, Mikael

2013-12-01

Observational studies favor percutaneous closure of patent foramen ovale (PFO) over medical treatment to reduce recurrent stroke while randomized trials fail to demonstrate significant superiority of percutaneous PFO closure. Few long-term studies are available post PFO closure. This study reports long-term clinical outcomes after percutaneous PFO closure. Between 1997 and 2006, 86 consecutive eligible patients with cerebrovascular events, presumably related to PFO, underwent percutaneous PFO closure. All 86 patients were invited to a long-term follow-up, which was carried out during 2011 and 2012. Percutaneous PFO closure was successfully performed in 85 of 86 patients. The follow-up rate was 100%. No cardiovascular or cerebrovascular deaths occurred. Two patients (both women) died from lung cancer during follow-up. Follow-up visits were conducted for 64 patients and the remaining 20 patients were followed up by phone. The mean follow-up time was 7.3 years (5 to 12.4 years). Mean age at PFO closure was 49 years. One patient had a minor stroke one month after PFO closure and a transient ischemic attack (TIA) two years afterwards. One other patient suffered from a TIA six years after closure. No long-term device-related complications were observed. Percutaneous PFO closure was associated with very low risk of recurrent stroke and is suitable in most patients. We observed no mortality and no long-term device-related complications related to PFO closure, indicating that percutaneous PFO closure is a safe and efficient treatment even in the long term.

Permanent Closure of the TAN-664 Underground Storage Tank

Energy Technology Data Exchange (ETDEWEB)

Bradley K. Griffith

2011-12-01

This closure package documents the site assessment and permanent closure of the TAN-664 gasoline underground storage tank in accordance with the regulatory requirements established in 40 CFR 280.71, 'Technical Standards and Corrective Action Requirements for Owners and Operators of Underground Storage Tanks: Out-of-Service UST Systems and Closure.'

Single-shell tank closure work plan. Revision A

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-06-01

In January 1994, the Hanford Federal Facility Agreement and Conset Order (Tri-Party Agreement) was amended to reflect a revised strategy for remediation of radioactive waste in underground storage tanks. These amendments include milestones for closure of the single-shell tank (SST) operable units, to be initiated by March 2012 and completed by September 2024. This SST-CWP has been prepared to address the principal topical areas identified in Tri-Party Agreement Milestone M-45-06 (i.e., regulatory pathway, operable unit characterization, waste retrieval, technology development, and a strategy for achieving closure). Chapter 2.0 of this SST-CWP provides a brief description of the environmental setting, SST System, the origin and characteristics of SST waste, and ancillary equipment that will be remediated as part of SST operable unit closure. Appendix 2A provides a description of the hydrogeology of the Hanford Site, including information on the unsaturated sediments (vadose zone) beneath the 200 Areas Plateau. Chapter 3.0 provides a discussion of the laws and regulations applicable to closure of the SST farm operable units. Chapter 4.0 provides a summary description of the ongoing characterization activities that best align with the proposed regulatory pathway for closure. Chapter 5.0 describes aspects of the SST waste retrieval program, including retrieval strategy, technology, and sequence, potential tank leakage during retrieval, and considerations of deployment of subsurface barriers. Chapter 6.0 outlines a proposed strategy for closure. Chapter 7.0 provides a summary of the programs underway or planned to develop technologies to support closure. Ca. 325 refs.

Single-shell tank closure work plan. Revision A

International Nuclear Information System (INIS)

1995-06-01

In January 1994, the Hanford Federal Facility Agreement and Conset Order (Tri-Party Agreement) was amended to reflect a revised strategy for remediation of radioactive waste in underground storage tanks. These amendments include milestones for closure of the single-shell tank (SST) operable units, to be initiated by March 2012 and completed by September 2024. This SST-CWP has been prepared to address the principal topical areas identified in Tri-Party Agreement Milestone M-45-06 (i.e., regulatory pathway, operable unit characterization, waste retrieval, technology development, and a strategy for achieving closure). Chapter 2.0 of this SST-CWP provides a brief description of the environmental setting, SST System, the origin and characteristics of SST waste, and ancillary equipment that will be remediated as part of SST operable unit closure. Appendix 2A provides a description of the hydrogeology of the Hanford Site, including information on the unsaturated sediments (vadose zone) beneath the 200 Areas Plateau. Chapter 3.0 provides a discussion of the laws and regulations applicable to closure of the SST farm operable units. Chapter 4.0 provides a summary description of the ongoing characterization activities that best align with the proposed regulatory pathway for closure. Chapter 5.0 describes aspects of the SST waste retrieval program, including retrieval strategy, technology, and sequence, potential tank leakage during retrieval, and considerations of deployment of subsurface barriers. Chapter 6.0 outlines a proposed strategy for closure. Chapter 7.0 provides a summary of the programs underway or planned to develop technologies to support closure. Ca. 325 refs

Social and macro economic impact of closure

International Nuclear Information System (INIS)

Medeliene, D.

1999-01-01

The social consequences of closure of Ignalina NPP will largely depend on the actions the Government takes. If it puts in place the conditions which enable the International Financial Institutions to assist Lithuania, both in providing loans and grants for decommissioning and (in the case of the EU) providing Structural Adjustment Funds for the regional economic development of the Visaginas area, then solutions to the problems of closure can be found. But if the Government delays putting into place the necessary conditions, then Lithuania will be left to solve the problems of - inter alia necessary - closure of Ignalina NPP on its own. (author)

Assessment of the anterior chamber parameters after laser iridotomy in primary angle close suspect using Pentacam and gonioscopy.

Science.gov (United States)

Esmaeili, Alireza; Barazandeh, Behzad; Ahmadi, Sina; Haghi, Alireza; Ahmadi Hosseini, Seyed Mahdi; Abolbashari, Fereshteh

2013-01-01

To evaluate the changes in the anterior segment parameters of the subjects with primary angle closure suspect (PACS) before and after laser iridotomy (LI) using the Pentacam and gonioscopy. Forty-eight eyes of 48 PACS were included. Anterior chamber angle (ACA), central anterior chamber depth (ACD), anterior chamber volume (ACV) and central corneal thickness (CCT) were recorded from the Pentacam before and one month after LI. ACA was graded according to Shaffer classification using the Goldmann gonioscopy. ACA increased significantly from 25.59±4.41 to 26.46±4.33 degrees (P=0.009) and ACV changed from 85.97±16.07mm(3) to 99.25±15.83mm(3) (P=0.000). The changes in ACD, CCT and intraocular pressure were non-significant (P>0.05). Gonioscopy showed significant widening of the Shaffer angle in 4 quadrants (P<0.001). Pentacam can serve as the objective instrument in assessing the efficacy of LI.

Strategic Planning for Hot Cell Closure

International Nuclear Information System (INIS)

LANGSTAFF, D.C.

2001-01-01

The United States Department of Energy (DOE) and its contractor were remediating a large hot cell complex to mitigate the radiological hazard. A Resource Conservation and Recovery Act (RCRA) closure unit was determined to be located within the complex. The regulator established a challenge to develop an acceptable closure plan on a short schedule (four months). The scope of the plan was to remove all excess equipment and mixed waste from the closure unit, establish the requirements of the legally binding Closure Plan and develop an acceptable schedule. The complex has several highly radioactive tanks, tank vaults, piping, and large hot cells containing complex chemical processing equipment. Driven by a strong need to develop an effective strategy to meet cleanup commitments, three principles were followed to develop an acceptable plan: (1) Use a team approach, (2) Establish a buffer zone to support closure, and (3) Use good practice when planning the work sequence. The team was composed of DOE, contractor, and Washington State Department of Ecology (Regulator) staff. The team approach utilized member expertise and fostered member involvement and communication. The buffer zone established an area between the unregulated parts of the building and the areas that were allegedly not in compliance with environmental standards. Introduction of the buffer zone provided simplicity, clarity, and flexibility into the process. Using good practice means using the DOE Integrated Safety Management Core Functions for planning and implementing work safely. Paying adequate attention to detail when the situation required contributed to the process credibility and a successful plan

Subcostal closure technique for prevention of postthoracotomy pain syndrome.

Science.gov (United States)

Hong, Kipyo; Bae, Mikyung; Han, Sora

2016-09-01

The purpose of this study was to evaluate the efficacy of our subcostal closure technique in prevention of postthoracotomy pain syndrome. From July 2012 to March 2015, 29 patients in whom a lobectomy was indicated underwent a thoracotomy. The thoracotomy wounds were closed using a subcostal closure technique (subcostal closure group) and outcomes were compared with 31 patients who underwent video-assisted thoracoscopic surgery (thoracoscopy group). The duration of oral opioid consumption was evaluated from medical records, and postoperative pain was evaluated by telephone interview conducted by a trained nurse practitioner who was unaware of the patient's group. Pain scores were higher in the thoracoscopy group compared to the subcostal closure group, reaching statistical significance (Numeric Rating Scale 0.55 ± 0.948 in the subcostal closure group vs. 1.84 ± 1.614 in the thoracoscopy group; p Pain Scale 0.24 ± 0.435 in the subcostal closure group vs. 0.81 ± 0.703 in the thoracoscopy group; p pain syndrome. © The Author(s) 2016.

Comparing over-the-scope clip versus endoloop and clips (KING closure) for access site closure: a randomized experimental study

Czech Academy of Sciences Publication Activity Database

Martínek, J.; Ryska, O.; Tučková, I.; Filípková, T.; Doležel, R.; Juhás, Štefan; Motlík, Jan; Zavoral, M.; Ryska, M.

2013-01-01

Roč. 27, č. 4 (2013), s. 1203-1210 ISSN 0930-2794 R&D Projects: GA MZd NS9994 Institutional research plan: CEZ:AV0Z50450515 Keywords : NOTES * gastrotomy closure * rectotomy closure Subject RIV: FJ - Surgery incl. Transplants Impact factor: 3.313, year: 2013

Hexone Storage and Treatment Facility closure plan

International Nuclear Information System (INIS)

1992-11-01

The HSTF is a storage and treatment unit subject to the requirements for the storage and treatment of dangerous waste. Closure is being conducted under interim status and will be completed pursuant to the requirements of Washington State Department of Ecology (Ecology) Dangerous Waste Regulations, Washington Administrative Code (WAC) 173-303-610 and WAC 173-303-640. Because dangerous waste does not include the source, special nuclear, and by-product material components of mixed waste, radionuclides are not within the scope of WAC 173-303 or of this closure plan. The information on radionuclides is provided only for general knowledge where appropriate. The known hazardous/dangerous waste remaining at the site before commencing other closure activities consists of the still vessels, a tarry sludge in the storage tanks, and residual contamination in equipment, piping, filters, etc. The treatment and removal of waste at the HSTF are closure activities as defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and WAC 173-303

Cyanoacrylate for Intraoral Wound Closure: A Possibility?

Directory of Open Access Journals (Sweden)

Parimala Sagar

2015-01-01

Full Text Available Wound closure is a part of any surgical procedure and the objective of laceration repair or incision closure is to approximate the edges of a wound so that natural healing process may occur. Over the years new biomaterials have been discovered as an alternate to conventional suture materials. Cyanoacrylate bioadhesives are one among them. They carry the advantages of rapid application, patient comfort, resistance to infection, hemostatic properties, and no suture removal anxiety. Hence this study was undertaken to study the effect of long chain cyanoacrylate as an adhesive for intraoral wound closure and also to explore its hemostatic and antibacterial effects. Isoamyl-2-cyanoacrylate (AMCRYLATE was used as the adhesive in the study. In conclusion isoamyl cyanoacrylate can be used for intraoral wound closure, as an alternative to sutures for gluing the mucoperiosteum to bone, for example, after impaction removal, periapical surgeries, and cleft repair. Its hemostatic and antibacterial activity has to be further evaluated.

Influence of timing of delayed hard palate closure on articulation skills in 3-year-old Danish children with unilateral cleft lip and palate.

Science.gov (United States)

Willadsen, Elisabeth; Boers, Maria; Schöps, Antje; Kisling-Møller, Mia; Nielsen, Joan Bogh; Jørgensen, Line Dahl; Andersen, Mikael; Bolund, Stig; Andersen, Helene Søgaard

2018-01-01

Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. To assess the influence of different timing of hard palate closure in a two-stage procedure on articulation skills in 3-year-olds born with unilateral cleft lip and palate (UCLP). Secondary aims were to compare results with peers without CP, and to investigate if there are gender differences in articulation skills. Furthermore, burden of treatment was to be estimated in terms of secondary surgery, hearing and speech therapy. A randomized controlled trial (RCT). Early hard palate closure (EHPC) at 12 months versus late hard palate closure (LHPC) at 36 months in a two-stage procedure was tested in a cohort of 126 Danish-speaking children born with non-syndromic UCLP. All participants had the lip and soft palate closed around 4 months of age. Audio and video recordings of a naming test were available from 113 children (32 girls and 81 boys) and were transcribed phonetically. Recordings were obtained prior to hard palate closure in the LHPC group. The main outcome measures were percentage consonants correct adjusted (PCC-A) and consonant errors from blinded assessments. Results from 36 Danish-speaking children without CP obtained previously by Willadsen in 2012 were used for comparison. Children with EHPC produced significantly more target consonants correctly (83%) than children with LHPC (48%; p < .001). In addition, children with LHPC produced significantly more active cleft speech characteristics than children with EHPC (p < .001). Boys achieved significantly lower PCC-A scores than girls (p = .04) and produced significantly more consonant errors than girls (p = .02). No significant differences were found between groups regarding burden of treatment. The control group performed significantly better than the EHPC and LHPC groups on all compared variables. © 2017 Royal College of Speech

Project Management Approach to Transition of the Miamisburg Closure Project From Environmental Cleanup to Post-Closure Operations

International Nuclear Information System (INIS)

Carpenter, C.P.; Marks, M.L.; Smiley, S.L.; Gallaher, D.M.; Williams, K.D.

2006-01-01

The U.S. Department of Energy (DOE) used a project management approach to transition the Miamisburg Closure Project from cleanup by the Office of Environmental Management (EM) to post-closure operations by the Office of Legacy Management (LM). Two primary DOE orders were used to guide the site transition: DOE Order 430.1B, Real Property Asset Management, for assessment and disposition of real property assets and DOE Order 413.3, Program and Project Management for Acquisition of Capital Assets, for project closeout of environmental cleanup activities and project transition of post-closure activities. To effectively manage these multiple policy requirements, DOE chose to manage the Miamisburg Closure Project as a project under a cross-member transitional team using representatives from four principal organizations: DOE-LM, the LM contractor S.M. Stoller Corporation, DOE-EM, and the EM contractor CH2M Hill Mound Inc. The mission of LM is to manage the Department's post-transition responsibilities and long-term care of legacy liabilities and to ensure the future protection of human health and the environment for cleanup sites after the EM has completed its cleanup activities. (authors)

Influence of timing of delayed hard palate closure on articulation skills in 3-year-old Danish children with unilateral cleft lip and palate

DEFF Research Database (Denmark)

Willadsen, Elisabeth; Boers, Maria; Schöps, Antje

2018-01-01

BACKGROUND: Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. AIMS: To assess the influence of different timing of hard palate closure in a two-stage procedure...... on articulation skills in 3-year-olds born with unilateral cleft lip and palate (UCLP). Secondary aims were to compare results with peers without CP, and to investigate if there are gender differences in articulation skills. Furthermore, burden of treatment was to be estimated in terms of secondary surgery...

A randomized clinical trial of knotless barbed suture vs conventional suture for closure of the uterine incision at cesarean delivery.

Science.gov (United States)

Peleg, David; Ahmad, Ronan Said; Warsof, Steven L; Marcus-Braun, Naama; Sciaky-Tamir, Yael; Ben Shachar, Inbar

2018-03-01

Knotless barbed sutures are monofilament sutures with barbs cut into them. These sutures self-anchor, maintaining tissue approximation without the need for surgical knots. The hypothesis of this study was that knotless barbed suture could be used on the myometrium to close the hysterotomy at cesarean delivery. The objective was to compare uterine closure time, need for additional sutures, and blood loss between this and a conventional suture. This was a prospective, unblinded, randomized controlled trial conducted at the Ziv Medical Center, Zefat, Israel. The primary outcome was the length of time needed to close the uterine incision, which was measured from the start of the first suture on the uterus until obtaining uterine hemostasis. To minimize provider bias, women were randomized by sealed envelopes that were opened in the operating room just prior to uterine closure with either a bidirectional knotless barbed suture or conventional suture. Secondary outcomes included the number of additional hemostatic sutures needed and blood loss during incision closure. Patients were enrolled from August 2016 until March 2017. One hundred two women were randomized. Fifty-one had uterine closure with knotless barbed suture and 51 with conventional suture. The groups were similar for demographics as well as number of previous cesarean deliveries. Uterine closure time using the knotless barbed suture was significantly shorter than the conventional suture by a mean of 1 minute 43 seconds (P barbed sutures were associated with a lower need for hemostatic sutures (median 0 vs 1, P barbed suture is a reasonable alternative to conventional sutures because it reduced the closure time of the uterine incision. There was also less need for additional hemostatic sutures and slightly reduced estimated blood loss. Copyright © 2018 Elsevier Inc. All rights reserved.

Design, production and initial state of the closure

International Nuclear Information System (INIS)

2010-12-01

The report is included in a set of Production reports, presenting how the KBS-3 repository is designed, produced and inspected. The production reports are included in the safety report for the KBS-3 repository and repository facility. The report provides input on the initial state of the closure and plugs in underground openings other than deposition tunnels for the assessment of the long-term safety, SR-Site. The initial state refers to the properties of the engineered barriers once they have been finally placed in the KBS-3 repository and will not be further handled within the repository facility. In addition, the report provides some input to the operational safety report, SR-Operation, on how the closure and plugs shall be handled and installed. The report presents the design premises and reference designs of the closure and plugs and verifies their conformity to the design premises. It also briefly deals with the production of the closure and plugs. Finally, the initial state of the closure and plugs and their conformity to the reference designs and design premises are presented

Design, production and initial state of the closure

Energy Technology Data Exchange (ETDEWEB)

2010-12-15

The report is included in a set of Production reports, presenting how the KBS-3 repository is designed, produced and inspected. The production reports are included in the safety report for the KBS-3 repository and repository facility. The report provides input on the initial state of the closure and plugs in underground openings other than deposition tunnels for the assessment of the long-term safety, SR-Site. The initial state refers to the properties of the engineered barriers once they have been finally placed in the KBS-3 repository and will not be further handled within the repository facility. In addition, the report provides some input to the operational safety report, SR-Operation, on how the closure and plugs shall be handled and installed. The report presents the design premises and reference designs of the closure and plugs and verifies their conformity to the design premises. It also briefly deals with the production of the closure and plugs. Finally, the initial state of the closure and plugs and their conformity to the reference designs and design premises are presented

Primary angle closure glaucoma (PACG) susceptibility gene PLEKHA7 encodes a novel Rac1/Cdc42 GAP that modulates cell migration and blood-aqueous barrier function.

Science.gov (United States)

Lee, Mei-Chin; Shei, William; Chan, Anita S; Chua, Boon-Tin; Goh, Shuang-Ru; Chong, Yaan-Fun; Hilmy, Maryam H; Nongpiur, Monisha E; Baskaran, Mani; Khor, Chiea-Chuen; Aung, Tin; Hunziker, Walter; Vithana, Eranga N

2017-10-15

PLEKHA7, a gene recently associated with primary angle closure glaucoma (PACG), encodes an apical junctional protein expressed in components of the blood aqueous barrier (BAB). We found that PLEKHA7 is down-regulated in lens epithelial cells and in iris tissue of PACG patients. PLEKHA7 expression also correlated with the C risk allele of the sentinel SNP rs11024102 with the risk allele carrier groups having significantly reduced PLEKHA7 levels compared to non-risk allele carriers. Silencing of PLEKHA7 in human immortalized non-pigmented ciliary epithelium (h-iNPCE) and primary trabecular meshwork cells, which are intimately linked to BAB and aqueous humor outflow respectively, affected actin cytoskeleton organization. PLEKHA7 specifically interacts with GTP-bound Rac1 and Cdc42, but not RhoA, and the activation status of the two small GTPases is linked to PLEKHA7 expression levels. PLEKHA7 stimulates Rac1 and Cdc42 GTP hydrolysis, without affecting nucleotide exchange, identifying PLEKHA7 as a novel Rac1/Cdc42 GAP. Consistent with the regulatory role of Rac1 and Cdc42 in maintaining the tight junction permeability, silencing of PLEKHA7 compromises the paracellular barrier between h-iNPCE cells. Thus, downregulation of PLEKHA7 in PACG may affect BAB integrity and aqueous humor outflow via its Rac1/Cdc42 GAP activity, thereby contributing to disease etiology. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Transcatheter Closure of Patent Foramen Ovale: Devices and Technique.

Science.gov (United States)

Price, Matthew J

2017-10-01

Transcatheter closure of a patent foramen ovale (PFO) reduces the risk of recurrent cryptogenic stroke compared with medical therapy. PFO closure is a prophylactic procedure, and will not provide the patient with symptomatic improvement, except in cases of hypoxemia due to right-to-left shunt or possibly migraine headaches. Therefore, appropriate patient selection is critical, and procedural safety is paramount. Herein, we review key characteristics of the devices currently available for transcatheter PFO closure within the United States, and highlight key technical aspects of the PFO closure procedure that will maximize procedural success. Copyright © 2017 Elsevier Inc. All rights reserved.

Digital signal processing of data from borehole creep closure

International Nuclear Information System (INIS)

Chakrabarti, S.; Patrick, W.C.; Duplancic, N.

1987-01-01

Digital signal processing, a technique commonly used in the fields of electrical engineering and communication technology, has been successfully used to analyze creep closure data obtained from a 0.91 m diameter by 5.13 deep borehole in bedded salt. By filtering the ''noise'' component of the closure data from a test borehole, important data trends were made more evident and average creep closure rates were able to be calculated. This process provided accurate estimates of closure rates that are used in the design of lined boreholes in which heat-generating transuranic nuclear wastes are emplaced at the Waste Isolation Pilot Plant

40 CFR 264.119 - Post-closure notices.

Science.gov (United States)

2010-07-01

...) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Closure... closure of each hazardous waste disposal unit, the owner or operator must submit to the local zoning... disposal unit of the facility. For hazardous wastes disposed of before January 12, 1981, the owner or...

Measurements of Atomic Rayleigh Scattering Cross-Sections: A New Approach Based on Solid Angle Approximation and Geometrical Efficiency

Science.gov (United States)

Rao, D. V.; Takeda, T.; Itai, Y.; Akatsuka, T.; Seltzer, S. M.; Hubbell, J. H.; Cesareo, R.; Brunetti, A.; Gigante, G. E.

Atomic Rayleigh scattering cross-sections for low, medium and high Z atoms are measured in vacuum using X-ray tube with a secondary target as an excitation source instead of radioisotopes. Monoenergetic Kα radiation emitted from the secondary target and monoenergetic radiation produced using two secondary targets with filters coupled to an X-ray tube are compared. The Kα radiation from the second target of the system is used to excite the sample. The background has been reduced considerably and the monochromacy is improved. Elastic scattering of Kα X-ray line energies of the secondary target by the sample is recorded with Hp Ge and Si (Li) detectors. A new approach is developed to estimate the solid angle approximation and geometrical efficiency for a system with experimental arrangement using X-ray tube and secondary target. The variation of the solid angle is studied by changing the radius and length of the collimators towards and away from the source and sample. From these values the variation of the total solid angle and geometrical efficiency is deduced and the optimum value is used for the experimental work. The efficiency is larger because the X-ray fluorescent source acts as a converter. Experimental results based on this system are compared with theoretical estimates and good agreement is observed in between them.

A closure test for time-specific capture-recapture data

Science.gov (United States)

Stanley, T.R.; Burnham, K.P.

1999-01-01

The assumption of demographic closure in the analysis of capture-recapture data under closed-population models is of fundamental importance. Yet, little progress has been made in the development of omnibus tests of the closure assumption. We present a closure test for time-specific data that, in principle, tests the null hypothesis of closed-population model M(t) against the open-population Jolly-Seber model as a specific alternative. This test is chi-square, and can be decomposed into informative components that can be interpreted to determine the nature of closure violations. The test is most sensitive to permanent emigration and least sensitive to temporary emigration, and is of intermediate sensitivity to permanent or temporary immigration. This test is a versatile tool for testing the assumption of demographic closure in the analysis of capture-recapture data.

Reliability in maintenance and design of elastomer sealed closures

International Nuclear Information System (INIS)

Lake, W.H.

1978-01-01

The methods of reliability are considered for maintenance and design of elastomer sealed containment closures. Component reliability is used to establish a replacement schedule for system maintenance. Reliability data on elastomer seals is used to evaluate the common practice of annual replacement, and to calculate component reliability values for several typical shipment time periods. System reliability methods are used to examine the relative merits of typical closure designs. These include single component and redundant seal closure, with and without closure verification testing. The paper presents a general method of quantifying the merits of closure designs through the use of reliability analysis, which is a probabilistic technique. The reference list offers a general source of information in the field of reliability, and should offer the opportunity to extend the procedures discussed in this paper to other design safety applications

Profile of glaucoma in a major eye hospital in North India

Directory of Open Access Journals (Sweden)

Das Jayachandra

2001-01-01

Full Text Available Purpose: To study the clinical profile and distribution of various subtypes of glaucoma in a referral practice in North India. Method: A retrospective analysis was done of 2425 patients who attended the glaucoma clinic in a tertiary eye-care centre for five years from Januaryl995 to December 1999. A detailed history was obtained and a thorough examination was performed, including gonioscopy, disc assessment, applanation tonometry and automated perimetry. Diurnal variation of IOP and provocative tests for glaucoma were done where applicable. Result: Primary angle closure glaucoma (PACG was the most common glaucoma subtype. The primary open angle glaucoma (POAG to the PACG ratio was 37:63. Chronic angle closure glaucoma (CACG was the most common PACG subtype. The majority of CACG cases were relatively asymptomatic. Male dominance was seen for POAG, juvenile open angle glaucoma (JOAG, CACG, normal tension glaucoma (NTG and secondary glaucomas. Female dominance was seen for ocular hypertension (OHT, acute or intermittent ACG and developmental glaucomas. The mean age in years at presentation was POAG: 60.54 years (males 61.54 years, females 59.01 years and PACG: 55.13 years (males 57.25 years, females 53.60. The three common secondary glaucomas were: glaucoma secondary to adherent leucoma, aphakic and pseudophakic glaucomas and traumatic glaucomas. Advanced glaucoma was detected in 42 to 53% of patients and bilateral blindness in 8 to 14% of patients in various subtypes. Conclusion: Compared to Caucasians, glaucoma patients in North India seem to present nearly a decade earlier and the disease is more advanced at presentation. While PACG is the most commonly encountered glaucoma, NTG and exfoliative glaucoma are relatively rare.

Comparison of two dose regimens of ibuprofen for the closure of patent ductus arteriosus in preterm newborns,

Directory of Open Access Journals (Sweden)

Laura Vargas Dornelles

2016-06-01

Full Text Available Abstract Objective: To compare the efficacy of intravenous ibuprofen at high (20-10-10 mg/kg/dose and low doses (10-5-5 mg/kg/dose the closure of patent ductus arteriosus in preterm newborns. Methods: A cohort study with historical control of newborns that received high- and low-dose intravenous ibuprofen, from 2010 to 2013 in a neonatal intensive care unit, for closure of the patent ductus arteriosus, documented by echocardiography. Secondary outcomes included the number of ibuprofen cycles, incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, changes in renal function, and death. Results: Seventy-seven patients received three doses of ibuprofen for the treatment of patent ductus arteriosus, with 33 receiving high-dose and 44 low-dose therapy. The ductus closed after the first cycle in 25 (56.8% low-dose patients and in 17 (51.5% high-dose patients (p > 0.99. Sixteen patients received a second cycle of ibuprofen, and the ductus closed in 50% after low-dose and in 60% after high-dose therapy (p > 0.99. Seven patients required surgery for ductus closure, 13.6% in the low-dose group and 3% in the high-dose group (p = 0.22. Thirty-nine patients developed bronchopulmonary dysplasia, 50% in the low-dose group and 51.5% in the high-dose group (p > 0.99. Twenty-two (50% low-dose patients died vs. 15 (45.5% high-dose patients (p = 0.86. Conclusions: There was no difference in closure of the ductus arteriosus or occurrence of adverse effects between the two dose regimens.

RELAP-7 Closure Correlations

Energy Technology Data Exchange (ETDEWEB)

Zou, Ling [Idaho National Lab. (INL), Idaho Falls, ID (United States); Berry, R. A. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Martineau, R. C. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Andrs, D. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Zhang, H. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Hansel, J. E. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Sharpe, J. P. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Johns, Russell C. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2017-04-01

The RELAP-7 code is the next generation nuclear reactor system safety analysis code being developed at the Idaho National Laboratory (INL). The code is based on the INL’s modern scientific software development framework, MOOSE (Multi-Physics Object Oriented Simulation Environment). The overall design goal of RELAP-7 is to take advantage of the previous thirty years of advancements in computer architecture, software design, numerical integration methods, and physical models. The end result will be a reactor systems analysis capability that retains and improves upon RELAP5’s and TRACE’s capabilities and extends their analysis capabilities for all reactor system simulation scenarios. The RELAP-7 code utilizes the well-posed 7-equation two-phase flow model for compressible two-phase flow. Closure models used in the TRACE code has been reviewed and selected to reflect the progress made during the past decades and provide a basis for the colure correlations implemented in the RELAP-7 code. This document provides a summary on the closure correlations that are currently implemented in the RELAP-7 code. The closure correlations include sub-grid models that describe interactions between the fluids and the flow channel, and interactions between the two phases.

The effectiveness of eye-closure in repeated interviews

OpenAIRE

Vredeveldt, A.; Baddeley, A.D.; Hitch, G.J.

2014-01-01

Purpose Closing the eyes during recall can help witnesses remember more about a witnessed event. This study examined the effectiveness of eye-closure in a repeated recall paradigm with immediate free recall followed 1 week later by both free and cued recall. We examined whether eye-closure was more or less effective during the second free-recall attempt compared with the first, whether eye-closure during the first recall attempt had an impact on subsequent free- and cued-recall performance, a...

Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

Directory of Open Access Journals (Sweden)

Edivaldo Massazo Utiyama

Full Text Available OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years; 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

Closure of the squared Zakharov--Shabat eigenstates

International Nuclear Information System (INIS)

Kaup, D.J.

1976-01-01

By solution of the inverse scattering problem for a third-order (degenerate) eigenvalue problem, the closure of the squared eigenfunctions of the Zakharov--Shabat equations is found. The question of the completeness of squared eigenstates occurs in many aspects of ''inverse scattering transforms'' (solving nonlinear evolution equations exactly by inverse scattering techniques), as well as in various aspects of the inverse scattering problem. The method used here is quite suggestive as to how one might find the closure of the squared eigenfunctions of other eigenvalue equations, and the strong analogy between these results and the problem of finding the closure of the eigenvectors of a nonself-adjoint matrix is pointed out

The Office of Site Closure: Progress in the Face of Challenges

International Nuclear Information System (INIS)

Fiore, J. J.; Murphie, W. E.; Meador, S. W.

2002-01-01

The Office of Site Closure (OSC) was formed in November 1999 when the Department of Energy's (DOE's) Office of Environmental Management (EM) reorganized to focus specifically on site cleanup and closure. OSC's objective is to achieve safe and cost-effective cleanups and closures that are protective of our workers, the public, and the environment, now and in the future. Since its inception, OSC has focused on implementing a culture of safe closure, with emphasis in three primary areas: complete our responsibility for the Closure Sites Rocky Flats, Mound, Fernald, Ashtabula, and Weldon Spring; complete our responsibility for cleanup at sites where the DOE mission has been completed (examples include Battelle King Avenue and Battelle West Jefferson in Columbus, and General Atomics) or where other Departmental organizations have an ongoing mission (examples include the Brookhaven, Livermore, or Los Alamos National Laboratories, and the Nevada Test Site); and create a framework a nd develop specific business closure tools that will help sites close, such as guidance for and decisions on post-contract benefit liabilities, records retention, and Federal employee incentives for site closure. This paper discusses OSC's 2001 progress in achieving site cleanups, moving towards site closure, and developing specific business closure tools to support site closure. It describes the tools used to achieve progress towards cleanup and closure, such as the application of new technologies, changes in contracting approaches, and the development of agreements between sites and with host states. The paper also identifies upcoming challenges and explores options for how Headquarters and the sites can work together to address these challenges. Finally, it articulates OSC's new focus on oversight of Field Offices to ensure they have the systems in place to oversee contractor activities resulting in site cleanups and closures

Tuning cofactor redox potentials: the 2-methoxy dihedral angle generates a redox potential difference of >160 mV between the primary (Q(A)) and secondary (Q(B)) quinones of the bacterial photosynthetic reaction center.

Science.gov (United States)

Taguchi, Alexander T; Mattis, Aidas J; O'Malley, Patrick J; Dikanov, Sergei A; Wraight, Colin A

2013-10-15

Only quinones with a 2-methoxy group can act simultaneously as the primary (QA) and secondary (QB) electron acceptors in photosynthetic reaction centers from Rhodobacter sphaeroides. (13)C hyperfine sublevel correlation measurements of the 2-methoxy in the semiquinone states, SQA and SQB, were compared with quantum mechanics calculations of the (13)C couplings as a function of the dihedral angle. X-ray structures support dihedral angle assignments corresponding to a redox potential gap (ΔEm) between QA and QB of ~180 mV. This is consistent with the failure of a ubiquinone analogue lacking the 2-methoxy to function as QB in mutant reaction centers with a ΔEm of ≈160-195 mV.

Anterior Chamber Angle Measurements Using Schwalbe's Line with High Resolution Fourier-Domain Optical Coherence Tomography

Science.gov (United States)

Qin, Bing; Francis, Brian A.; Li, Yan; Tang, Maolong; Zhang, Xinbo; Jiang, Chunhui; Cleary, Catherine; Huang, David

2012-01-01

Purpose To use Fourier-domain optical coherence tomography (OCT) to measure the angle opening distance at Schwalbe's line (AOD-SL) and determine its value in anterior chamber angle assessment. Methods Horizontal scans of the nasal and temporal anterior chamber angles in glaucoma subjects were performed by 830 nm wavelength Fourier-domain OCT. Images were graded by two ophthalmologists who assessed the visibility of Schwalbe’s line (SL), anterior limbus (AL), scleral spur (SS), and angle recess (AR). AOD-SL was measured with computer calipers. SL was manually identified by the termination of the corneal endothelium. Gonioscopy was used to classify anterior chamber angles according to a modified Shaffer system. Spearman's rho analysis was performed to assess correlation between AOD-SL and modified Shaffer grade. A cut-off value of AOD-SL for diagnosing occludable angles (modified Shaffer grade ≤1) was determined by receiver operating characteristic (ROC) analyses. Results Thirty-five glaucoma subjects (65 eyes) were enrolled. SL, AL, AR, and SS were visible by OCT in 97.7%, 99.2%, 87.3%, and 80.8% of eyes, respectively. Nasal and temporal AOD-SLs were 322.6 ± 200.2 µm and 341.4 ± 197.4 µm, respectively. Correlation coefficients between AOD-SL and modified Shaffer grade were 0.80 (nasal) and 0.81 (temporal). The diagnostic cut-off value of AOD-SL for occludable angles was 290 µm. The areas under the ROC curve, sensitivity, specificity values were 0.90, 0.80, 0.87 (nasal) and 0.90, 0.85, 0.77 (temporal). Conclusions The measurement of AOD-SL by Fourier-domain OCT is highly correlated with gonioscopy and may be a useful noncontact method of assessing angle closure risk. PMID:22827999

Stomal Closure: Strategies to Prevent Incisional Hernia

Science.gov (United States)

Harries, Rhiannon L.; Torkington, Jared

2018-01-01

Incisional hernias following ostomy reversal occur frequently. Incisional hernias at the site of a previous stoma closure can cause significant morbidity, impaired quality of life, lead to life-threatening hernia incarceration or strangulation and result in a significant financial burden on health care systems Despite this, the evidence base on the subject is limited. Many recognised risk factors for the development of incisional hernia following ostomy reversal are related to patient factors such as age, malignancy, diabetes, COPD, hypertension and obesity, and are not easily correctable. There is a limited amount of evidence to suggest that prophylactic mesh reinforcement may be of benefit to reduce the post stoma closure incisional hernia rate but a further large scale randomised controlled trial is due to report in the near future. There appears to be weak evidence to suggest that surgeons should favour circular, or “purse-string” closure of the skin following stoma closure in order to reduce the risk of SSI, which in turn may reduce incisional hernia formation. There remains the need for further evidence in relation to suture technique, skin closure techniques, mechanical bowel preparation and oral antibiotic prescription focusing on incisional hernia development as an outcome measure. Within this review, we discuss in detail the evidence base for the risk factors for the development of, and the strategies to prevent ostomy reversal site incisional hernias. PMID:29670882

Stomal Closure: Strategies to Prevent Incisional Hernia

Directory of Open Access Journals (Sweden)

Rhiannon L. Harries

2018-04-01

Full Text Available Incisional hernias following ostomy reversal occur frequently. Incisional hernias at the site of a previous stoma closure can cause significant morbidity, impaired quality of life, lead to life-threatening hernia incarceration or strangulation and result in a significant financial burden on health care systems Despite this, the evidence base on the subject is limited. Many recognised risk factors for the development of incisional hernia following ostomy reversal are related to patient factors such as age, malignancy, diabetes, COPD, hypertension and obesity, and are not easily correctable. There is a limited amount of evidence to suggest that prophylactic mesh reinforcement may be of benefit to reduce the post stoma closure incisional hernia rate but a further large scale randomised controlled trial is due to report in the near future. There appears to be weak evidence to suggest that surgeons should favour circular, or “purse-string” closure of the skin following stoma closure in order to reduce the risk of SSI, which in turn may reduce incisional hernia formation. There remains the need for further evidence in relation to suture technique, skin closure techniques, mechanical bowel preparation and oral antibiotic prescription focusing on incisional hernia development as an outcome measure. Within this review, we discuss in detail the evidence base for the risk factors for the development of, and the strategies to prevent ostomy reversal site incisional hernias.

Case Report: Rapid staged abdominal closure using Gore-Tex® mesh as a bridge to primary omphalocele sac closure

Directory of Open Access Journals (Sweden)

William C. Kethman

2016-06-01

Full Text Available Omphaloceles present an ongoing challenge due to significant variations in presentation and associated co-morbidities. Diverse management strategies have been described to tackle many of the fundamental challenges of closure and reconstruction of the abdominal wall – this fact demonstrates a need for increasingly individualized management options for this complex disease. We describe a novel method of rapid staged abdominal wall closure using Gore-Tex® mesh as a bridge to primary omphalocele closure in an infant with partial Pentalogy of Cantrell and giant ruptured omphalocele. This strategy can be used in management of some of the most complex abdominal wall defects.

Bidirectional Barbed Sutures for Wound Closure: Evolution and Applications

Science.gov (United States)

Paul, Malcolm D.

2009-01-01

Traditionally, wound closure sutures have in common the need to tie knots with the inherent risk of extrusion, palpability, microinfarcts, breakage, and slippage. Bidirectional barbed sutures have barbs arrayed in a helical fashion in opposing directions on either side of an unbarbed midsegment. This suture is inserted at the midpoint of a wound and pulled through till resistance is encountered from the opposing barbs; each half of the suture is then advanced to the lateral ends of the wound. This design provides a method of evenly distributing tension along the incision line, a faster suture placement and closure time with no need to tie knots, and the possibility of improved cosmesis. Bidirectional barbed sutures, which are available in both absorbable and nonabsorbable forms, can be used for simple closures, multilayered closures, and closure of high-tension wounds in a variety of surgical settings. PMID:24527114

Closure of a mixed waste landfill: Lessons learned

International Nuclear Information System (INIS)

Phifer, M.A.

1990-01-01

Much experience has been gained during the closure of the Mixed Waste Management Facility (MWMF) at the Savannah River Site (SRS) and many lessons were learned. This knowledge was applied to other closures at SRS yielding decreased costs, schedule enhancement, and increased overall project efficiency. The next major area of experience to be gained at SRS in the field of waste site closures will be in the upkeep, maintenance, and monitoring of clay caps. Further test programs will be required to address these requirements

Influence of Closure & Non-Closure of the Visceral and Parietal Peritoneum on Post Cesarean Morbidity

Directory of Open Access Journals (Sweden)

Tabasi Z.

2010-01-01

Full Text Available AbstractBackground and Objectives: One of the most important issues in promoting mother and child health is reducing the morbidity rate after cesarean section. The aim of this study was to investigate the influence of closure and non-closure of the visceral and parietal peritoneum on post cesarean morbidity in women attending Shabihkhani Maternity Hospital in Kashan, Iran.Methods: This study was conducted with a single blind randomized clinical trial method on 100 parturient women that underwent emergency or elective cesarean section. Patients with previous cesarean section and or abdominal surgery, diseases such as hypertension, diabetes mellitus and premature rupture of membrane and pre operative bleeding, were excluded from this study. Then, the participants were randomly divided into two groups: in one group both peritoneal layers were closed while in the other group, they were not closed. Post operative morbidity including fever, bleeding, post operative pain, analgesic consumption and time of operation were assessed. Data were analyzed with t-tests, and χ2 and a P<0.05 were considered significant.Results: In this study, there were no significant differences between the two groups with respect to age, gestational age, the reason for caesarean section and gravidity, nor were there any differences with respect to the incidence of fever or bleeding and was similar between the two groups, but there was a significant difference between the two groups regarding to feeling of severe pain (P=0.0003, analgesic consumption (P=0.0003 and time of operation (P=0.004. In the non-closure group, dose of analgesic drugs, pain severity and time of operation were less than those of the other group.Conclusion: The Findings showed that non-closure of peritoneal layers as a shorter and simpler procedure has no influence on increasing post cesarean morbidity. Therefore, due to maternal health promotion and early neonatal breastfeeding, non closure of peritoneal

Secondary Channel Bifurcation Geometry: A Multi-dimensional Problem

Science.gov (United States)

Gaeuman, D.; Stewart, R. L.

2017-12-01

The construction of secondary channels (or side channels) is a popular strategy for increasing aquatic habitat complexity in managed rivers. Such channels, however, frequently experience aggradation that prevents surface water from entering the side channels near their bifurcation points during periods of relatively low discharge. This failure to maintain an uninterrupted surface water connection with the main channel can reduce the habitat value of side channels for fish species that prefer lotic conditions. Various factors have been proposed as potential controls on the fate of side channels, including water surface slope differences between the main and secondary channels, the presence of main channel secondary circulation, transverse bed slopes, and bifurcation angle. A quantitative assessment of more than 50 natural and constructed secondary channels in the Trinity River of northern California indicates that bifurcations can assume a variety of configurations that are formed by different processes and whose longevity is governed by different sets of factors. Moreover, factors such as bifurcation angle and water surface slope vary with discharge level and are continuously distributed in space, such that they must be viewed as a multi-dimensional field rather than a single-valued attribute that can be assigned to a particular bifurcation.

Hamiltonian closures in fluid models for plasmas

Science.gov (United States)

Tassi, Emanuele

2017-11-01

This article reviews recent activity on the Hamiltonian formulation of fluid models for plasmas in the non-dissipative limit, with emphasis on the relations between the fluid closures adopted for the different models and the Hamiltonian structures. The review focuses on results obtained during the last decade, but a few classical results are also described, in order to illustrate connections with the most recent developments. With the hope of making the review accessible not only to specialists in the field, an introduction to the mathematical tools applied in the Hamiltonian formalism for continuum models is provided. Subsequently, we review the Hamiltonian formulation of models based on the magnetohydrodynamics description, including those based on the adiabatic and double adiabatic closure. It is shown how Dirac's theory of constrained Hamiltonian systems can be applied to impose the incompressibility closure on a magnetohydrodynamic model and how an extended version of barotropic magnetohydrodynamics, accounting for two-fluid effects, is amenable to a Hamiltonian formulation. Hamiltonian reduced fluid models, valid in the presence of a strong magnetic field, are also reviewed. In particular, reduced magnetohydrodynamics and models assuming cold ions and different closures for the electron fluid are discussed. Hamiltonian models relaxing the cold-ion assumption are then introduced. These include models where finite Larmor radius effects are added by means of the gyromap technique, and gyrofluid models. Numerical simulations of Hamiltonian reduced fluid models investigating the phenomenon of magnetic reconnection are illustrated. The last part of the review concerns recent results based on the derivation of closures preserving a Hamiltonian structure, based on the Hamiltonian structure of parent kinetic models. Identification of such closures for fluid models derived from kinetic systems based on the Vlasov and drift-kinetic equations are presented, and

Monitoring calculation of closure change of Extradosed Cable-stayed Bridge

Science.gov (United States)

Shi, Jing Xian; Ran, Zhi Hong

2018-06-01

During the construction of extradosed cable-stayed bridge in Yunnan province, China, the construction unit has made certain changes in the construction process of the closure section due to environmental restrictions: remove the hanging basket after the closure, the sling shall not be provided in closure section, the function of the sling is realized by the hanging basket on the 16th beam. In case of this change, the bridge has been constructed to section 15th. In order to ensure the smooth and orderly progress of each stage in the closure phase, this article is arranged according to the construction plan, appropriate adjustment of related procedures, checking the bridge safety at all stages of construction, the stress and force of the main girder are compared to ensure the safety of the construction after closure changes. Adjust the height of the beam of the 16th and 17th to adapt the new construction plan, and the bridge closure smoothly.

Patent foramen ovale closure with GORE HELEX or CARDIOFORM Septal Occluder vs. antiplatelet therapy for reduction of recurrent stroke or new brain infarct in patients with prior cryptogenic stroke

DEFF Research Database (Denmark)

Kasner, Scott E; Thomassen, Lars; Søndergaard, Lars

2017-01-01

Rationale The utility of patent foramen ovale (PFO) closure for secondary prevention in patients with prior cryptogenic stroke is uncertain despite multiple randomized trials completed to date. Aims The Gore REDUCE Clinical Study (REDUCE) aims to establish superiority of patent foramen ovale...... with truly cryptogenic strokes. Medical therapy is limited to antiplatelet agents in both arms thereby reducing confounding. The trial should determine whether patent foramen ovale closure with the Gore septal occluders is safe and more effective than medical therapy alone for the prevention of recurrent...... closure in conjunction with antiplatelet therapy over antiplatelet therapy alone in reducing the risk of recurrent clinical ischemic stroke or new silent brain infarct in patients who have had a cryptogenic stroke. Methods and design This controlled, open-label trial randomized 664 subjects...

MNC Subsidiary Closures

DEFF Research Database (Denmark)

Sofka, Wolfgang; Torres Preto, Miguel; de Faria, Pedro

2014-01-01

We investigate the consequences of MNC subsidiary closures for employees who lose their jobs. In particular, we examine the extent to which the human capital that these employees acquired while employed by the MNC influences the wages they receive in their new jobs. We propose an employee...

Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: a prospective case–control study

Science.gov (United States)

Lone, Ali M.; Zaroo, Mohd I.; Laway, Bashir A.; Pala, Nazir A.; Bashir, Sheikh A.; Rasool, Altaf

2014-01-01

Objective To compare the effectiveness of vacuum-assisted closure (VAC) versus conventional dressings in the healing of diabetic foot ulcerations (DFUs) in terms of healing rate (time to prepare the wound for closure either spontaneously or by surgery), safety, and patient satisfaction. Methods Randomized case–control study enrolling 56 patients, divided into two groups. Group A (patients treated with VAC) and Group B (patients treated with conventional dressings), with an equal number of patients in each group. DFUs were treated until wound closure, either spontaneously, surgically, or until completion of the 8-week period. Results Granulation tissue appeared in 26 (92.85%) patients by the end of Week 2 in Group A, while it appeared in 15 (53.57%) patients by that time in Group B. 100% granulation was achieved in 21 (77.78%) patients by the end of Week 5 in Group A as compared to only 10 (40%) patients by that time in Group B. Patients in Group A had fewer number of positive blood cultures, secondary amputations and were satisfied with treatment as compared to Group B. Conclusion VAC appears to be more effective, safe, and patient satisfactory compared to conventional dressings for the treatment of DFUs. PMID:24765245

Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: a prospective case–control study

Directory of Open Access Journals (Sweden)

Ali M. Lone

2014-04-01

Full Text Available Objective: To compare the effectiveness of vacuum-assisted closure (VAC versus conventional dressings in the healing of diabetic foot ulcerations (DFUs in terms of healing rate (time to prepare the wound for closure either spontaneously or by surgery, safety, and patient satisfaction. Methods: Randomized case–control study enrolling 56 patients, divided into two groups. Group A (patients treated with VAC and Group B (patients treated with conventional dressings, with an equal number of patients in each group. DFUs were treated until wound closure, either spontaneously, surgically, or until completion of the 8-week period. Results: Granulation tissue appeared in 26 (92.85% patients by the end of Week 2 in Group A, while it appeared in 15 (53.57% patients by that time in Group B. 100% granulation was achieved in 21 (77.78% patients by the end of Week 5 in Group A as compared to only 10 (40% patients by that time in Group B. Patients in Group A had fewer number of positive blood cultures, secondary amputations and were satisfied with treatment as compared to Group B. Conclusion: VAC appears to be more effective, safe, and patient satisfactory compared to conventional dressings for the treatment of DFUs.

Improvement of tricuspid regurgitation after transcatheter ASD closure in older patients.

Science.gov (United States)

Chen, L; Shen, J; Shan, X; Wang, F; Kan, T; Tang, X; Zhao, X; Qin, Y

2017-07-19

Adult patients with undiagnosed atrial septal defect (ASD) may have right heart cavity enlargement and functional tricuspid valve insufficiency. Moderate or more severe tricuspid regurgitation has been associated with a worse prognosis, and more serious complications are typically seen in older patients. This study aimed to evaluate the improvement in functional tricuspid regurgitation and heart geometry after transcatheter ASD closure in older patients. The data of 111 patients over 60 years of age with moderate or severe tricuspid regurgitation before ASD closure were analyzed. At the 1‑month and 6‑month follow-up after closure, both tricuspid regurgitation jet area and right atrial volume decreased significantly. Right ventricular volume decreased 1 month after closure, showing a further decrease at the end of the 6‑month follow-up. However, 24 patients (21.6%) still had persistent severe tricuspid regurgitation after the procedure. Multivariate analysis revealed that patient age at ASD closure and pulmonary artery systolic pressure determined by echocardiography before closure were predictors of persistent tricuspid regurgitation after closure. Transcatheter ASD closure in older patients could significantly decrease tricuspid regurgitation and improve right heart geometry.

2727-S Nonradioactive Dangerous Waste Storage Facility clean closure evaluation report

International Nuclear Information System (INIS)

Luke, S.N.

1994-01-01

This report presents the analytical results of 2727-S NRDWS facility closure verification soil sampling and compares these results to clean closure criteria. The results of this comparison will determine if clean closure of the unit is regulatorily achievable. This report also serves to notify regulators that concentrations of some analytes at the site exceed sitewide background threshold levels (DOE-RL 1993b) and/or the limits of quantitation (LOQ). This report also presents a Model Toxics Control Act Cleanup (MTCA) (WAC 173-340) regulation health-based closure standard under which the unit can clean close in lieu of closure to background levels or LOQ in accordance with WAC 173-303-610. The health-based clean closure standard will be closure to MTCA Method B residential cleanup levels. This report reconciles all analyte concentrations reported above background or LOQ to this health-based cleanup standard. Regulator acceptance of the findings presented in this report will qualify the TSD unit for clean closure in accordance with WAC 173-303-610 without further TSD unit soil sampling, or soil removal and/or decontamination. Nondetected analytes require no further evaluation

Waste Dump Closure and Cost Estimates at AngloGold Ashanti ...

African Journals Online (AJOL)

Michael

2017-12-02

Dec 2, 2017 ... 2University of Mines and Technology, P.O. Box 237, Tarkwa, Ghana ... The mine has closure plans for the waste dumps and the closure activity ... incur additional cost, it was advised that the mine should execute the closure and reclamation plan without delay. .... Progressively rehabilitate the project area.

A short summary on finite element modelling of fatigue crack closure

Energy Technology Data Exchange (ETDEWEB)

Singh, Konjengbam Darunkumar [Indian Institute of Technology, Guwahati (India); Parry, Matthew Roger [Airbus Operations Ltd, Bristol(United Kingdom); Sinclair, Ian [University of Southampton, Southampton (United Kingdom)

2011-12-15

This paper presents a short summary pertaining to the finite element modelling of fatigue crack closure. Several key issues related to finite element modelling of fatigue crack closure are highlighted: element type, mesh refinement, stabilization of crack closure, crack-tip node release scheme, constitutive model, specimen geometry, stress-states (i.e., plane stress, plane strain), crack closure monitoring. Reviews are presented for both straight and deflected cracks.

Staged closure of a giant omphalocele with amnion preservation, modified technique

Directory of Open Access Journals (Sweden)

Akram H. Aljahdali

2017-04-01

Full Text Available Closure of a giant omphalocele can be challenging. Preservation of the amnion in staged closure is not commonly practiced. Here, we describe 2 cases of giant omphalocele treated with a modified amnion preservation, staged closure technique. This paper demonstrates the feasibility and safety of this technique, and the versatility of amnion to adapt to an escharization strategy if closure is not achievable.

DESIGN OF A WELDING AND INSPECTION SYSTEM FOR WASTE STORAGE CLOSURE

International Nuclear Information System (INIS)

H.B. Smartt; A.D. Watkins; D.P. Pace; R.J. Bitsoi; E.D. Larsen T.R. McJunkin; C.R. Tolle

2005-01-01

This work reported here was done to provide a conceptual design for a robotic welding and inspection system for the Yucca Mountain Repository waste package closure system. The welding and inspection system is intended to make the various closure welds that seal and/or structurally join the lids to the waste package vessels. The welding and inspection system will also perform surface and volumetric inspections of the various closure welds and has the means to repair closure welds, if required. The system is designed to perform these various activities remotely, without the necessity of having personnel in the closure cell

Friction or Closure

DEFF Research Database (Denmark)

Lundahl, Mikela

2014-01-01

Heritage is a discourse that aims at closure. It fixates the narrative of the past through the celebration of specific material (or sometimes immaterial non-) ob-jects. It organizes temporality and construct events and freezes time. How does this unfold in the case of the UNESCO World Heritage si...

Multipass mining sequence room closures: In situ data report

International Nuclear Information System (INIS)

Munson, D.E.; Jones, R.L.; Northrop-Salazar, C.L.; Woerner, S.J.

1992-12-01

During the construction of the Thermal/Structural In Situ Test Rooms at the Waste Isolation Pilot Plant (WIPP) facility, measurements of the salt displacements were obtained at very early times, essentially concurrent with the mining activity. This was accomplished by emplacing manually read closure gage stations directly at the mining face, actually between the face and the mining machine, immediately upon mining of the intended gage location. Typically, these mining sequence closure measurements were taken within one hour of mining of the location and within one meter of the mining face. Readings were taken at these gage stations as the multipass mining continued, with the gage station reestablished as each successive mining pass destroyed the earlier gage points. Data reduction yields the displacement history during the mining operation. These early mining sequence closure data, when combined with the later data of the permanently emplaced closure gages, gives the total time-dependent closure displacements of the test rooms. This complete closure history is an essential part of assuring that the in situ test databases will provide an adequate basis for validation of the predictive technology of salt creep behavior, as required by the WIPP technology development program for disposal of radioactive waste in bedded salt

Closure Plan for Active Low Level Burial Grounds

Energy Technology Data Exchange (ETDEWEB)

SKELLY, W.A.

2000-11-16

This plan has been prepared in response to direction from the U.S. Department of Energy. The purpose of the plan is to define approaches that will be implemented to ensure protection of the public and the environment when active Low-Level Burial Grounds (LLBGs) at the Hanford Site are closed. Performance assessments for active burial grounds in the 200 East and West 200 Areas provide current estimates of potential environmental contamination and doses to the ''maximum exposed individual'' from burial ground operation and closure and compare dose estimates to performance objective dose limits for the facilities. This is an Operational Closure Plan. The intent of the guidance in DOE Order 435.1 is that this plan will be a living document, like the facility performance assessments, and will be revised periodically through the operational life of the LLBGs to reflect updated information on waste inventory. management practices, facility transition planning, schedule dates, assessments of post-closure performance, and environmental consequences. Out year dates identified in this plan are tentative. A Final Closure Plan will be prepared in the future when the timing and extent of closure-related activities for LLBGs can be established with greater certainty. After current operations at the LLBGs are concluded, this plan proposes transitioning of these facilities to the Environmental Restoration Program. This action will enable the Environmental Restoration Program to design and implement consistent and coordinated final remedial actions for active and inactive LLBGs. Active and inactive burial grounds in the 200 West and 200 East Areas are commingled. This plan describes approaches that will be implemented during Interim Closure, Final Closure, and Institutional Control Periods to prepare LLBGs for surface barriers, and the construction of barriers, as well as the scope of inspection, monitoring and maintenance practices that will be performed during

Regional neural tube closure defined by the Grainy head-like transcription factors.

Science.gov (United States)

Rifat, Yeliz; Parekh, Vishwas; Wilanowski, Tomasz; Hislop, Nikki R; Auden, Alana; Ting, Stephen B; Cunningham, John M; Jane, Stephen M

2010-09-15

Primary neurulation in mammals has been defined by distinct anatomical closure sites, at the hindbrain/cervical spine (closure 1), forebrain/midbrain boundary (closure 2), and rostral end of the forebrain (closure 3). Zones of neurulation have also been characterized by morphologic differences in neural fold elevation, with non-neural ectoderm-induced formation of paired dorso-lateral hinge points (DLHP) essential for neural tube closure in the cranial and lower spinal cord regions, and notochord-induced bending at the median hinge point (MHP) sufficient for closure in the upper spinal region. Here we identify a unifying molecular basis for these observations based on the function of the non-neural ectoderm-specific Grainy head-like genes in mice. Using a gene-targeting approach we show that deletion of Grhl2 results in failed closure 3, with mutants exhibiting a split-face malformation and exencephaly, associated with failure of neuro-epithelial folding at the DLHP. Loss of Grhl3 alone defines a distinct lower spinal closure defect, also with defective DLHP formation. The two genes contribute equally to closure 2, where only Grhl gene dosage is limiting. Combined deletion of Grhl2 and Grhl3 induces severe rostral and caudal neural tube defects, but DLHP-independent closure 1 proceeds normally in the upper spinal region. These findings provide a molecular basis for non-neural ectoderm mediated formation of the DLHP that is critical for complete neuraxis closure. (c) 2010 Elsevier Inc. All rights reserved.

Glaucoma: Symptoms and Causes

Science.gov (United States)

... types of glaucoma include the following: Open-angle glaucoma Open-angle glaucoma is the most common form ... re even aware of a problem. Angle-closure glaucoma Angle-closure glaucoma, also called closed-angle glaucoma, ...

300 Area waste acid treatment system closure plan

International Nuclear Information System (INIS)

LUKE, S.N.

1999-01-01

The Hanford Facility Dangerous Waste Permit Application is considered to be a single application organized into a General Information Portion (document number DOERL-91-28) and a Unit-Specific Portion. The scope of the Unit-Specific Portion includes closure plan documentation submitted for individual, treatment, storage, and/or disposal units undergoing closure, such as the 300 Area Waste Acid Treatment System. Documentation contained in the General Information Portion is broader in nature and could be used by multiple treatment, storage, and/or disposal units (e.g., the glossary provided in the General Information Portion). Whenever appropriate, 300 Area Waste Acid Treatment System documentation makes cross-reference to the General Information Portion, rather than duplicating text. This 300 Area Waste Acid Treatment System Closure Plan (Revision 2) includes a Hanford Facility Dangerous Waste Permit Application, Part A, Form 3. Information provided in this closure plan is current as of April 1999

300 Area waste acid treatment system closure plan

Energy Technology Data Exchange (ETDEWEB)

LUKE, S.N.

1999-05-17

The Hanford Facility Dangerous Waste Permit Application is considered to be a single application organized into a General Information Portion (document number DOERL-91-28) and a Unit-Specific Portion. The scope of the Unit-Specific Portion includes closure plan documentation submitted for individual, treatment, storage, and/or disposal units undergoing closure, such as the 300 Area Waste Acid Treatment System. Documentation contained in the General Information Portion is broader in nature and could be used by multiple treatment, storage, and/or disposal units (e.g., the glossary provided in the General Information Portion). Whenever appropriate, 300 Area Waste Acid Treatment System documentation makes cross-reference to the General Information Portion, rather than duplicating text. This 300 Area Waste Acid Treatment System Closure Plan (Revision 2) includes a Hanford Facility Dangerous Waste Permit Application, Part A, Form 3. Information provided in this closure plan is current as of April 1999.

Predictors of successful closure of patent ductus arteriosus with indomethacin.

Science.gov (United States)

Ahamed, M F; Verma, P; Lee, S; Vega, M; Wang, D; Kim, M; Fuloria, M

2015-09-01

To determine whether platelet counts can predict the likelihood of successful closure of patent ductus arteriosus (PDA) with indomethacin. This was a retrospective cohort study of infants closure with indomethacin and those who failed were compared. Multivariable logistic regression was used to identify predictors of successful ductal closure. In infants with hemodynamically significant PDA, older GA (odds ratio=1.54; 95% confidence interval: 1.12 to 2.13), male gender (odds ratio=3.02; 95% confidence interval: 1.08 to 8.49) and higher platelet count (odds ratio=1.5; 95% confidence interval: 1.04 to 2.17) prior to indomethacin treatment were associated with successful ductal closure with indomethacin. Older GA, male gender and higher platelet count at time of treatment of hemodynamically significant PDA are predictors of successful ductal closure with indomethacin.

300 Area Process Trenches Closure Plan

International Nuclear Information System (INIS)

Luke, S.N.

1994-01-01

Since 1987, Westinghouse Hanford Company has been a major contractor to the US Department of Energy, Richland Operations Office and has served as co-operator of the 300 Area Process Trenches, the waste management unit addressed in this closure plan. For the purposes of the Resource Conservation and Recovery Act, Westinghouse Hanford Company is identified as ''co-operator.'' The 300 Area Process Trenches Closure Plan (Revision 0) consists of a Resource Conservation and Recovery Act Part A Dangerous Waste Permit Application, Form 3 and a Resource Conservation and Recovery Act Closure Plan. An explanation of the Part A Permit Application, Form 3 submitted with this document is provided at the beginning of the Part A Section. The closure plan consists of nine chapters and six appendices. The 300 Area Process Trenches received dangerous waste discharges from research and development laboratories in the 300 Area and from fuels fabrication processes. This waste consisted of state-only toxic (WT02), corrosive (D002), chromium (D007), spent halogenated solvents (F001, F002, and F003), and spent nonhalogented solvent (F005). Accurate records are unavailable concerning the amount of dangerous waste discharged to the trenches. The estimated annual quantity of waste (item IV.B) reflects the total quantity of both regulated and nonregulated waste water that was discharged to the unit

Catheter-based closure of the patent ductus arteriosus in lower weight infants.

Science.gov (United States)

Pavlek, Leeann R; Slaughter, Jonathan L; Berman, Darren P; Backes, Carl H

2018-06-13

Risks associated with drug therapy and surgical ligation have led health care providers to consider alternative strategies for patent ductus arteriosus (PDA) closure. Catheter-based PDA closure is the procedure of choice for ductal closure in adults, children, and infants ≥6kg. Given evidence among older counterparts, interest in catheter-based closure of the PDA in lower weight (closure devices; (3) review the technical success (feasibility); (4) review the risks (safety profile); (5) discuss the quality of evidence on procedural efficacy; (6) consider areas for future research. The review provided herein suggests that catheter-based PDA closure is technically feasible, but the lack of comparative trials precludes determination of the optimal strategy for ductal closure in this subgroup of infants. Copyright © 2018 Elsevier Inc. All rights reserved.

Oral Paracetamol for Patent Ductus Arteriosus Rescue Closure.

Science.gov (United States)

Pharande, Pramod; Watson, Hadley; Tan, Kenneth; Sehgal, Arvind

2018-01-01

The objective of this study was to ascertain the efficacy of oral paracetamol in closing a symptomatic patent ductus arteriosus (PDA) when used as 'rescue' option. After obtaining ethics approval, a retrospective appraisal of the data from April 2014 to July 2015 was performed. Infants who were administered oral paracetamol either after unsuccessful therapy with ibuprofen or where it was considered contraindicated were included. A previously published echocardiographic scoring schema to stratify for ductal disease severity was used. Using univariate analysis, characteristics of infants with successful closure were compared with partial (a priori reduction in composite score by ≥ 50% of pretreatment) or no closure. Twenty infants with gestation age and birthweight of 25.7 ± 1.5 weeks and 724.1 ± 143 g, respectively, were studied. Complete closure was noted in 10 (50%) infants with additional four infants showing a significant reduction in haemodynamic shunting. Gestational age at birth and at therapy, chronological age at therapy, birthweight and total fluid intake were comparable between the two groups. The pre-therapy composite score had a significant association with successful closure (the higher the echocardiographic score, the lesser the closure). Concomitant furosemide therapy and late-onset sepsis had a high likelihood ratio of unsuccessful closure (11.01 [2-tailed, p = 0.005] and 5.3 [2-tailed, p = 0.07]), respectively. Oral paracetamol may be a possible therapeutic option in premature infants where therapy with first-line agents is unsuccessful or contraindicated. Concomitant sepsis and furosemide administration may affect successful therapy.

Growth plate closure: Apex view on bone scan

International Nuclear Information System (INIS)

Giles, P.H.; Trochei, M.; Yeates, K.

1984-01-01

Angular deformities of the extremities in children following premature closure of the growth plate are well known. The deformities depend on the position of an osseus bridge which forms between the epiphysis and metaphysis. Several surgical procedures including resection of the osseus bridge have been described, however, delineation of the site of fusion is difficult to define. The commonest site of growth plate arrest is the distal femoral or proximal tibial growth plate. A new technique using the bone scan has been developed which accurately defines the area and position of these osseus bridges. Two hours after injection of technetium 99m methylene diphosphonate apex views of the affected distal femoral growth plate were performed. The knee was flexed into its smallest angle. Using a pinhole collimator the gamma camera was angled to face the affected growth plate end on. The image was collected onto computer and analysed by: (I) regions of interest over segments of the growth plate to calculate the relative area of total growth plate affected: (II) generating histograms: (III) thresholding or performing isocontours to accentuate abnormal areas. The growth plate is normally uniformly increased when compared to the normal shaft of the bone. Fusion across the plate appears as an area of diminished uptake. The apex view gives a unique functional map of the growth plate such that abnormal areas are displayed, and the site, size and position of osseus fusion obtained. The technique has the potential for determining the metabolic activity of the growth plate before and after surgery. Serial studies will allow assessment of regneration of the plate and reformation of new osseus bridges

Hanford Patrol Academy demolition sites closure plan

Energy Technology Data Exchange (ETDEWEB)

1993-09-30

The Hanford Site is owned by the U.S. Government and operated by the U.S. Department of Energy, Richland Operations Office. Westinghouse Hanford Company is a major contractor to the U.S. Department of Energy, Richland Operations Office and serves as co-operator of the Hanford Patrol Academy Demolition Sites, the unit addressed in this paper. This document consists of a Hanford Facility Dangerous Waste Part A Permit Application, Form 3 (Revision 4), and a closure plan for the site. An explanation of the Part A Form 3 submitted with this closure plan is provided at the beginning of the Part A section. This Hanford Patrol Academy Demolition Sites Closure Plan submittal contains information current as of December 15, 1994.

Impact of Vial Capping on Residual Seal Force and Container Closure Integrity.

Science.gov (United States)

Mathaes, Roman; Mahler, Hanns-Christian; Roggo, Yves; Ovadia, Robert; Lam, Philippe; Stauch, Oliver; Vogt, Martin; Roehl, Holger; Huwyler, Joerg; Mohl, Silke; Streubel, Alexander

2016-01-01

The vial capping process is a critical unit operation during drug product manufacturing, as it could possibly generate cosmetic defects or even affect container closure integrity. Yet there is significant variability in capping equipment and processes, and their relation to potential defects or container closure integrity has not been thoroughly studied. In this study we applied several methods-residual seal force tester, a self-developed system of a piezo force sensor measurement, and computed tomography-to characterize different container closure system combinations that had been sealed using different capping process parameter settings. Additionally, container closure integrity of these samples was measured using helium leakage (physical container closure integrity) and compared to characterization data. The different capping equipment settings lead to residual seal force values from 7 to 115 N. High residual seal force values were achieved with high capping pre-compression force and a short distance between the capping plate and plunge. The choice of container closure system influenced the obtained residual seal force values. The residual seal force tester and piezoelectric measurements showed similar trends. All vials passed physical container closure integrity testing, and no stopper rupture was seen with any of the settings applied, suggesting that container closure integrity was warranted for the studied container closure system with the chosen capping setting ranges. The vial capping process is a critical unit operation during drug product manufacturing, as it could possibly generate cosmetic defects or even affect container closure integrity. Yet there is significant variability in capping equipment and processes, and their relation to potential defects or container closure integrity has not been thoroughly studied. In this study we applied several methods-residual seal force tester, a self-developed system of a piezo force sensor measurement, and

Military Base Closures: Updated Status of Prior Base Realignments and Closures

Science.gov (United States)

As the Department of Defense (DOD) prepares for the 2005 base realignment and closure (BRAC) round, questions continue to be raised about the transfer and environmental cleanup of unneeded property arising from the prior four BRAC rounds and their impact on cost and savings and on local economies.

Comparison of two dose regimens of ibuprofen for the closure of patent ductus arteriosus in preterm newborns.

Science.gov (United States)

Dornelles, Laura Vargas; Corso, Andréa Lúcia; Silveira, Rita de Cássia; Procianoy, Renato Soibelmann

2016-01-01

To compare the efficacy of intravenous ibuprofen at high (20-10-10mg/kg/dose) and low doses (10-5-5mg/kg/dose) the closure of patent ductus arteriosus in preterm newborns. A cohort study with historical control of newborns that received high- and low-dose intravenous ibuprofen, from 2010 to 2013 in a neonatal intensive care unit, for closure of the patent ductus arteriosus, documented by echocardiography. Secondary outcomes included the number of ibuprofen cycles, incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, changes in renal function, and death. Seventy-seven patients received three doses of ibuprofen for the treatment of patent ductus arteriosus, with 33 receiving high-dose and 44 low-dose therapy. The ductus closed after the first cycle in 25 (56.8%) low-dose patients and in 17 (51.5%) high-dose patients (p>0.99). Sixteen patients received a second cycle of ibuprofen, and the ductus closed in 50% after low-dose and in 60% after high-dose therapy (p>0.99). Seven patients required surgery for ductus closure, 13.6% in the low-dose group and 3% in the high-dose group (p=0.22). Thirty-nine patients developed bronchopulmonary dysplasia, 50% in the low-dose group and 51.5% in the high-dose group (p>0.99). Twenty-two (50%) low-dose patients died vs. 15 (45.5%) high-dose patients (p=0.86). There was no difference in closure of the ductus arteriosus or occurrence of adverse effects between the two dose regimens. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Transuranic Storage Area (TSA)-2 container storage unit RCRA closure plan

International Nuclear Information System (INIS)

Lodman, D.W.; Spry, M.J.; Nolte, E.P.; Barry, G.A.

1992-11-01

This document describes the proposed plans for closure of the Transuranic Storage Area (TSA)-2 container storage unit at the Idaho National Engineering Laboratory in accordance with the Resource Conservation and Recovery Act closure requirements. The location, size, capacity, history, and current status of the unit are described. Future plans for the unit include incorporating the earthen-covered portion of the TSA-2 pad into a TSA retrieval enclosure along with the TSA-1 and TSAR pads, and closure of the portion of the TSA-2 pad under the Air Support Weather Shield (ASWS-2). This plan addresses closure of the ASWS-2 by decontaminating structures and equipment that may have contacted the waste. Sufficient sampling and documentation of all closure activities will be performed to demonstrate clean closure. A tentative schedule is provided in the form of a milestone chart

Phenomenology of convection-parameterization closure

Directory of Open Access Journals (Sweden)

J.-I. Yano

2013-04-01

Full Text Available Closure is a problem of defining the convective intensity in a given parameterization. In spite of many years of efforts and progress, it is still considered an overall unresolved problem. The present article reviews this problem from phenomenological perspectives. The physical variables that may contribute in defining the convective intensity are listed, and their statistical significances identified by observational data analyses are reviewed. A possibility is discussed for identifying a correct closure hypothesis by performing a linear stability analysis of tropical convectively coupled waves with various different closure hypotheses. Various individual theoretical issues are considered from various different perspectives. The review also emphasizes that the dominant physical factors controlling convection differ between the tropics and extra-tropics, as well as between oceanic and land areas. Both observational as well as theoretical analyses, often focused on the tropics, do not necessarily lead to conclusions consistent with our operational experiences focused on midlatitudes. Though we emphasize the importance of the interplays between these observational, theoretical and operational perspectives, we also face challenges for establishing a solid research framework that is universally applicable. An energy cycle framework is suggested as such a candidate.

Crack closure and sequential effects in fatigue: A literature survey

Science.gov (United States)

Holmgren, M.

A literature survey of the phenomenon of crack closure is reported here. The state of the art is reviewed and several empirical formulas for determining the crack closure are compared with each other. Their properties, advantages and disadvantages are briefly discussed. Experimental techniques for determining the crack closure stress are presented and experimental data from the literature are reported.

303-K Storage Facility: Report on FY98 closure activities

International Nuclear Information System (INIS)

Adler, J.G.

1998-01-01

This report summarizes and evaluates the decontamination activities, sampling activities, and sample analysis performed in support of the closure of the 303-K Storage Facility. The evaluation is based on the validated data included in the data validation package (98-EAP-346) for the 303-K Storage Facility. The results of this evaluation will be used for assessing contamination for the purpose of closing the 303-K Storage Facility as described in the 303-K Storage Facility Closure Plan, DOE/RL-90-04. The closure strategy for the 303-K Storage Facility is to decontaminate the interior of the north half of the 303-K Building to remove known or suspected dangerous waste contamination, to sample the interior concrete and exterior soils for the constituents of concern, and then to perform data analysis, with an evaluation to determine if the closure activities and data meet the closure criteria. The closure criteria for the 303-K Storage Facility is that the concentrations of constituents of concern are not present above the cleanup levels. Based on the evaluation of the decontamination activities, sampling activities, and sample data, determination has been made that the soils at the 303-K Storage Facility meet the cleanup performance standards (WMH 1997) and can be clean closed. The evaluation determined that the 303-K Building cannot be clean closed without additional closure activities. An additional evaluation will be needed to determine the specific activities required to clean close the 303-K Storage Facility. The radiological contamination at the 303-K Storage Facility is not addressed by the closure strategy

Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications.

Science.gov (United States)

Backes, Carl H; Cheatham, Sharon L; Deyo, Grace M; Leopold, Scott; Ball, Molly K; Smith, Charles V; Garg, Vidu; Holzer, Ralf J; Cheatham, John P; Berman, Darren P

2016-02-12

Percutaneous closure of patent ductus arteriosus (PDA) in term neonates is established, but data regarding outcomes in infants born very preterm (closure at weights closure. Twenty-five percent (13/52) of infants were closure. Compared to precatheterization trends, percutaneous PDA closure resulted in improved respiratory status, including less exposure to mechanical ventilation (mixed effects logistic model, Pclosure at weights closure versus alternative (surgical ligation) management strategies. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Mixed Waste Management Facility closure at the Savannah River Site

International Nuclear Information System (INIS)

Bittner, M.F.

1991-08-01

The Mixed Waste Management Facility of the Savannah River Plant received hazardous and solid low level radioactive wastes from 1972 until 1986. Because this facility did not have a permit to receive hazardous wastes, a Resource Conservation and Recovery Act closure was performed between 1987 and 1990. This closure consisted of dynamic compaction of the waste trenches and placement of a 3-foot clay cap, a 2-foot soil cover, and a vegetative layer. Operations of the waste disposal facility, tests performed to complete the closure design, and the construction of the closure cap are discussed herein

Predicting dihedral angle probability distributions for protein coil residues from primary sequence using neural networks

DEFF Research Database (Denmark)

Helles, Glennie; Fonseca, Rasmus

2009-01-01

residue in the input-window. The trained neural network shows a significant improvement (4-68%) in predicting the most probable bin (covering a 30°×30° area of the dihedral angle space) for all amino acids in the data set compared to first order statistics. An accuracy comparable to that of secondary...... seem to have a significant influence on the dihedral angles adopted by the individual amino acids in coil segments. In this work we attempt to predict a probability distribution of these dihedral angles based on the flanking residues. While attempts to predict dihedral angles of coil segments have been...... done previously, none have, to our knowledge, presented comparable results for the probability distribution of dihedral angles. Results: In this paper we develop an artificial neural network that uses an input-window of amino acids to predict a dihedral angle probability distribution for the middle...

Cystic Duct Closure by Sealing With Bipolar Electrocoagulation

Science.gov (United States)

Damgaard, B.; Jorgensen, L. N.; Larsen, S. S.; Kristiansen, V. B.

2010-01-01

Background: Cystic duct leakage after cholecystectomy is not uncommon and is a potentially serious complication. The aim of this study was to assess a bipolar sealing system (LigaSure®) for closure of the cystic duct. Methods: The records from consecutive laparoscopic cholecystectomies performed in 2 hospitals with closure of the cystic duct with LigaSure after informed consent were recorded and complications and morbidity registered. The records were compared with those of patients undergoing laparoscopic cholecystectomy with closure of the cystic duct with clips during the same period. Results: During the study period, 218 laparoscopic cholecystectomies were performed; 102 of these were performed with the LigaSure. One patient was excluded due to violation of the protocol. We experienced no cases of cystic duct leakage, but in one patient, bile leakage from the gallbladder bed was observed probably due to a small aberrant duct. Conclusion: The LigaSure system was safe and effective for closure and division of the cystic duct in laparoscopic cholecystectomy. PMID:20412641

LLNL/YMP Waste Container Fabrication and Closure Project

International Nuclear Information System (INIS)

1990-10-01

The Department of Energy's Office of Civilian Radioactive Waste Management (OCRWM) Program is studying Yucca Mountain, Nevada as a suitable site for the first US high-level nuclear waste repository. Lawrence Livermore National Laboratory (LLNL) has the responsibility for designing and developing the waste package for the permanent storage of high-level nuclear waste. This report is a summary of the technical activities for the LLNL/YMP Nuclear Waste Disposal Container Fabrication and Closure Development Project. Candidate welding closure processes were identified in the Phase 1 report. This report discusses Phase 2. Phase 2 of this effort involved laboratory studies to determine the optimum fabrication and closure processes. Because of budget limitations, LLNL narrowed the materials for evaluation in Phase 2 from the original six to four: Alloy 825, CDA 715, CDA 102 (or CDA 122) and CDA 952. Phase 2 studies focused on evaluation of candidate material in conjunction with fabrication and closure processes

Stress analysis of closure bolts for shipping casks

International Nuclear Information System (INIS)

Mok, G.C.; Fischer, L.E.; Hsu, S.T.

1993-01-01

This report specifies the requirements and criteria for stress analysis of closure bolts for shipping casks containing nuclear spent fuels or high level radioactive materials. The specification is based on existing information conceming the structural behavior, analysis, and design of bolted joints. The approach taken was to extend the ASME Boiler and Pressure Vessel Code requirements and criteria for bolting analysis of nuclear piping and pressure vessels to include the appropriate design and load characteristics of the shipping cask. The characteristics considered are large, flat, closure lids with metal-to-metal contact within the bolted joint; significant temperature and impact loads; and possible prying and bending effects. Specific formulas and procedures developed apply to the bolt stress analysis of a circular, flat, bolted closure. The report also includes critical load cases and desirable design practices for the bolted closure, an in-depth review of the structural behavior of bolted joints, and a comprehensive bibliography of current information on bolted joints

Secondary instabilities of hypersonic stationary crossflow waves

Science.gov (United States)

Edelman, Joshua B.

A sharp, circular 7° half-angle cone was tested in the Boeing/AFOSR Mach-6 Quiet Tunnel at 6° angle of attack. Using a variety of roughness configurations, measurements were made using temperature-sensitive paint (TSP) and fast pressure sensors. High-frequency secondary instabilities of the stationary crossflow waves were detected near the aft end of the cone, from 110° to 163° from the windward ray. At least two frequency bands of the secondary instabilities were measured. The secondary instabilities have high coherence between upstream and downstream sensor pairs. In addition, the amplitudes of the instabilities increase with the addition of roughness elements near the nose of the cone. Two of the measured instabilities were captured over a range of axial Reynolds numbers of about 1 - 2 million, with amplitudes ranging from low to turbulent breakdown. For these instabilities, the wave speed and amplitude growth can be calculated. The wave speeds were all near the edge velocity. Measured growth before breakdown for the two instabilities are between e3 and e4 from background noise levels. The initial linear growth rates for the instabilities are near 50 /m. Simultaneous measurement of two frequency bands of the secondary instabilities was made during a single run. It was found that each mode was spatially confined within a small azimuthal region, and that the regions of peak amplitude for one mode correspond to regions of minimal amplitude for the other.

Influence of Closure & Non-Closure of the Visceral and Parietal Peritoneum on Post Cesarean Morbidity

Directory of Open Access Journals (Sweden)

Z Tabasi

2012-05-01

Full Text Available

Background and Objectives: One of the most important issues in promoting mother and child health is reducing the morbidity rate after cesarean section. The aim of this study was to investigate the influence of closure and non-closure of the visceral and parietal peritoneum on post cesarean morbidity in women attending Shabihkhani Maternity Hospital in Kashan, Iran.

Methods: This study was conducted with a single blind randomized clinical trial method on 100 parturient women that underwent emergency or elective cesarean section. Patients with previous cesarean section and or abdominal surgery, diseases such as hypertension, diabetes mellitus and premature rupture of membrane and pre operative bleeding, were excluded from this study. Then, the participants were randomly divided into two groups: in one group both peritoneal layers were closed while in the other group, they were not closed. Post operative morbidity including fever, bleeding, post operative pain, analgesic consumption and time of operation were assessed. Data were analyzed with t-tests, and χ2 and a P<0.05 were considered significant.

Results: In this study, there were no significant differences between the two groups with respect to age, gestational age, the reason for caesarean section and gravidity, nor were there any differences with respect to the incidence of fever or bleeding and was similar between the two groups, but there was a significant difference between the two groups regarding to feeling of severe pain (P=0.0003, analgesic consumption (P=0.0003 and time of operation (P=0.004. In the non-closure group, dose of analgesic drugs, pain severity and time of operation were less than those of the other group.