Purpose: To evaluate the efficacy and survival rates of same session ab interno trabeculectomy with the trabectome and Ahmed glaucoma valve implant (AT) in comparison to the Ahmed glaucoma valve alone (A). Method: A total of 107 eyes undergoing primary glaucoma surgery were enrolled in this retrospective comparative case series, including 48 eyes which underwent AT and 59 eyes which received A alone. Participants were identified using the procedural terminology codes, and their medical records were reviewed. The primary outcome measure was surgical success, defined as intraocular pressure (IOP) > 5 mmHg, ≤ 21 mmHg, and IOP reduction ≥ 20% from baseline at two consecutive visits after three months, no reoperation for glaucoma. Secondary outcome measures were IOP, the number of glaucoma medications, incidence of a hypertensive phase, and best corrected visual acuity (BCVA). Results: The cumulative probability of success at one year was 70% in AT, and 65% in A (p=0.85). IOP decreased significantly from 26.6 ± 10.1 mmHg at baseline to 14.7 ± 3.3 mmHg at the final follow-up in AT (p= 0.001). The corresponding numbers for A were 28.8 ± 10.2 and 16.7 ± 4.9, respectively (p= 0.001). The final IOP was significantly lower in AT (p= 0.022). The number of medications at baseline was comparable in both groups (2.6 ± 1.2 in AT and 2.5 ± 1.3 in A, p=0.851). Corresponding number at 1 year visit was 1.2±2 in AT and 2.8±1.8 in A (p=0.001). The incidence of a hypertensive phase was 18.7% in AT and 35.5% in A (p=0.05). HP resolved in only 30% of eyes. The criteria for HP resolution were fulfilled in 9 eyes (30%). There was no difference in the rate of resolution of the hypertensive phase between AT and A (33.3% and 28.5%, respectively, p=0.67). Conclusion: Ahmed glaucoma valve implant with same session trabectome surgery significantly decreased the rate of the hypertensive phase and postoperative IOP as well as the number of glaucoma medications.

Purpose: To compare the efficacy and safety of graft-free short tunnel small flap (STSF) technique with that of scleral patch graft (SPG) in Ahmed glaucoma valve (AGV) implantation. Design: Randomized clinical trial. Participants: Eighty-eyes of eighty patients with medically uncontrolled glaucoma including 41 in STSF and 39 eyes in SPG. Methods: Patients were enrolled and assigned randomly to STSF or SPG. Main Outcome Measures: tube exposure, Intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), surgical complications, and success rate ( defined as intraocular pressure (IOP) >5 mmHg, ≤21 mmHg, and IOP reduction ≥20% from baseline at two consecutive visits after three months, no reoperation for glaucoma). Results: only one case in SPG developed tube exposure at 1-year follow-up. The cumulative probability of success during the first year of follow-up was 70% in the STSF and 65% in SPG (P = 0.36). IOP decreased significantly from 29.6 ± 8.6 mmHg at baseline to 16.4 ± 3.6 mmHg at the final follow-up in STSF (p = 0.001). The corresponding numbers for SPG were 30.9 ± 11.2 and 15.8 ± 4.7, respectively (p = 0.001). The final IOP was comparable between both groups (p = 0.65). Mean ± standard deviation of the number of glaucoma medications was 1.8 ± 0.9 in STSF and 1.6 ± 0.9 in SPG at final follow-up (P = 0.32). Postoperative complications developed in 8 patients (19%) in STSF and 9 patients (23%) in SPG (P = 0.81). Conclusions: STSF and SPG techniques had comparable complication rate at one-year follow-up. Both techniques were comparable in terms of success rate, postoperative IOP, and glaucoma medications.

Biomechanics is a branch of biophysics that deals with mechanics applied to biology. The biomechanics of the cornea plays a significant role in managing patients with glaucoma. While evidence suggests a higher risk of glaucoma in patients with thin and stiffer corneas, it also affects the measurement of intraocular pressure (IOP). We reviewed the pertinent literature to help the understanding of corneal biomechanics and how it can help optimize clinical and surgical treatments and a better approach to diagnosing and managing patients with glaucoma.

Transcatheter Aortic Valve Implantation (TAVI) now represents the mainstay in the treatment of severe aortic stenosis. Owing to its exceptional procedural efficacy and safety, TAVI has been extended to include patients at lower surgical risk, thus now encompassing a diverse patient population receiving this treatment. Yet, long-term outcomes also depend on optimal medical therapy for secondary vascular prevention, with antithrombotic therapy serving as a cornerstone. Leveraging data from multiple randomized controlled trials, current guidelines generally recommend single antithrombotic therapy, with either single antiplatelet therapy (SAPT) or oral anticoagulation (OAC) alone in those patients without, or with atrial fibrillation respectively. Yet, individualization of this pattern, as well as specific case uses, may be needed based on individual-patient characteristics and concurrent procedures. This review aims to discuss the evidence supporting antithrombotic treatments in patients treated with TAVI, indications for a standardized treatment, as well as specific considerations for an individualized approach to treatment.

Purpose: We hypothesized that a recently introduced epibulbar micro-shunt (PRESERFLO, P) produces nycthemeral (24h) intraocular pressure (IOP) profiles different from ab-interno trabeculectomy (Trabectome, T). P is a flow restrictor that drains fluid into the sub-tenon space. In contrast, T increases conventional outflow, which is limited by episcleral venous pressure. Methods: In this prospective cohort, we analyzed 68 patients (34 P and 34 T) who presented for 24-h IOP monitoring 6 to 12 months after surgery. IOP and tonographic outflow facility were measured in the habitual position using a pneumatonometer. The IOP variation was considered the primary outcome measure. Glaucoma medications were also compared. Results: P had a higher baseline IOP than T (24.8±10.0 vs. 17.3±7.9 mmHg, p=0.001). Postoperatively, P and T had similar nycthemeral IOP profiles, but IOP in P was significantly lower than in T, except at 4 pm. P had a lower absolute IOP variation than T (5.8±2.6 vs. 7.1±2.7 mmHg, p=0.049). The relative IOP variation was similar in both (34.8±13.2 vs. 37.2±13.1, p=0.45) as was the tonographic outflow facility (0.35±0.23 vs. 0.26±0.18 µl/min/mmHg, p=0.097). Conclusion: Nycthemeral IOP profiles of P and T were similar, but P had lower IOPs and less variation than T. This could reflect how T, unlike P, is more impacted by habitual, positional factors, especially at night.

Background/Objectives: Infectious Endocarditis often requires surgical intervention, with postoperative acute kidney injury (AKI) posing a significant concern. This retrospective study aimed to investigate AKI incidence, its impact on short-term mortality, and identify modifiable factors in patients with endocarditis scheduled for valve surgery. Methods: This single center study enrolled 130 consecutive endocarditis patients from 2013 to 2021 undergoing valve surgery. Creatinine levels were monitored pre- and postoperatively, and AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patient demographics, comorbidities, procedural details, and complications were recorded. Primary outcomes included AKI incidence, the relevance of creatinine levels for AKI detection, and the association of AKI with 30-, 60- and 180-day mortality. Modifiable factors contributing to AKI were explored as secondary outcomes. Results: Postoperatively, 35.4% developed AKI. The highest creatinine elevation occurred on the 2nd postoperative day. Best predictive value for AKI was a creatinine level of 1.35 mg/dl on the 2nd day (AUC: 0.901; sensitivity: 0.89, specificity: 0.79). Elevated creatinine levels on the 2nd day were robust predictors for short-term mortality at 30, 60 and 180 days postoperatively (AUC ranging from 0.708 to 0.789). CK-MB levels at 24 hours postoperatively and minimum hemoglobin during surgery were identified as independent predictors for AKI in logistic regression. Conclusions: This study highlights the crucial role of creatinine levels in predicting short-term mortality in surgical endocarditis patients. A specific threshold (1.35 mg/dl) provides a practical marker for risk stratification, offering insights for refining perioperative strategies and optimizing outcomes in this challenging patient population.

Infective endocarditis (IE) is a life-threatening condition caused by infection within the endocardium of the heart, and commonly involves the valves. The subsequent cascading inflammation leads to the appearance of a highly friable thrombus that is large enough to become lodged within the heart chambers. As a result, fever, fatigue, heart murmurs, and embolization phenomena may be seen in patients with IE. Embolization results in the seeding of bacteria, and obstruction of circulation, causing cell ischemia. Of concern, bacteria with the potential to gain pan-drug resistance, such as methicillin-resistant Staphylococcus aureus (MRSA), are increasingly being identified as the causative agent of IE in hospitals and among intravenous drug abusers. We retrospectively reviewed de-identified clinical data to summarize the clinical course of a patient with MRSA isolated using an automated blood culture system. At the time of presentation, the patient showed a poor consciousness level, and the calculated Glasgow scale was 10/15. A high-grade fever with circulatory shock indicated an occult infection, and a systolic murmur was observed with peripheral signs of embolization. This case demonstrated the emerging threat of antimicrobial resistance in the community, and revealed clinical findings of IE that may be helpful to clinicians for the early recognition of the disease. The management of such cases requires a multi-specialty approach, which is not widely available in small island developing states like the Maldives.

Background: Redo mitral valve surgery is the standard of care for failed mitral bioprostheses or recurrence of mitral regurgitation after repair. Nonetheless, catheterbased valve-in-valve (ViV) or valve-in-ring (ViR)-procedures increasingly become viable alternatives in high risk subpopula-tions. Despite reported good initial results, only little is known about longer-term outcomes. The present series report long-term outcomes of transcatheter mitral ViV- and ViR-procedures. Methods: All consecutive patients (n=54) undergoing transcatheter mitral ViV- or ViR-procedures for failed bioprostheses or recurring regurgitation after mitral repair were retrospectively en-rolled in the time period between 2011 and 2021. The mean age was 76.5 ± 6.5 years, and 30 (55.6%) of the patients were male. The procedures were done using a commercially available balloon-expandable transcatheter heart valve. Clinical and echocardiographic follow-up data were obtained out of the hospital’s database and analyzed. Follow-up reached up to 9.9 years with a total of 164.3 patient-years. Results: A total 25 patients received a ViV- and 29 patients a ViR-procedure. Both groups were at high surgical risk with an STS-PROM of 5.9 ± 3.7 % in ViV- and 8.7 ± 9.0% in ViR-patients, respectively (p<0.01). The procedures itself were mainly unevent-ful with no intraoperative deaths and a low conversion rate (n=2/54; 3.7%). VARC-2 procedural success was low (ViV 20.0% and ViR 10.3%; p=0.45), which was either driven by high rates of transvalvular pressure gradients “>5mmHg” (ViV 92.0% and ViR 27.6%; p<0.01) or residual regurgitation “>trace” (ViV 28.0% and ViR 82.7%; p<0.01). ICU-stay was prolonged in both groups (ViV 3.8 ± 6.8 days and ViR 4.3 ± 6.3 days; p=0.96) with acceptable hospital stay (ViV 9.9 ± 5.9 days and ViR 13.5 ± 8.0 days; p=0.13). Despite 30-days mortality was acceptable (ViV 4.0% and ViR 6.9%; p=1.00), the mean posthospital survival time was disappointingly low (ViV 3.9 ± 2.6 years and ViR 2.3 ± 2.7 years; p<0.01). Overall survival I the entire group was 33.3%.Cardiac reasons for death were frequent in both groups (ViV 38.5% and ViR 52.2%). Cox-regression analysis identified ViR-procedures as a predictor of mortality (HR 2.36, CI 1.19 - 4.67, p=0.01). Conclusions: Despite acceptable immediate outcomes in this high-risk subpopulation, long-terms results are discouraging. Transvalvular pressure gradients as well as residual regurgitations remained drawbacks in this real-world population. The indication for catheterbased mitral ViV- or ViR-procedures thoughtfully must be made in consideration of conventional redo-surgery or conservative treatment.

Automotive aerodynamics comprises of the study of aerodynamics of road vehicles. Its main goals are reducing drag, minimizing noise emission, improving fuel economy, preventing undesired lift forces and minimizing other causes of aerodynamic instability at high speeds. The Ahmed body has the form of a highly simplified car, consisting of a blunt nose with rounded edges fixed onto a box-like middle section and a rear end that has an upper slanted surface, the angle of which can be varied. It retains vital features of real vehicles in order to study the flow fields around it and the related turbulence models which characterizes the actual flow at elevated Reynolds number. In the present study, the aerodynamic behavior of this body is investigated numerically by the aid of commercial CFD tool: Ansys Fluent. The results of the simulation are validated with available experimental data and results of the simulations from other literatures. The numerical data were obtained for a fixed free stream velocity of 25 m/s at the inlet. The simulations were performed at a fixed slant angle of 25 degree and zero yaw angle. The present study focuses on how local refinement of mesh inside the concerned body and the outside, helps affect the results and for which grid dependency test is the primary objective of this paper. The present study also helps demonstrate how the drag of the body behaves, which is mainly the effect of pressure drag force generated at the rear portion of the body. The study also focuses on important properties like the velocity magnitude at different locations for different meshing cases, and to capture the flow pattern in the front or near the wake region. The study can be further helpful to future researchers in determining resistance, fuel efficiency etc. helping designers to optimize in specialized areas for better efficiency.

Background: We compared corneal visualization Scheimpflug technology (CST) parameters between eyes with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Methods: A retrospective analysis was done on data from 89 eyes with POAG and 83 eyes with PACG that had CST examinations. CST parameters were compared between eyes with POAG and those with PACG using a linear mixed model (LMM). Results: No differences were observed in age, central corneal thickness, intraocular pressure, or use of antiglaucoma eye drops between the two groups. Patients with PACG had a significantly shorter axial length (AL), a higher proportion of females, CST parameters, longer applanation 2 (A2) time, deeper A2 deformation amplitude, shorter peak distance (PD), longer whole eye movement, and longer whole eye movement time than patients with POAG. Highest concavity (HC) length and PD showed a significant positive correlation with AL. However, A1 length, A1 deformation amplitude, A2 time, A2 velocity, A2 length, A2 deformation amplitude, HC time, whole eye movement, and whole eye movement time were negatively correlated with AL. Conclusions: Biomechanical properties of the cornea differed between PACG and POAG. In some parts, AL differences between the POAG and PACG groups might contribute to the variation in CST parameters.

The aim of this study was to analyze surgical and refractive outcomes of XEN glaucoma implant (Allergan, an Abbvie company, Irvine, CA, USA), a minimally invasive surgical device for the treatment of refractory glaucoma. A retrospective chart review of eyes that received XEN Gel Stent placement from December 2014 to October 2019 was conducted. Intraocular pressure (IOP) change, best corrected visual acuity (BCVA), change in glaucoma medications, frequency of slit lamp revision procedures, and frequency of secondary glaucoma surgeries were the primary outcomes. Seventy-two subjects were included in the study: 32 (44%) males and 40 (56%) females. The mean follow-up time was 26.87 ± 15.33 months. The mean IOP before surgery was 24.82 ± 8.03 mmHg and decreased to 17.45 ± 5.84 mmHg at the end of the study, MD = -7.48, CI95 [-10.04; -4.93], p < 0.001. The mean decrease from baseline was 23%. Before surgery BCVA was 0.38±0.30 and at the end of the follow-up period it had improved to 0.47±0.37, MD = 0.09, CI95 [0.04; 0.13], p < 0.001. Additional procedures (fluorouracil injection, Bleb needling) were performed in 11/72 patients (15%). Further glaucoma surgery was necessary for 23.9%% of the patients. Implantation of XEN Gel Stent is both safe and effective for lowering IOP in refractory glaucoma patients.

Glaucoma, a group of diseases characterized by progressive retinal ganglion cell loss, cupping of the optic disc and by a typical pattern of visual field defects, is a leading cause of severe visual impairment and blindness worldwide. Elevated intraocular pressure (IOP) is the leading risk factor for glaucoma development. However, glaucoma can also develop at normal pressure levels. An increased susceptibility of retinal ganglion cells to IOP, systemic vascular dysregulation, endothelial dysfunction and autoimmune imbalances have been suggested to play a role in the pathophysiology of normal tension glaucoma. Since inflammation and oxidative stress play a role in all forms of glaucoma, the goal of this review article is to resent an overview on the inflammatory and prooxidant mechanisms in the pathophysiology of glaucoma and to discuss immunomodulatory and antioxidant treatment approaches.

There is increasing evidence that some adult mitral valve pathologies may have developmental origins involving errors in cell signaling and protein deposition during valvulogenesis. While early and late gestational stages are well-documented in zebrafish and small mammalian models, longitudinal studies in large mammals with a similar gestational period to humans are lacking. Further, the mechanism of chordae tendineae formation and multiplication remains unclear. This current study presents a comprehensive examination of mitral anterior leaflet and chordae tendineae development in a bovine model (with a gestational period of 9 months). Remarkably distinct from small mammals, bovine development displayed early branched chordae, with increasing attachments only until birth, while the anterior leaflet grew both during gestation and postnatally. Chordae also exhibited accelerated collagen deposition, maturation, and crimp development during gestation. These findings suggest that the bovine anterior leaflet and chordae tendineae possess unique compartmentalized processes of development despite being a continuous collagenous structure.

For the first time, mathematical models were obtained for evaluating biomedical images using fuzzy set methods on the basis of expert knowledge bases, which made it possible to carry out complex qualitative diagnostics and increase the reliability and efficiency of diagnosis, to form a methodology for analyzing biomedical images based on the fuzzy set apparatus, which allowed to more fully assess the level of the disease for glaucoma. Aspects of practical implementation of the optical-electronic system of biomedical information processing are considered. An algorithm and an optical-electronic system of biomedical image analysis are proposed, which are used to increase the informativeness and reliability of diagnosing eye pathologies, in particular, glaucoma.

Digital twins are an emerging technology that could be harnessed for the digitalization of the industry. Steel industry systems contain a large number of electro-hydraulic components, as proportional valves. An input-output model for a novel water proportional cartridge valve is derived from physical modelling based on fluid mechanics, dynamics, and electrical principles. The valve is a two-stage valve with two 2/2-way water proportional valves as the pilot stage and a marginally stable poppet-type cartridge valve as the main valve. The orifice equation, which is based on Bernoulli principles, is approximated by a polynomial which makes parameter estimation easier and makes modelling possible without measuring pressure of the varying control volume situated in the pilot stage part of the valve. Data were collected when the valve was operating as a component in a closed-loop system as part of a press-mill machine in a steel manufacturing plant. Parameter estimation was made by convex optimization with physical constraints to overcome problems caused by poor system excitation. For comparison, a simple linear model was derived and the least squares method used for parameter estimation. A thorough estimation of the parameters relative errors is presented. The model contains 5 parameters related to the design parameters of the valve. The modelled position output is in good agreement with experimental data for training and test data. The model can be used for real time monitoring of the valve’s status by the model parameters. One of the model parameters varies linearly with production cycles. Thus, aging of the valve can be monitored.

Recent research efforts in bone tissue engineering have been primarily directed towards manufacture-viable synthesis of biomaterials that can significantly enhance the biocompatibilities and osteogenic capabilities on the new biomaterials. This paper presents a straightforward, cost-effective, optimized, and well-controlled hydrothermal synthesis of Nb-doped potassium titanate nanofibers in high-purity. Characterization data revealed that the Nb-doping potassium titanate maintained the crystal structure, showing great promise for applications in bone tissue engineering.

Progressive loss of retinal ganglionic cells (RGC) causes blindness in glaucoma. Elevated intraocular pressure (IOP) is the most important, treatable risk factor. Currently, the management of glaucoma is centred at reducing the IOP, and drugs in the form of topical drops are the first line of management. Drugs reduce IOP either by suppressing aqueous humour secretion or improving the aqueous humour outflow. Newer drugs added during the past three decades to the armamentarium of glaucoma treatment have targeted the aqueous outflow. With an evolving understanding of the pathogenesis of glaucoma, the role of 24-hour IOP control and other IOP-independent risk factors affecting ocular blood flow and RGC toxicity is also recognised. The role of available drugs in controlling IOP over 24-hours is being evaluated. Improvement of ocular blood flow and neuroprotection are seen as potential drug targets in preventing the loss of RGC. In this article, we review the pharmacotherapy of glaucoma based on current therapeutic principles.

Glaucoma is undoubtedly a major worldwide disease and cause of blindness. The term glaucoma however encompasses a group of disorders with differing age of incidence, intraocular pressures and varying degrees of hereditability in which vision loss occurs through a characteristic mode of retinal ganglion cell death. There are also significant differences in frequencies of incidence and gene associations for this group of disorders amongst different groups of populations. The current literature often states definitive trends in incidence for ethnic groups that fail to take into account an overall genetic fine structure for these groups. The present review intends to present an overview of some of the background necessary to discuss the genetic basis of glaucoma before describing some of the literature concerning the illness in Gypsy, Japanese, Scandinavian, Latino (Mexican and Brazilian) and Sub-Saharan African populations. It is intended that this review will give the reader a clearer picture of the diversity of worldwide glaucoma presentation which perhaps prove to question the current Ethnic view.

Glaucoma poses a serious public health concern as it is the second leading cause of blindness after cataracts, while also being the leading cause of irreversible blindness worldwide. Glaucoma is more prevalent among Black, Latino, and Asian populations and it is essential to examine both racial and ethnic disparities that exist in treatment and prevention. As the number of people with glaucoma continues to grow, it is important to review aspects of this condition in order to better care for those affected. This article will review significant forms of glaucoma and what differentiates them in a diagnosis, treatment options, and recommendations on prevention and improving awareness

Abstract: The glucocorticoid receptor (GR), including both alternative spliced isoforms (GRa and GRb), has been implicated in the development of primary open-angle glaucoma (POAG) and iatrogenic glucocorticoid-induced glaucoma (GIG). POAG is the most common form of glaucoma, which is the leading cause of irreversible vision loss and blindness in the world. Glucocorticoids (GCs) are commonly used therapeutically for ocular and numerous other diseases/conditions. One serious side effect of prolonged GC therapy is the development of iatrogenic secondary ocular hypertension (OHT) and OAG (i.e. GC-induced glaucoma (GIG)) that clinically and pathologically mimics POAG. GC-induced OHT is caused by pathogenic damage to the trabecular meshwork (TM), a tissue involved in regulating aqueous humor outflow and intraocular pressure. TM cells derived from POAG eyes (GTM cells) have lower expression of GRb, a dominant negative regulator of GC activity, compared to TM cells from age-matched control eyes. Therefore, GTM cells have a greater pathogenic response to GCs. Almost all POAG patients develop GC-OHT when treated with GCs, in contrast to a GC responder rate of 40% in the normal population. Increased expression of GRb can block GC-induced pathogenic changes in TM cells and reverse GC-OHT in mice. Endogenous expression of GRb in the TM may relate to differences in the development of GC-OHT among the normal population. A number of studies have suggested increased levels of endogenous cortisol in POAG patients as well as differences in cortisol metabolism, suggesting that GCs may be involved in the development of POAG. Additional studies are warranted to better understand the molecular mechanisms involved in POAG and GIG in order to develop new disease modifying therapies to better treat these two sight threatening forms of glaucoma.

Objective: Evaluation of patients with prosthetic valves who developed infective endocarditis by comparing treatment outcomes in both early- and late-onset IE episodes following prosthetic valve replacement surgery. This study sought to conduct a comprehensive assessment of the efficacy of these methodologies. The insights derived from this assessment will be utilized to enhance the quality of care for individuals with infective endocarditis who have received prosthetic valve replacement surgery. Results: During the period of investigation (January 2018 - December 2022), 78 patients diagnosed with infective endocarditis (IE) on prosthetic valve were admitted to the Infectious Diseases Department of the "Dr. Carol Davila" Central Military Emergency University Hospital in Bucharest. In 28 cases (35.8%), the onset of PVE occurred within 12 months of surgery (early onset), whereas in 50 patients (64.2%), the onset occurred more than 12 months after surgery (late onset). The mortality rate was 35.9% (53.6% among the early onset patients and 26% among the late-onset patients). Among patients who received surgical and medical therapy, the mortality rate was 29.6%, whereas among those who underwent only medical therapy, a 39.2% mortality rate was reported. According to the extracted data, antibiotic therapy was successful in 72.6% of patients. In contrast, a combination of surgical and drug-based approaches resulted in a cure in 76.1% of the patients. The most common etiological agent was Staphylococcus aureus (38.5%), followed by Enterococcus faecalis (26.9%), and Streptococcus mitis (10.3%). The mortality rate of patients with S. aureus was 29.2%, indicating the severity of this infectious agent. Conclusions: Prosthetic valve endocarditis (PVE) is a serious condition associated with a high mortality rate both in the short and long term. Regardless of the therapy used, the risk of death remains high. All patients with PVE who survived received effective early treatment, highlighting the need for prophylactic measures.

Minimally invasive approaches to the aortic valve have been described since 1993, with great hopes that they would become universal and facilitate day-case cardiac surgery. The literature has shown that these procedures can be undertaken with equivalent mortality, similar operative time, comparative cost and some benefits in hospital length of stay. The competing efforts of the transcatheter aortic valve implantation for these same outcomes have provided an excellent range of treatment options for patients from the Heart Team. We describe the current state of the art, including technical considerations, caveats and complications of minimal access aortic surgery and predict future directions in this space.

In this review, we outline our current understanding of the mechanisms involved in the absorption, storage, and transport of dietary vitamin A to the eye, the trafficking of rod opsin protein to the photoreceptor outer segments, which encompasses the logistical backbone required for visual function. Two key mechanisms of this process are emphasized in this manuscript: Ocular and systemic vitamin A membrane transporters, and rhodopsin transporters. Understanding the complementary mechanisms responsible for the generation and proper transport of the retinylidene opsin to the photoreceptor outer segment will eventually shed light on the importance of genes encoded by these proteins, and their relationship on normal visual function and in the pathophysiology of retinal degenerative diseases.

Background: Retinal vascular abnormalities may be associated with glaucomatous damage. Adaptive optics (AO) is a new technology that enables analysis of retinal vasculature at the cellular level in vivo. The purpose of this study is to evaluate retinal arteriolar parameters using the adaptive optics fundus camera (AO -FC) rtx1 in patients with primary open-angle glaucoma (POAG) at different stages and to investigate the relationship between these parameters and changes in optical coherence tomography (OCT) and perimetry. We wanted to assess whether vascular changes could be a cause or effect of glaucomatous damage. Methods: Parameters of retinal supratemporal and infratemporal arterioles (wall thickness (WT), lumen diameter (LD), total diameter (TD), wall-to-lumen ratio (WLR), and cross-sectional area of the vascular wall (WCSA)) were analysed with the rtx1 in 111 POAG eyes, divided into three groups according to the severity of disease and 70 healthy eyes in correlation of structural defects in retinal nerve fibre layer and visual fields defects. Results: Compared with the control group, the POAG groups showed significantly smaller TD and LD values (p<0,05) and significantly higher WLR and WT values (p<0,05) for supratemporal and infratemporal arterioles. Rtx1 parameters significantly correlated with OCT parameters (retinal nerve fibre layer, ganglion cell complex and rim area) and visual field parameters (mean deviation and pattern standard deviation) (p<0.05). Conclusion:  The results suggest that vascular dysfunction may be involved in POAG pathogenesis and neurodegenerative damage, even at the very early stage of glaucoma, without visual field defects.

Aortic valve stenosis and malignancy frequently coexist and share the same risk factors as atherosclerotic disease. Data reporting the prognosis of patients with severe aortic stenosis and cancer are limited. Tailoring the correct and most optimal care for cancer patients with severe aortic stenosis is complex. Cancer patients may be further disadvantaged by aortic stenosis if it interferes with their treatment by increasing the risk associated with oncologic surgery and compounding the risks associated with cardiotoxicity and heart failure (HF). Nowadays, several therapeutic options are available for aortic valve stenosis (surgical valve replacement , transcatheter valve implantation, balloon valvuloplasty, or medical therapy), but in presence of malignancy, the use of one of these versus the others should be decided on a case-by-case approach, depending on cancer stage and associated treatment, expected outcome, comorbidities and after an accurate physical examination and Doppler-echocardiography which are the key tools for diagnosing and evaluating aortic stenosis. The current review considers the available data on the association between aortic stenosis and cancer, and therapeutic options.

Mitral regurgitation (MR) is a broadly diffuse valvular heart disease (VHD) with a significant impact on healthcare system and patient’s prognosis. Transcatheter mitral valve interventions (TMVI) are now well-established techniques included in the therapeutic armamentarium for managing patients with mitral regurgitation, either primary or functional MR. Even if guidelines give indications regarding the correct management of this VHD, the wide heterogeneity of patient’s clinical background, valvular and heart’s anatomy make each patient a unique case, in which the appropriate device’s selection requires a multimodality imaging evaluation and a multidisciplinary discussion. Proper pre-procedural evaluation plays a pivotal role to judge the feasibility of TMVI, as well as a cooperative works between imagers and interventionalist is crucial for procedural success. This manuscript aims to provide an exhaustive overview of the main parameters that need to be evaluated for appropriate device selection, pre-procedural planning, intraprocedural guidance and post-operative assessment in the setting of TMVI. In addition, it tries to give some insights about next perspective of structural cardiovascular imaging.

Glaucoma is a disease associated with retina of eye. Presently, millions of human being is suffering from this disease. Early detection of these diseases can save the people from blindness. Therefore, various methods have been developed for its detection. In this paper, we have studied the reported methods and summarized their performance in terms of accuracy of detection.

Glaucoma secondary to Peters' anomaly (PA) is an important factor affecting visual prognosis, but there are few reports on it. This study aimed to investigate the characteristics of glaucoma asso-ciated with PA and glaucoma surgery outcomes. This retrospective study included 31 eyes of 20 patients with PA. PA was classified into three stages: Stage 1, with a posterior corneal defect only; Stage 2, a corneal defect with iridocorneal adhesion; and Stage 3, a corneal defect with lens ab-normalities. The associations between glaucoma and anterior segment dysgenesis severity, visual prognosis, and glaucoma surgery outcomes were analyzed. Sixteen eyes of 10 patients developed glaucoma. Stage 1 PA had no glaucoma, 52% of Stage 2 had glaucoma, and 75% of Stage 3 had glaucoma. Of the 16 eyes with glaucoma, 11 underwent surgery. Eight of these 11 eyes achieved intraocular pressure (IOP) control. Five of the nine eyes that underwent trabeculotomy (TLO) succeeded, and none had corneal staphyloma. Three of the four eyes for which TLO was ineffective had corneal staphyloma (P=0.0331). Patients with PA are more likely to develop glaucoma as anterior segment dysgenesis progresses, and the effect of TLO is limited if corneal staphyloma is present.

(1) Background: To identify the association between the presence or absence of raphe and aortic valve dysfunction as well as the presence of aortopathy in patients with bicuspid aortic valve (BAV); (2) Methods: This retrospective study enrolled 312 participants (mean [SD] age, 52.7 [14.3] years; 227 men [72.8%]) with BAV. The BAVs were divided into those with presence (raphe+) or absence (raphe-) of raphe. Valvular function was classified as normal, aortic regurgitation (AR), or aortic stenosis (AS) using TTE. The pattern of BAV aortopathy was determined by the presence of dilatation at the sinus of Valsalva and the middle ascending aorta using CCT.; (3) Results: BAVs with raphe+ had a higher prevalence of AR (148 [79.5%] vs. 48 [37.8%], P < .001) but a lower prevalence of AS (90 [48.6%] vs. 99 [78.0%], P < .001) compared with those with raphe-. The types of BAV aortopathy were significantly different (P = 0.021) according to those with BAV-raphe+ and BAV-raphe-.; (4) Conclusions: The presence of a raphe was significantly associated with a higher prevalence of AR but a lower prevalence of AS and combined dilatation of the aortic root and middle ascending aorta. The presence of raphe was an independent determinant of AR.

Transcatheter aortic valve implantation (TAVI) has grown exponentially within the cardiology and cardiac surgical spheres. It has now become a routine approach for treating aortic stenosis. Several uncertainties have been raised about TAVI in comparison to conventional surgical aortic valve replacement (SAVR). The primary concerns are with regards to the longevity of the valves. Several factors have been identified that may predict poor outcomes following TAVI. These include the lesser-used finite element analysis (FEA) to quantify the properties of calcifications that affect TAVI valves. This can also be used in conjunction with other integrated software to ascertain the functionality of these valves. Other imaging modalities are now widely available such as Multi-detector row computed tomography(MDCT) which can accurately size the aortic valve annulus.. This may help reduce the incidence of paravalvular leaks and regurgitation which may necessitate further intervention. Structural valve degeneration (SVD) remains a key factor with varying results from current studies. The true incidence of SVD in TAVI compared to SAVR remains unclear with the lack of long term data. It is now widely accepted that both are part of the armamentarium and are not mutually exclusive. Decision-making for the appropriate intervention should be made via shared decision-making involving the heart team.

Background: The association of echocardiographic findings and subsequent risk of left-sided native valve endocarditis (LS-NVE) is undefined. The aim of this study was to determine if transthoracic echocardiographic (TTE) measurements are associated with the subsequent development of LS-NVE in patients without cardiac predisposing conditions. Methods: Institutional databases were evaluated for adults diagnosed with LS-NVE from 2008 to 2020. Patients with prosthetic valves, cardiovascular implantable electronic devices, intracardiac devices, injection drug use, and predisposing cardiac conditions were excluded. Only patients who had a TTE performed 6 months to 3 years before the development of LS-NVE were included as cases. Controls were patients within the same Mayo location with a TTE report and were matched in a 1:3 ratio according to age, gender, Charlson Comorbidity Index, and echocardiography date. Results: There were 148 cases and 431 matched controls. As compared to controls, IE cases had a higher prevalence of diabetes mellitus (46.6% vs. 30.4%) and chronic kidney disease (46.6% vs. 28.1%) (p<0.001). Left ventricular outflow tract velocity (p=0.017), left ventricular ejection fraction (p=0.018), and E: e’ ratio (p=0.050) were associated with LS-NVE. Conclusions: Echocardiographic measurements were associated with subsequent LS-NVE development in this pilot study. A larger cohort of LS-NVE patients, however, is needed to validate these findings.

Pigment dispersion can lead to pigmentary glaucoma, a poorly understood condition of younger myopic eyes with fluctuating high intraocular pressure. It has been difficult to investigate its pathogenesis without a model similar to human eyes in size and behavior. Here we present a porcine ex vivo model that recreates several features of pigmentary glaucoma, including intraocular hypertension, accumulation of pigment in the trabecular meshwork, and declining phagocytosis. We found that trabecular meshwork cells regulate outflow, form actin stress fibers, and have a decreased phagocytic activity. Gene expression microarrays and a pathway analysis of TM monolayers as well as ex vivo anterior segment perfusion cultures indicated that RhoA plays a central role in regulating the cytoskeleton, motility, and phagocytosis in the trabecular meshwork, providing new insights and targets to investigate in pigmentary glaucoma.

Purpose: To determine whether 24-hour IOP monitoring can be a predictor for glaucoma progression and to analyze the inter-eye relationship of IOP, perfusion and progression parameters. Methods: We extracted data from manually drawn IOP curves with HIOP-Reader, a software suite we developed. The relationship between measured IOPs and mean ocular perfusion pressures (MOPP) to retinal nerve fiber layer (RNFL) thickness was analyzed. We determined the ROC curves for peak IOP (Tmax), average IOP (Tavg), IOP variation (IOPvar) and historical IOP cut-off levels to detect glaucoma progression (rate of RNFL loss). Bivariate analysis was conducted to check for various inter-eye relationships. Results: 217 eyes were included. The average IOP was 14.8±3.5 mmHg, with a 24-hour variation of 5.2±2.9 mmHg. 52% of eyes with RNFL data showed disease progression. There was no significant difference in Tmax, Tavg and IOPvar between progressors and non-progressors (all p>0.05). Except for Tavg and the temporal RNFL, there was no correlation between disease progression in any quadrant, Tmax, Tavg and IOPvar. 24-hour and outpatient IOP variables had poor sensitivities and specificities in detecting disease progression. The correlation of inter-eye parameters was moderate; correlation with disease progression was weak. Conclusion: In line with our previous study, IOP data obtained during a single visit (outpatient or inpatient monitoring) make for a poor diagnostic tool, no matter the method deployed. Glaucoma progression and perfusion pressure in left and right eyes correlated weakly to moderately with each other.

Aortic stenosis continues to be still the most frequently valvular pathology in the elderly population of the Western countries. According to the latest guidelines, the therapeutic choice of aortic stenosis depends on the age of the patient (&lt;75 years or &gt;75 years) and the risk class (STS-Prom/ Euroscore II &lt; o &gt; 4%). Therefore, if the surgical indication is clear in young and low risk patients and percutaneous treatment is the gold standard in older and high-risk patients, the therapeutic choice is still debated in intermediate-risk patients. In this group of patients the aortic valve stenosis treatment depends on the patient's global evaluation, on the experience of the center and no less important on the patient's will. Two main therapeutic options are debated: surgical aortic valve replacement with sutureless prosthesis versus transcatheter aortic valve implantation. In addition, the progressive development of mininvasive techniques for aortic valve surgery (right -anterior minitoracotomy) has also reduced the peri and post -operative risk in this group of patients. The goal of our review is to analyze the literature evidence of the best therapeutic choice in intermediate risk patients with severe aortic stenosis.

In new Guideline for the Management of Patients with Valvular Heart Disease for tricuspid regurgitation (TR) is focused the importance of measurement of right-sided diastolic pressures and right ventriculography, pulmonary artery pressures, and pulmonary vascular resistance. Assessment of right ventricular (RV) dimensions and function is pivotal to select patients with severe tricuspid regurgitation who may benefit from tricuspid valve intervention. However, with the exception of tricuspid valve annulus diameter, there is no other cut-off value that defines severe RV dysfunction or dilation for this specific group of patients. It may be difficult, if not impossible, to establish a cut-off value of RV dysfunction since the RV may be exposed to pressure and volume overload, myocardial ischemia, intrinsic myocardial disease or pericardial constraint. Furthermore, the response of the RV to tricuspid valve intervention may vary according to each aetiology and the time course of the disease (acute or chronic). Comprehensive assessment of RV function should address in shape remodelling; functional remodelling; tissue remodelling. This assessment should be performed in optimal loading conditions and after euvolemia has been achieved. It’s now that there is no other cut-off value that defines severe RV dysfunction or dilation for patients with severe TR with the exception of tricuspid valve annulus diameter. It may be difficult, if not impossible, to establish a cut-off value of RV dysfunction since the RV may be exposed to pressure and volume overload, myocardial ischemia, intrinsic myocardial disease or pericardial constraint. In this review we analyze the relationship between right ventricular (RV) and TR in term of outcomes and mortality predictor in patients undergoing percutaneous or invasive treatment for severe TR.

To evaluate whether the extent of cardiac damage in severe aortic stenosis (AS) might be associated with the occurrence of conduction system disorders after TAVI. A total of 153 symptomatic patients with severe AS who had a TAVI were categorized before the procedure according to the extent of cardiac damage: stage 1 (13.5%): no or LV damage; stage 2 (58.8%): left atrial/mitral valve damage, atrial fibrillation (AF); stage 3 (27.7%): low-flow state, pulmonary vasculature/tricuspid valve/RV damage. After TAVI, 34% of patients exhibited LBBB and 10% high-degree atrioventricular block (HD-AVB). No patient in group 1 developed HD-AVD whereas new LBBB was frequent in groups 2 and 3. Twenty-one patients presented with resolutive paroxysmal AF with a higher rate for each group increment (group 1: n=0, 0%; group 2: n=11,15.7%; group 3: n=10, 30.3%) (p = 0.012). Patients in group 3 had the higher rate of permanent pacemaker implantation (PPMI) (group 1: n=1, 6.3%; group 2: n=7,10%; group 3: n=9, 27.3%) (p=0.012). No patient in group 1 died during the hospital stay. In conclusion, cardiac damage staging of AS might help identify patients at higher risk of conduction disorders and PPMI requirement after TAVI.

Purpose: Glaucoma is the second leading cause of blindness, however, it remains incurable even with the appropriate treatment. Intraocular pressure (IOP) reduction is currently the only proven method to decline glaucoma progression. When medical therapy fails, surgical treatment usually arises as the solution to a better IOP control. Nevertheless, its success is compromised by frequent post-operative complications, most of them due to excessive fibrous tissue formation during wound healing process. Nanotechnology devices for glaucoma surgery can improve post-operative IOP control and reduce undesirable fibrosis. This systematic review aims to summarize some advances of nanotechnology application to ophthalmology, giving an overview about the state of the art of the nanotechnology based glaucoma drainage devices. Methods: A literature search in the PubMed/Medline database was performed using the keywords: “glaucoma surgery”, “glaucoma drainage device”, “nanotechnology”, “nanoparticles”, “nanomedicine” and “valve”. Were included articles published until March 1, 2023. A first identification of relevant articles was done through the title and abstract’s information, and a second selection was done by full-text articles assessment. Seven articles were included in this systematic review. Results: Nanotechnology-based glaucoma drainage devices included in this review promise to overcome the challenges of glaucoma surgical treatment by allowing a more effective control over post-operative scarring, a noninvasive and customized control of aqueous humour (AH) drainage while achieving optimal IOP reduction through all phases of the post-operative period. Conclusion: Despite the decreased post-operative complications and apparently enhanced biocompatibility of nano-based drainage devices, further in vivo tests and human studies are needed to evaluate cytotoxicity and corroborate the biocompatibility and efficacy showed in the initial testing results of these devices.

Introduction. Recent studies revealed that differentiation of valvular interstitial cell into myofibroblasts played an important role in pathological valve remodeling in rheumatic valvular disease. Objective. To investigate effects of atorvastatin, olmesartan, and resveratrol on Transforming Growth Factor β1-induced fibrosis. Methods. Valvular interstitial cell was isolated from 12-weeks male New Zealand rabbit (Oryctolagus cuniculus). Culture cells was divided into 4 groups, control group, group I (0.5 mg/mL Atorvastatin), group II (100 nmol/L Olmesartan), group III (50 μM/L Resveratrol) and group IV (combinations). All group were exposed to 100 nM Transforming Growth Factor β1 for 24 hours. Results. Immunochemical staining demonstrated that cells were completely differentiated into myofibroblasts with mean expression of α-smooth muscle actin 24522.64±4566.994. Atorvastatin, olmesartan, resveratrol, and its combination significantly reduced α-smooth muscle actin expression (6823±1735.3, 6942.7±2455.9, 14176.2±3343.3, 5051.8±1612.2 respectively (p<0.001). Conclusion. Our data showed atorvastatin, olmesartan, resveratrol, and its combination significantly reduce Transforming Growth Factor β1-induced valvular fibrosis.

Purpose To investigate secondary glaucoma resulting from uveitis in a patient infected with Human T-cell Leukemia Virus Type 1 (HTLV-1) pathologically and discuss the management of glaucoma with recurrent uveitis. Clinical course An octogenarian woman diagnosed as a carrier of HTLV-1 experienced recurrent uveitis and a sudden rise in intraocular pressure (IOP) in both eyes. Due to the uncontrolled IOP and severely damaged visual field in her left eye, a combined procedure of trabeculectomy and DGIS (Glaucoma drainage implant surgery, Baerveldt 350) was performed. The presence of HTLV-1 provirus was detected in the aqueous humor. Her trabeculectomy sample was processed for light microscopic observation. Following an irregular follow-up, she presented with a sudden decrease in vision and pain in her fellow eye, four years after the glaucoma surgeries. Her right eye exhibited a significant accumulation of mutton-fat-like keratic precipitates. Results Clinical manifestations revealed the presence of granulomatous uveitis. The combined glaucoma surgery, along with continuous topical corticosteroid medication post-surgery in her left eye, effectively suppressed the high IOP spikes and the recurrence of uveitis for 4 years. The pathological examination of the outflow pathways showed a range of damages in Schlemm's canal (SC), including SC endothelial loss, narrowing, and occlusion, as well as loss of trabecular meshwork (TM) cells and fused TM beams. Conclusion Combined GDIS and trabeculectomy represents a promising approach for managing such refractory cases of secondary glaucoma. The continuous topical corticosteroid medication is strongly recommended to prevent irreversible changes in SC and TM associated with granulomatous uveitis.

: Inflammation may mediate the association of mitral valve prolapse (MVP) with ventricular scarring and arrhythmia. The purpose of this study is to investigate the association of neutrophil- and platelet-to-lymphocyte ratios (NLR, PLR) with ventricular arrhythmia in MVP. Clinical and demographic data were extracted from electronic medical records for all patients aged 18-90 years with MVP on echocardiography between 2016-19 at our institution. We studied 65 patients who had a differential blood count within six months prior to ambulatory ECG (A- ECG) (medi-an age [IQR] 70 [61-77] years; 62% female; 12% African American). Patients with surgery or in-fection within six months prior to CBC were excluded. Complex or frequent ventricular ectopy (cfVE) was defined as the presence of two or more premature ventricular contractions (PVCs) on a 10-second ECG tracing or greater than 1% PVC burden or NSVT on ambulatory ECG monitoring. Logistic and bivariate regression was used to analyze clinical, electrocardiographic and echo-cardiographic factors associated with NLR and PLR. Factors associated with higher NLR were congestive heart failure (p=0.005), male sex (p=0.01), age (p=0.003), and bileaflet MVP (p=0.04). NLR was associated with higher absolute PVC burden (rs=0.28, p=0.03) and cfVE (median NLR [IQR] 3.0 [1.6 – 6.3]) with cfVE versus (2.4 [1.4-3.4], p=0.04) without cfVE. An NLR of 5.6 yielded 50% sensitivity and 90% specificity for PVC burden >1% (AUC 0.69). No significant association was found between PLR and PVC burden or cfVE. NLR is associated with PVC burden and com-plex ventricular ectopy in MVP, suggesting that inflammation is a significant factor in the patho-genesis of ventricular arrhythmia in this condition.

The Tesla valve (TV), a valvular conduit invented by Nicola Tesla over a decade ago, has recently gained significant attention and application in various fields due to the growing interest in microfluidics and nanofluidics. The unique architecture of TV characterized by an asymmetrical design and an arc-shaped channel, has long been an intriguing yet underrated design for building a passive component in a microfluidic system. While previously regarded as a technology without significant use, TV structures have been implemented in wearable devices, thermal manipulation fluidics, micromixers, micropumps, and fuel cell devices. This article presents the first comprehensive review of TV structures in the literature, which has seen significant growth in the last two years. The review discusses typical TV structures, including single-stage TV (STV), multistage TV (MSTV), and TV derivatives (TVD), along with their characteristics and potential applications. The designs of these structures vary based on their intended applications, but all are constructed based on the fundamental principle of the TV structure. Finally, future trends and potential applications of TV structures are summarized and discussed. This review provides a valuable reference for students, early-career scientists, and practitioners in the field of fluidic devices, particularly those interested in using TV structures as passive components.

Nowadays energy saving is a topical issue due to increasing fuel costs and this aspect is amplified by more stringent emissions regulations that impact on vehicle development. A recent study conducted by the U.S. Department of Energy shows that about five percent of the U.S. energy consumption is transmitted by fluid power equipment. Nevertheless, this study also shows that the efficiency of fluid power averages 21 percent. This offers a huge opportunity to improve the current state-of-the-art of fluid power machines, in particular to improve the energy consumption of current applications. These facts dictate a continuous strive toward improvements and more efficient solutions: to accomplish this objective a strong reduction of hydraulic losses and better control strategies of the hydraulic systems are needed. In fluid power, there exist many techniques to reduce/recover energy losses of the conventional layouts, e.g. load sensing, electrohydraulic flow matching, independent metering, etc. One of the most efficient ways to analyze these different layouts and identify the best hydraulic solution is done through virtual simulations instead of prototyping, since the latter involves higher investment costs to deliver the product into the market. However, to build a fluid power machine virtual model, some problems arise relative to different aspects, for instance: loads on actuators (both linear and rotational) are not constant and pumps are driven by a real engine whose speed depends on required torque. Furthermore, it is important to achieve higher level of detail to simulate each component in the circuit: the greater detail, the better the machine behavior is portrayed, but it obviously entails heavy impact on simulation time and computational resources. Therefore, there is a need to create mathematical model of components and systems with sufficient level of detail to easily acquire all those phenomena necessary to correctly evaluate machine performance and make modifications to the fluid power component design. In this context, a hydraulic proportional valve PVG 32 by Danfoss is taken as an object of study, its performance is analyzed with suitable mathematical model and simulation is done to observe closeness of a model to the laboratory experiment.

This paper proposes a position control method for low cost EGR valve system in automotive application. Generally, position control system using in automotive application has many restrictions such as cost and space, the mechanical structure of actuator implies high friction and large difference between static friction and coulomb friction. This large friction difference occurs the vibrated position control result when the controller uses conventional linear controller such as P, PI. In this paper, low cost position control method which can apply under the condition of high difference friction mechanical system. Proposed method is verified by comparing conventional control result of experiments.

Purpose is to o review the pathogenic mechanism for ocular hypertension and glaucoma development after pars plana vitrectomy. Both acute and chronic causes are considered and special attention is paid to the theories and clinical evidence on the risk of developing Open Angle Glaucoma (OAG) after Pars Plana Vitrectomy (PPV). Most existing scientific literature on the issue agree on the role of ascorbate as an oxygen scavenger within the vitreous chamber. Oxygen tension in the vitreous and anterior chamber is maximum inn proximity of the retinal surface and endothelium, respectively and steeply decreases toward the lens; on both sides, and trabeculate. Vitreous removal and, to a lesser extent, liquefaction, greatly reduces oxygen tension gradient in vitreous chamber while cataract extraction has similar effects on anterior chamber oxygen gradients. Oxygen derivatives originated from the cornea and retina are actively reduced by the vitreous gel and/or the crystalline lens. Vitreous removal and cataract extraction reduce drastically this function. Most reported clinical series confirm this hypothesis although protocol difference and follow-up length greatly impact the reliability of results.

Ascorbate; Pars Plana Vitrectomy; Open Angle Glaucoma; Oxidative Stress; Vitreous Me-tabolism 0. How to Use This Template

Percutaneous aortic valve replacement (TAVI) has become the treatment of choice for elderly patients with severe aortic valve stenosis because of its less invasiveness compared to surgery. However, it introduces new complications, such as vascular lesions, access site problems, paravalvular leaks, and aortic dissection. Aortic dissection after TAVI is rare but serious, occurring in 0.2% to 0.3% of cases, with both intraprocedural and late cases reported. This case study concerns a 68-year-old woman who developed Stanford B aortic dissection, external iliac artery dissection, and right common femoral artery occlusion after TAVI. Treatment included stenting of the iliac and common femoral arteries, followed by a staged procedure: debranching, thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR), with satisfactory results. This case, underscores the importance of vigilance in the management of TAVI-related complications to optimize patient care and outcomes.

During the Renaissance, Leonardo Da Vinci was the first person to successfully detail the anatomy of the aortic root and its adjacent structures. Ever since, novel insights into morphology, function and their interplay have accumulated resulting in advanced knowledge on complex functional characteristics of the aortic valve (AV) and root. This shifted the vision from the AV as being a static structure towards that of a dynamic interconnected apparatus within the aortic root as a functional unit, exhibiting a complex interplay with adjacent structures via both humoral and mechanical stimuli. This paradigm shift has stimulated surgical treatment strategies of valvular disease that seek to recapitulate healthy AV function, whereby AV disease can no longer be seen as an isolated morphological pathology which needs to be replaced. As prostheses still cannot reproduce the complexity of human nature, treatment of diseased AVs, whether stenotic or insufficient, has tremendously evolved with a similar shift towards treatments options that are more hemodynamically centered such as the Ross procedure and valve-conserving surgery. Native AV and root components allow for an efficient Venturi effect over the valve to allow for optimal opening during the cardiac cycle, while also alleviating the left ventricle. Next to that, several receptors are present on native AV leaflets, enabling messenger pathways based on their interaction with blood and other shear-stress related stimuli. Many of these physiological and hemodynamical processes are under acknowledged but may hold important clues for innovative treatment strategies, or as potential novel targets for therapeutic agents that halt or reverse the process of valve degeneration. A structured overview of these pathways and their implications for cardiothoracic surgeons and cardiologists is lacking. As such, we provide an overview on embryology, hemodynamics, and messenger pathways of the healthy and diseased AV and its implications for clinical practice, by relating this knowledge to current treatment alternatives and clinical decision-making.

In the current study, a two-dimensional numerical study is carried out to investigate the performance of a novel Double-chamber Parallel Flexible Valves micropump, which utilized the electrowetting-on-dielectrics (EWOD) effect to drive the microfluid flow. By observing the flow fields, the internal circulations are seen on both the left and right side of the pump. The generation of the backflow is discussed by tracking the movement of the vortices. Only slight flow fluctuation is seen in the micropump. Based on the simulation outcomes, the structural parameters including the width of the inlet/outlet, the width of the pumping channel and the diverging angle in the micropump are analyzed, the influence of these parameters on the pumping volume and the maximum pressure have been discussed. Eventually, a group of optimal parameter combinations is given according to the results to extend the operating potential of the micropump.

This study describes the development of an automated bag valve mask (BVM) compression system, which, during acute shortages and supply chain disruptions can serve as a temporary emergency ventilator. The resuscitation system is based on the Arduino controller with a real-time operating system installed on a largely RepRap 3-D printable parametric component-based structure. The cost of the system is under $170, which makes it affordable for replication by makers around the world. The device provides a controlled breathing mode with tidal volumes from 100 to 800 milliliters, breathing rates from 5 to 40 breaths/minute, and inspiratory-to-expiratory ratio from 1:1 to 1:4. The system is designed for reliability and scalability of measurement circuits through the use of the serial peripheral interface and has the ability to connect additional hardware due to the object-oriented algorithmic approach. Experimental results demonstrate repeatability and accuracy exceeding human capabilities in BVM-based manual ventilation. Future work is necessary to further develop and test the system to make it acceptable for deployment outside of emergencies in clinical environments, however, the nature of the design is such that desired features are relatively easy to add with the test using protocols and parametric design files provided.

With the increase of the Artificial Neural Network (ANN), machine learning has taken a forceful twist in recent times. One of the most spectacular kinds of ANN design is the Convolutional Neural Network (CNN). The Convolutional Neural Network (CNN) is a technology that mixes artificial neural networks and up to date deep learning strategies. In deep learning, Convolutional Neural Network is at the center of spectacular advances. This artificial neural network has been applied to several image recognition tasks for decades and attracted the eye of the researchers of the many countries in recent years as the CNN has shown promising performances in several computer vision and machine learning tasks. This paper describes the underlying architecture and various applications of Convolutional Neural Network.

One of the most prevalent illnesses, diabetes does not directly result in patient mortality. But, it increases the risk of death. Any disease that may be predicted in its early stages can lessen its fatal effects while also enhancing the quality of the healthcare system. For the early-stage prediction of diabetes or such types of non-communicable diseases, we need the proper set of influential features. This research has developed a machine learning-based disease prediction model to identify the influential features for diabetes prediction and give a near-perfect classification accuracy. This model includes Min-Max normalization for data normalization, Isolation Forest (iForest) for outlier removal, Synthetic Minority Oversampling Technique (SMOTE) for oversampling, Random Forest based Recursive Feature Elimination (RFE-RF) test, Chi-Square test, and Minimum Redundancy Maximum Relevancy (mRMR) test based feature selection methods for identifying the influential features, and Support Vector Machine (SVM), K Nearest Neighbor (KNN), and Naive Bayes (NB) for the classification. The results clarify that the proposed model outperforms the previous models and studies. The SVM has attained an accuracy of 99.58% in classification using the five features chosen from the Chi-Square test. Lastly, SHAP, an explainable AI model, has been used to assess the classifier model’s performance. These selected features and the classifier model can be used for early-stage diabetes prediction.

Purpose: To investigate the molecular basis of congenital glaucoma in a family with GAPO (growth retardation, alopecia, pseudoanodontia, and progressive optic atrophy) syndrome. Methods: We report ocular features of 3 girls with GAPO syndrome born of consanguineous marriage in a multi- generation consanguineous family. The proband (4year old girl) and her younger sibling (1 year old girl) were operated for bilateral congenital glaucoma in both eyes. The elder sibling (10year old female) had features of GAPO syndrome but did not manifest features of glaucoma. Results: A genetic evaluation using whole exome sequencing revealed a homozygous ANTXR1 mutation in all 3 affected siblings with GAPO. No other mutations were detected in the genes associated with glaucoma. A rare missense mutation in TGFBI gene was shared in the two siblings with congenital glaucoma and GAPO syndrome.Conclusions: Mutations in TGFBI gene could have a role in the pathogenesis of congenital glaucoma.

Despite of being an exceptionally biodiversity rich country, the forest coverage of Bangladesh is declining at an alarming rate. Declaration and management of protected areas in this regard is one of the efforts from government side to tackle the loss of biodiversity. The limited numbers of forest-protected areas (FPA), established to conserve the dwindling forest biodiversity of the country with high pressure on them for timber, non-timber forest products, and fuelwood - makes their management challenging. Moreover, most of the FPAs of the country declared only in the recent decades with very limited infrastructure, manpower and policy support for monitoring and governance. Some people-centred approaches for the management of FPAs and alternative livelihood and income generation subsidies although made available through a few project interventions, their number are still inadequate and performance remains less than satisfactory. This chapter provides a critical review of the FPAs of Bangladesh looking at their role in biodiversity conservation, management challenges, and key lessons from previous management interventions with recommendations for the future. It has been revealed that the FPA system of Bangladesh still poorly represents the diverse forest ecosystems with relatively small forest size and lack of corridors for the movement of wildlife. There are ample opportunities to render co-management of FPAs an effective strategy to minimize the conflicts in FPAs management in the country. It is, however, important to ensure the access of local forest-dependent people to different alternative income generating options that may adequately support their livelihoods.

Although initially conceived for high-risk patients who are ineligible for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) is now recommended in a wider spectrum of indications including young patients. However, as for SAVR, TAVR is also associated with a risk of infectious complications, namely prosthetic valve endocarditis (PVE). As the number of performed TAVR procedure increases, and despite the low incidence of PVE post TAVR, clinicians should be familiar with the associated risk factors and the clinical presentation. Whereas the diagnosis of native valve endocarditis can be straightforward applying the modified Duke criteria, the diagnosis of PVE is more challenging given its atypical symptoms, lower sensitivity of the criteria, and low diagnostic yield of conventional echocardiography. Delay in proper management can be associated with increased morbidity and mortality. Therefore, clinicians should have a high index of suspicion and initiate proper work-up according to the severity of illness, the underlying host, and the local epidemiology of the causative organisms. The most common causative pathogens are Gram-positive bacteria such as S. aureus, coagulase negative staphylococci, Enterococcus spp. and Streptococcus spp. (particularly the viridans group) and, less likely Gram-negative and fungal pathogens. The high prevalence of antimicrobial resistance complicates the choice of therapy. There remain controversies regarding the optimal management strategies including indications for surgical interventions. Surgical assessment is recommended early in the course of illness and surgical intervention should be considered in selected patients. As in other PVE, duration of therapy depends on the isolated pathogen, the host, and the clinical response. Since TAVR is a relatively new procedure, the outcome of TAVR-PVE is yet to be fully understood.

This review article explores the transformative impact of Artificial Intelligence (AI) on glaucoma care, focusing on advancements in diagnosis, monitoring, and treatment algorithms. AI technologies have revolutionized the field of ophthalmology by enhancing the accuracy and efficiency of diagnosing glaucoma. Furthermore, AI-powered monitoring systems enable continuous and personalized patient care, facilitating early detection of disease progression. Integrating AI algorithms in treatment protocols promises individualized and optimized therapeutic strategies for better management of glaucoma. This comprehensive review elucidates AI applications' current state and future directions in transforming glaucoma care, emphasizing the potential benefits of improving patient outcomes.

The early failure of glaucoma surgery is mainly caused by an overly fibrosis at the subconjunctival space causing obliteration of the filtration bleb. Because fibrosis has a suspected basis of genetic predisposition, we have undertaken a prospective study to identify upregulated profibrotic genes in a population of glaucoma patients with signs of conjunctival fibrosis and early postoperative surgical failure. Clinical data of re-operated fibrosis patients, hyperfibrosis patients re-operated more than once in a short time, and control patients with no fibrosis were recorded and analyzed at each follow-up visit. Conjunctival-Tenon surgical specimens were obtained intraoperatively to evaluate the local expression of a panel of genes potentially associated with fibrosis. In order to correlate gene expression signature with protein levels, we quantified secreted proteins in primary cultures of fibroblasts from patients. Expression of VEGF-A, IL-8, C-MYC, and CDKN1A was induced in the conjunctiva of hyperfibrosis patients. VEGF-A and IL-8 protein levels were also increased in fibroblast supernatants. We propose that these proteins may act as biomarkers of conjunctival fibrosis in glaucoma patients undergoing filtering surgery. Molecular markers could be crucial for early detection of patients at high risk of failure of filtration surgery leading to more optimal and personalized treatments.

Glaucoma is one of the most common causes of irreversible vision loss worldwide. It is an insidious disease with a multifactorial pathogenesis. Despite progress in treatment methods, prevention and lifestyle modifications may be useful in slowing the progression of this disease. This systematic review aimed to evaluate the influence of diet, oxidative stress, and disturbances in blood serum levels of nutrients on the incidence and severity of glaucoma based on scientific reports on the role of nutrition in the pathogenesis and course of glaucoma. This paper presents an analysis of the above issues; however, further research is required to develop this topic. Future clinical trials are needed to assess the influence of nutrition and to develop nutritional management strategies for patients with glaucoma.

Primary congenital glaucoma (PCG) is a heterogeneous, inherited, and severe optical neuropathy caused by apoptotic degeneration of the retinal ganglion cell layer. Whole-exome sequencing analysis of one PCG family identified two affected siblings who carried a low-frequency homozygous nonsense GUCA1C variant (c.52G>T/p.Glu18Ter/rs143174402). This gene encodes GCAP3, a member of the guanylate cyclase activating protein family, involved in phototransduction and with a potential role in intraocular pressure regulation. Segregation analysis supported the notion that the variant was coinherited with the disease in an autosomal recessive fashion. GCAP3 was detected immunohistochemically in the adult human ocular ciliary epithelium and retina. To evaluate the ocular effect of GUCA1C loss-of-function, a guca1c knockout zebrafish line was generated by CRISPR/Cas9 genome editing. Immunohistochemistry demonstrated the presence of GCAP3 in the non-pigmented ciliary epithelium and retina of adult wild-type fishes. Knockout animals presented up-regulation of the glial fibrillary acidic protein in Müller cells and evidence of retinal ganglion cell apoptosis, indicating the existence of gliosis and glaucoma-like retinal damage. In summary, our data provide evidence for the role of GUCA1C as a candidate gene in PCG and offer new insights into the function of this gene in the ocular anterior segment and the retina.

The article evaluates the use of machine learning methods to predict valve plate failures in hydraulic pumps. To conduct this assessment, a laboratory setup was developed that allowed the creation of a training dataset containing both the normal operating state of the pump and the operating state with three different valve plate damages. Five different predictive models were evaluated, including three composite models based on decision trees: Random Forest, Gradient-Boosted Trees, and Rotation Forest, as well as the kNN algorithm and a neural network. The analysis showed that neural networks achieved the highest prediction accuracy, enabling a prediction accuracy level of 89%. The kNN algorithm ranked second, and tree-based algorithms performed 4% worse than the neural network. Additionally, the attribute importance analysis revealed that leak flow, pressure output together with output flow, are the most important parameters for accurate prediction.

The valve controlled cylinder drive system is the most common type among hydraulic applications. The nonlinear behaviour in such system is inevitable when the valve spool around its null position [1] , Leaney [2] utilised component linking method to investigate the nonlinearities in a Moog valve controlled asymmetric cylinder drive system by simulation in Fortran, in which a generalised concept is introduced and validated by comparing to the experimental results. An factor is proposed in the generalised concepts to describe the asymmetric cylinder state, which is a constant when the cylinder in extending or retracting, but numerically calculated when the valve spool in the underlap region [2]. This paper utilises the component linking method to simulate the Moog valve controlled asymmetric cylinder drive system in Matlab Simulink, and proposed an analytical solution for factor when the valve spool in the underlap region.

Spin valves with a synthetic antiferromagnet were fabricated by magnetron sputtering. It was shown that the fabricated spin valves had perfect microstructure of layers and smooth interfaces, therefore RKKY interaction dominates in coupling of ferromagnetic layers separated by a copper spacer. Rhombus-shaped microobjects were fabricated from a single spin valve film. The thermomagnetic treatment procedure was found, to form unidirectional anisotropy in the microobject so, that the values of the exchange bias fields in the rhombus’ nonparallel sides were opposite in sign. For the synthetic antiferromagnet CoFeNi/Ru/CoFeNi the difference between ferromagnetic layers thicknesses was found, at which the thermomagnetic treatment forms the same exchange bias all over the rhombus’ side. The sensor element was fabricated in which each side of the rhombus was a shoulder of a Wheatstone bridge. After the thermomagnetic treatment procedure each shoulder worked as an active magnetosensitive element, thus the device operated as the full Wheatstone bridge. The sensor output has the shape of a step, high sensitivity to field change and significant magnetic hysteresis. Such characteristics are suitable for switching devices.

Background. Minimally invasive surgery via right mini-thoracotomy has become the standard of care for the treatment of mitral valve disease worldwide, particularly at high volume centers. In recent years, the spectrum of indications has progressively shifted and extended to fragile and higher risk patients, also addressing more complex mitral valve disease and ultimately including patients with native or prosthetic infective endocarditis. The rationale for the adoption of the minimally invasive approach is to minimize the surgical trauma, promote an earlier postoperative recovery and reduce the incidence of surgical wound infection and other nosocomial infections. The aim of this retrospective observational study is to evaluate the effectiveness and the early and late outcome in patients undergoing minimally invasive surgery for mitral valve infective endocarditis. Methods. Prospectically collected data regarding minimally invasive surgery in patients with mitral valve infective endocarditis were entered into a dedicated database for the period between January 2007 and December 2022 and retrospectively analyzed. All comers during the study period underwent a preoperative evaluation based upon clinical history and anatomy for the allocation to the most appropriate surgical strategy. Selection for the mini-thoracotomy approach was primarily driven by a thorough transthoracic and especially transesophageal echocardiographic evaluation, coupled with total body and vascular imaging. Results. During the study period, 92 patients underwent right mini-thoracotomy to treat native (80/92, 87%) or prosthetic (12/92, 13%) mitral valve endocarditis at our institution, representing 5% of the patients undergoing minimally invasive mitral surgery. Twenty-six (28%) patients had undergone previous cardiac operations, whereas 18 (20%) presented preoperatively with complications related to endocarditis, most commonly systemic embolization. Sixty-nine and 23 patients, respectively, underwent early surgery (75%) or were operated on after the completion of targeted antibiotic treatment (25%). A conservative procedure was feasible in 16/80 (20%) patients with native valve endocarditis. Conversion to standard sternotomy was necessary in a single case (1.1%). No cases of intraoperative iatrogenic aortic dissection were reported. Four patients died perioperatively, accounting for a thirty-day mortality of 4.4%. Causes of death were refractory heart or multiorgan failure and/or septic shock. New onset stroke was observed postoperatively in one case (1.1%). Overall actuarial survival rate at 1 and 5 years after operation was 90.8% and 80.4%, whereas freedom from mitral valve reoperation at 1 and 5 years was 96.3% and 93.2%, respectively. Conclusions. The present study shows good early and long-term results in higher-risk patients undergoing minimally invasive surgery for mitral valve infective endocarditis. Total body, vascular and echocardiographic screening represent the key points to select the optimal approach and allow the extension of indications for minimally invasive surgery to sicker patients, including active endocarditis and sepsis.

Annually, more than 1.5 million preventable new hepatitis B (HBV) infections continue to occur, with an estimated global burden of 296 million individuals living with chronic hepatitis B infection. This substantial health challenge results in over 820,000 annual deaths attributed to complications such as liver cirrhosis and hepatocellular carcinoma (HCC). HBV vaccination remains the cornerstone of public health policy to prevent chronic hepatitis B and its related complications. It serves as a crucial element in the global effort to eliminate HBV, as established by the World Health Organization (WHO), with an ambitious 90% vaccination target by 2030. However, reports on global birth dose coverage reveal substantial variability, with an overall coverage rate of only 46%. This comprehensive review thoroughly examines global trends in HBV vaccination coverage, investigating the profound impact of vaccination on HBV prevalence and its consequences across diverse populations, including both high-risk and general demographics. Additionally, the review addresses the formidable challenges and facilitating factors essential for achieving WHO's HBV vaccination coverage objectives and elimination strategies in the coming decade and beyond.

Traditional metals such as stainless steel, titanium and cobalt chrome are used in biomedical applications (implants, scaffolds etc.) but suffer from issues such as osseointegration and compatibility with existing bone. One way to improve traditional biomaterials is to incorporate ceramics with these metals so that their mechanical properties can be similar to cortical bones. Tricalcium phosphate is such a ceramic with properties so that it can be used in human body. This research explores the use of binder jetting based additive manufacturing process to create a novel biocomposite made of cobalt chrome and tricalcium phosphate. Experiments were conducted and processing parameters were varied to study their effect on the printing of this biocomposite. Layer thickness, binder saturation and drying time affected the dimensional tolerance and the density of the green samples. This effect is important to understand so that the material can be optimized for use in specific applications.

Purpose: To analyze the five-year results of Trabectome ab interno trabeculectomy of a single glaucoma center. Method: In this retrospective interventional single-center case series, data of 93 patients undergoing ab interno trabeculotomy between September 2010, and December 2012 were included. Kaplan-Meier analysis was performed using success criteria defined as postoperative intraocular pressure (IOP) ≤21 mm Hg, or >20% reduction from preoperative IOP, and no need for further glaucoma surgery. Risk factors for failure were identified using Cox proportional hazards ratio (HR). Results: The retention rate for five years follow-up was 66%. The cumulative probability of success at 1, 2, 3, 4 and 5 years was 82.6%, 76.7%, 73.9%, 72.3%, and 67.5%. Risk factors for failure were lower baseline IOP (HR=0.27, P=0.001), younger age (HR=0.25, P=0.02), and higher central corneal thickness (HR=0.18, P= 0.01). Pseudoexfoliation was associated with a higher success rate (HR= 0.39, P=0.02). IOP was decreased significantly from 20.0±5.6 mmHg at baseline to 15.6±4.6 mmHg at 5-year follow-up (P=0.001). The baseline number of glaucoma medications was 1.8±1.2, which decreased to 1.0±1.2 medications at 5 years. Conclusion: Trabectome surgery was associated with a good long-term efficacy and safety profile in this single-center case series with a high retention rate. A higher baseline IOP, older age, thinner cornea, and pseudoexfoliation glaucoma were associated with a higher success rate.

This study examines the relationship between entrepreneurship and sustainable devel-opment in Saudi Arabia from 2006 to 2022, focusing on the economic, social, and en-vironmental dimensions. Using the Autoregressive Distributed Lag (ARDL) model, the research investigates both short-run and long-run dynamics to understand how entre-preneurial activities influence sustainable development within the framework of Saudi Arabia's Vision 2030 initiative. The findings indicate that entrepreneurship significantly contributes to economic growth through job creation and innovation, thereby aiding in the diversification of the economy away from oil dependency. Socially, entrepreneurial ini-tiatives have a positive impact on gender equality and social inclusion by empowering women and integrating youth into the labour market. Environmentally, entrepreneurship helps reduce carbon emissions and promotes sustainable business practices. Despite these positive outcomes, challenges such as regulatory barriers, limited access to finance, and the need for a supportive entrepreneurial ecosystem remain. Recommendations include enhancing entrepreneurial education, providing financial incentives, and streamlining regulatory processes to better support start-ups and SMEs. The study highlights the ne-cessity of addressing these challenges to fully realize the potential of entrepreneurship for sustainable development in Saudi Arabia. By providing empirical evidence on the sig-nificant role of entrepreneurship in driving sustainable development, this research offers actionable insights for policymakers aiming to foster a more resilient and diversified economy in line with Vision 2030. .

This study investigates the impact of intellectual capital on the sustainable performance of banks in Saudi Arabia, focusing on the period from 2012 to 2022. Utilizing data from ten major Saudi banks, the research examines how different components of intellectual capital—Human Capital Efficiency (HCE), Structural Capital Efficiency (SCE), and Capital Employed Efficiency (CEE)—influence key financial performance indicators such as Return on Equity (ROE) and Net Profit Margin (NPM). The study is grounded in the resource-based view of the firm, which suggests that a firm’s internal resources can provide a sustainable competitive advantage. The analysis employs panel data techniques, including fixed and random effects models, to assess the relationships between intellectual capital components and bank performance while controlling for variables like bank size, financial leverage, GDP growth, inflation, and the impact of the COVID-19 pandemic. The findings reveal that intellectual capital significantly enhances bank performance in Saudi Arabia, with human capital efficiency showing the most decisive influence on ROE and NPM. Structural capital and capital employed efficiency also contribute positively but vary in their impact on different performance measures. This research contributes to the theoretical and practical understanding of the role of intellectual capital in promoting sustainable banking practices. It underscores the importance of strategic management of intellectual capital in enhancing financial performance and achieving sustainability goals, particularly in the context of Saudi Arabia's Vision 2030. The study's insights are relevant for bank managers and policymakers who leverage intellectual capital for economic diversification and sustainable development.

We report the case of a 44-year-old woman who suffered gastric perforation after receiving bag-valve-mask (BVM) ventilation in the setting of alcohol intoxication. She had a markedly distended abdomen and cold, dusky lower extremities upon arrival to the emergency department. Imaging revealed a large volume intraabdominal accumulation of air with compression of the aorta. Needle decompression relieved symptoms of lower extremity arterial insufficiency. However, the patient quickly decompensated and subsequent exploratory laparotomy confirmed gastric rupture. A subtotal gastrectomy was performed but the patient ultimately passed on post-operative day two due to multi-organ dysfunction. Although BVM ventilation is commonplace in both the hospital and field, there is a lack of awareness of the serious complications of abdominal air accumulation due to their rareness in the adult population. Checking for abdominal distention during resuscitation ought to be routine in all patients. Signs of arterial insufficiency accompanying abdominal distention, once confirmed by diagnostic imaging that shows extensive pneumoperitoneum, are indicators of having reached a life-threatening level of air accumulation, calling for immediate needle decompression and exploratory laparotomy.

Saudi Arabia is an oil-reliant nation as a large percentage of its GDP comes from oil resources. Oil dependency leaves a county at the mercy of the international crude market, and a decrease in the price of crude can seriously destabilize the economy of such nations. An example is the case of Venezuela whose dependence on oil caused a national disaster (McCarthy, 2017). As such, the nation’s exports, GDP, and government revenue are primarily dependent on oil revenue, and the recent decrease in the oil prices has decreased Venezuela’s national revenue resulting in economic collapse as well as inflation. A shift from a resource based economy to a knowledge based economy will help Saudi Arabia become less reliant on its oil revenues for its economic stability and growth (Nurunnabi, 2017).

Purpose The objective of this study was to eliminate any ambiguity by examining the correlation between gut microbiota and both AMD and glaucoma. Methods Mendelian randomization studies were conducted utilizing the data sourced from the GWAS database for the gut microbiome, AMD, and glaucoma. SNP estimates were summarized through five MR methods. We utilized Cochran's Q statistic to evaluate the heterogeneity of the instrumental variables. Additionally, we employed a "leave-one-out" approach to verify the stability of our findings. Results IVW suggests that Eubacterium (oxidoreducens group) and Parabacteroides had a protective effect on AMD. Both weighted median and IVW suggests that Lachnospiraceae (NK4A136 group) and Ruminococcaceae (UCG009) had a protective effect on AMD. However, both weighted median and IVW suggests that Dorea had a risk effect on AMD. Similarly, The IVW of Eubacterium (ventriosum group) showed a risk effect on AMD. The weighted median of Eubacterium (nodatum group), Lachnospiraceae (NC2004 group), and Roseburia had a risk effect on glaucoma. IVW suggested that Ruminococcaceae (UCG004) had a risk effect on glaucoma. Reverse MR analysis found a causal link between Eubacterium (nodatum group) and glaucoma. No causal relationships were found between AMD or glaucoma and the other mentioned bacterial groups. No significant heterogeneity or evidence of horizontal pleiotropy was detected. Conclusions This study found that certain gut bacteria had protective effects on AMD, while others may be risk factors for AMD or glaucoma. Besides, reverse MR found that glaucoma led to increased abundance of certain gut bacteria. Further trials are needed to clarify the specific mechanisms involved.

Purpose: Nycthemeral (24-hour) glaucoma inpatient intraocular pressure (IOP) monitoring has been used in Europe for more than 100 years to detect peaks missed during regular office hours. Data supporting this practice is lacking, partially because it is difficult to correlate manually drawn IOP curves to objective glaucoma progression. To address this, we deployed automated IOP data extraction tools and tested for a correlation to a progressive retinal nerve fiber layer loss on spectral-domain optical coherence tomography (SDOCT). Methods: We created and deployed a machine-learning image analysis software to extract IOP data from hand-drawn, nycthemeral IOP curves of 225 retrospectively identified glaucoma patients. The relationship between demographic parameters, IOP and mean ocular perfusion pressure (MOPP) data to SDOCT data was analyzed. Sensitivities and specificities for the historical cut-off values of 15 mmHg and 22 mmHg in detecting glaucoma progression were calculated. Results: IOP data could be extracted efficiently. The IOP average was 15.2±4.0 mmHg, nycthemeral IOP variation was 6.9±4.2 mmHg, and MOPP was 59.1±8.9 mmHg. Peak IOP occurred at 10 AM and trough at 9 PM. Disease progression occurred mainly in the temporal-superior and -inferior SDOCT sectors. No correlation could be established between demographic, IOP, or MOPP parameters and SDOCT disease progression. The sensitivity and specificity of both cut-off points (15 and 22 mmHg) were insufficient to be clinically useful. Outpatient IOPs were non-inferior to nycthemeral IOPs. Conclusion: IOP data obtained during a single visit make for a poor diagnostic tool, no matter whether obtained using nycthemeral measurements or during outpatient hours.

From the hospital wastewater, a novel bacteriophage was isolated and characterized. According to characterization properties, this bacteriophage belongs to the Siphoviridae family, the maximum bacteriophage titer was recorded at 37°C and a pH of 7.2, had a 44,789 bp linear double-strand DNA genome, and within the genome sequence, there are 61 genes, all of which are encoded into proteins. Although this bacteriophage does not have any virulence factors or antimicrobial resistance genes and had specific lytic activity against some antimicrobial resistance S. aureus clinical isolates.

The climate crisis necessitates a global shift to achieve a secure, sustainable, and affordable energy system toward a green energy transition reaching climate neutrality by 2050. Because of this, renewable energy sources have come to the forefront and the research interest in microgrids which rely on distributed generation and storage systems has exploded. Furthermore, many new markets for energy trading, ancillary services, and frequency reserve markets have provided attractive investment opportunities in exchange for balancing the supply and demand of electricity. Artificial intelligence can be utilized to locally optimize energy consumption, trade energy with the main grid, and participate in these markets. Reinforcement learning (RL) is one of the most promising approaches to achieve this goal because it enables an agent to learn optimal behavior in a microgrid by executing specific actions that maximize the long-term reward signal/function. The study focuses on testing two optimization algorithms: logic-based optimization and reinforcement learning. This paper proposes an optimization algorithm based on reinforcement learning in an industrial microgrid that is capable of trading energy with the main grid, providing significant cost savings. The RL-based approach is implemented in Python based on real data from the site and in combination with MATLAB-Simulink to validate its results. The application of the RL algorithm achieved an average monthly cost saving of 20% compared to logic-based optimization and 86% savings compared to not using any optimization. These findings contribute to digitalization and decarbonization of energy technology and support fundamental goals and policies of the European Green Deal.

This study delves into the dynamic field of medical education research, emphasizing the integration of research training within medical curricula. It seeks to understand the impact of such integration on the competencies of future medical professionals. The primary aim is to systematically categorize and analyze the current trends and future directions in medical education research. This involves assessing the influence of research training on medical students' skills and the methodologies used in such research. Methods: The research employs an extensive bibliographic literature review across multiple databases. It classifies studies into categories like experiential or case studies, editorials, and original research articles. This classification is based on criteria such as geographical location, research objectives, theoretical frameworks, and methodologies. Results: Findings reveal a diverse landscape in medical education research, with a significant emphasis on research training. The research showcases varying methodologies and approaches used globally, highlighting the thematic focus and geographical distribution of these studies. Conclusion: Medical education research is a globally expansive and evolving field. It underscores the importance of continuous investigation, particularly focusing on integrating research elements at curricular levels and exploring innovative educational strategies. The study also points out potential gaps in research, especially in underrepresented regions, indicating directions for future research efforts.

: Glaucoma is the most common cause of blindness, which significantly reduces quality of life. Most glaucoma cases are primary glaucoma; nevertheless, many patients suffer from glaucoma caused by drugs, such as corticosteroids. A comprehensive review of the risks associated with corticosteroid-induced glaucoma is limited. Therefore, we used the Japanese Adverse Drug Event Reporting Database (JADER) published by the Pharmaceuticals and Medical Devices Agency (PMDA) to analyze the risk factors associated with glaucoma and the trends and characteristics of corticosteroid-induced glaucoma. We did not find sex or age differences associated with the onset of glaucoma. Hierarchical clustering and principal component analysis revealed that triamcinolone acetonide and betamethasone sodium phosphate, which are used around the eyes in Japan, are more likely to induce intraocular pressure (IOP) elevation compared with other corticosteroids. Increased IOP is a direct cause of glaucoma. Based on these findings, it may be necessary to limit or avoid the use of these corticosteroids.

Purpose: To investigate whether microsurgical excision of trabecular meshwork (TM) in an ex vivo pigmentary glaucoma model can normalize the hypertensive phenotype. Methods: Eight eyes of a porcine pigmentary glaucoma model underwent 90° of microsurgical TM excision with an aspirating dual-blade (Goniotome (G)). 24 hours later, an additional 90° of TM were removed. Anterior segments with sham surgeries served as the control (C). Outflow facility and intraocular pressure (IOP) were analyzed. Histology with hematoxylin and eosin (H&E) was obtained. Results: After the first 90° TM excision, IOP was significantly lower in G (10.23±2.39 mmHg, n=7) than C (20.04±1.97mmHg, n=8, P<0.01). Outflow facility in G (0.38±0.07 µl/min/mmHg) was higher than C (0.16±0.02 µl/min/mmHg, P<0.01). After the second 90° TM excision, IOP in G (6.46±0.81 mmHg, n=7) was significantly lower than C (20.25±1.66 mmHg, n=8, P<0.001), while the outflow facility in G (0.50±0.05 µl/min/mmHg, n=7) was higher than C (0.16±0.01 µl/min/mmHg, n=8, P<0.001). Compared to the first excision, excision of an additional 90° did not change of IOP (P=0.20) or outflow facility (P=0.17) further. Conclusion: Excision of 90° of TM in a pigmentary glaucoma model using an aspirating dual-blade decreased IOP and increased outflow facility. Translational Relevance: Microsurgical TM excision over 90° can effectively restore outflow in pigmentary glaucoma.

This paper presents a concise mathematical framework for investigating both feed-forward and backward process, during the training to learn model weights, of an artificial neural network (ANN). Inspired from the idea of the two-step rule for backpropagation, we define a notion of F_adjoint which is aimed at a better description of the backpropagation algorithm. In particular, by introducing the notions of F-propagation and F-adjoint through a deep neural network architecture, the backpropagation associated to a cost/loss function is proven to be completely characterized by the F-adjoint of the corresponding F-propagation relatively to the partial derivative, with respect to the inputs, of the cost function.

As prominent oil producers, the Gulf Cooperation Council (GCC) countries have played a significant role in the global energy market. However, as the world's attention increasingly shifts towards environmental sustainability, understanding the implications of the GCC's economic activities on CO2 emissions becomes indispensable. This research paper investigates the relationship between specific economic indicators and their impact on CO2 emissions in the GCC from 2001 to 2021. The study employs quantile regression, a powerful statistical method that estimates the conditional quantiles of a response variable given a set of predictor variables. The findings reveal several important insights: Financial institution efficiency is significant and negative at a 1% level at the lower (10th) -83537.3 and the higher quantile (90th) -549002.3. The relationship between GDP per capita and CO2 emissions varies across quantiles, highlighting the complexity of the growth-environment nexus. Total patents exhibit a positive and significant relationship with emissions, underscoring the importance of directing innovation towards environmentally sustainable solutions. Renewable energy consumption displays a nuanced relationship with CO2 emissions, with a stronger negative impact observed at higher consumption levels. This underscores the potential of renewable energy to mitigate emissions when integrated at scale. The study's outcomes hold crucial policy implications for the GCC countries as they seek to align economic growth with environmental sustainability. The findings emphasize the importance of fostering financial institution efficiency, promoting green innovation, and expanding renewable energy sources to reduce emissions

Background. Recent studies revealed that differentiation of valvular interstitial cell into myofibroblasts played an important role in pathological valve remodeling in rheumatic valvular disease. Objective. To investigate effects of atorvastatin, olmesartan, and resveratrol on Transforming Growth Factor β1-induced fibrosis. Methods. Valvular interstitial cell was isolated from 12-weeks male New Zealand rabbit (Oryctolagus cuniculus). Culture cells was divided into 4 groups, control group, group I (0.5 mg/mL Atorvastatin), group II (100 nmol/L Olmesartan), group III (50 μM/L Resveratrol) and group IV (combinations). All group were exposed to 100 nM Transforming Growth Factor β1 for 24 hours. Results. Immunochemical staining demonstrated that cells were completely differentiated into myofibroblasts with mean expression of α-smooth muscle actin 24522.64±4566.994. Atorvastatin, olmesartan, resveratrol, and its combination significantly reduced α-smooth muscle actin expression (6823±1735.3, 6942.7±2455.9, 14176.2±3343.3, 5051.8±1612.2 respectively (p&lt;0.001). Conclusion. Our data showed atorvastatin, olmesartan, resveratrol, and its combination significantly reduce Transforming Growth Factor β1-induced valvular fibrosis.

Diesel engines, as power equipment, are widely used in the fields of automobile industry, ship and power equipment. Due to wear or faulty adjustment, the valve train clearance abnormal fault is a typical failure of diesel engines, which may result in the performance degradation, even valve fracture and cylinder hit fault. However, the failure mechanism features mainly in time domain and angular domain, on which the current diagnosis methods based, are easily affected by working conditions or hard to extract accurate enough, as the diesel engine keeps running in transient and non-stationary process. This work arms at diagnosing this fault mainly based on frequency band features which would change when the valve clearance fault occurs. For the purpose of extracting a series of frequency band features adaptively，a decomposition technique based on improved variational mode decomposition is investigated in this work. As the connection between the features and the fault is fuzzy, the random forest algorithm is used to analyze the correspondence between features and faults. In addition, the feature dimension is reduced to improve the operation efficiency according to importance score. The experimental results under variable speed condition show that the method based on variational mode decomposition and random forest is capable to detect valve clearance fault effectively.

This paper examines how housing prices are determined by macroeconomic factors in Saudi Arabia, namely, Gross Domestic Product Per capita (GDPP), Consumer Prices Index (CPI), and Unemployment Rate (UNEMP). Quarterly data for a period (2014q1 – 2019q4) were collected from publications of Saudi Arabian Monetary Authority (SAMA). Vector Autoregression Analysis (VAR) is employed to capture the dynamic effect of the variables on housing prices. Granger Causality, Variance Decomposition and Impulse response function are also used. The results show that housing prices are insignificantly and positively related to GDPP, whereas it is negatively related to both (CPI & UNEMP). Only CPI has a significant relationship. The three variables, jointly, have Granger causality on HPI. Variance decompositions show that CPI is the variable with the highest explanatory power over the variation of housing prices, followed by GDPP and the UNEMP respectively indicating that CPI is the most influential determinants for housing prices.

The paper draws attention and opens the debate on major societal issues that concern not only Muslims but human societies, at large, because of their profound implications, afflictions, and their present and future transitive dimensions. The paper discusses two major issues that have attracted a great deal of attention in the recent past: wealth and income disparities, and global indebtedness. Four remedies have stressed upon and/or proposed to eradicate and/or lessen some of the burdens of these problems have been thoroughly examined. These are: - Stripping commercial banks of their power to create money out of thin air (i.e., Ex Nihilo). Thus, reviving financial reform in line with the spirit of the call for the “Establishment of a National Bank [in England]” in the 1820s by the renowned British economist David Ricardo (1772-1823). The Bank of England was a private commercial entity at that time. - Prohibiting of ‘harmful’ speculation activities in financial and economic transactions and/or imposing hefty taxes on transactions relating to such activities. The implementation of such a policy requires and clear-cut distinction between the ‘harmful’ and ‘non-harmful’ speculative activities in financial and non-financial markets. - Levying adequate and fair taxes on the wealthiest upper class at the global scene. Calls for such a policy is on rise in the past few years. For instance, “Speakers at the European Development Days summit in Brussels, [in 2017], said that a just tax system should be “at the heart” of the development debate, and that more transparency is needed to ensure that companies pay their fair share. Tax avoidance schemes used by multinational companies, such as moving profits to tax havens, result in global losses of around $650 billion a year in tax receipts — with developing countries losing $200 billion, according to a study from the International Monetary Fund”, (Edwards, 2017; Crivello et al., 2015, p. 21) - Establishing a neutral legislative and tax regimes for different modes of financing. Thus, providing ‘a level playing field’ for equity and debt modes of financing due to the current biasness of the tax regimes to debt-based financing instruments as it has been documented in various studies carried out by the IMF, the European Commission, and other international prominent bodies.

Infrastructure development is rapidly increasing, driving up demand for concrete, a key construction material. Cement and aggregate are essential constituents, with global cement production reaching 4.1 billion metric tons in 2011 and CO2 emissions hitting 1.7 billion metric tons by 2024, a significant contributor to carbon emissions. To address this, alternative constituents like Rice Husk Ash (RHA) and Animal Bone Powder (ABP) are proposed. With rice husk comprising 20% of rice weight and a substantial cattle population in Bangladesh, RHA and ABP offer promising alternatives. This study examines the benefits and limitations of incorporating RHA and ABP into cement, focusing on concrete strength and permeability. By replacing varying percentages of cement with RHA and ABP simultaneously, experiments evaluate their impact on concrete properties after 28 days of curing. The research aims to identify the optimal combination for sustainable concrete production, reducing environmental impact by curbing waste generation and pollution. Results show that compressive strength increases and permeability decreases with up to 5% replacement of RHA and ABP, highlighting their potential for enhancing concrete performance while mitigating environmental concerns.

Few prior works study self-driving cars by deep learning with IoT collaboration. SDC-Net, which is an end-to-end multitask self-driving car camera cocoon IoT-based system, is one of the research that tackles this direction. However, by design SDC-Net is not able to identify the accident locations, it only classifies if it is a crash scene or not. In this work, we introduce an enhanced design for the SDC-Net system by 1) replacing the classification network with a detection one, 2) adapting our benchmark dataset labels built on the CARLA simulator to include the vehicles bounding boxes while keeping the same training, validation, and testing samples, 3) modifying the shared information via IoT to include the accident location. We keep the same path planning and automatic emergency braking network, the digital automation platform, and the input representations to formulate the comparative study. SDC-Net++ system is proposed to 1) output the relevant control actions, especially in case of accidents: accelerate, decelerate, maneuver, and brake, and 2) share the most critical information to the connected vehicles via IoT, especially the accident locations. A comparative study is also conducted between SDC-Net and SDC-Net++ with the same input representations: front camera only, panorama and bird-eye views, and with single-task networks: crash avoidance only, and multitask networks. Multitask network with a BEV input representation outperforms the nearest representation in precision, recall, f1-score, and accuracy by more than 15.134%, 12.046%, 13.593%, and 5%, respectively. SDC-Net++ multitask network with BEV outperforms SDC-Net multitask with BEV in precision, recall, f1-score, accuracy, and average MSE by more than 2.201%, 2.8%, 2.505%, 2%, and 18.677% respectively.

This study delves into the intricate interplay of economic growth components, specifically focusing on Consumption and investment in Saudi Arabia from 2000 to 2022. Employing vector error correction models and cointegration techniques, we analyze the short- and long-term dynamics within the relationship of Consumption, investment, and economic growth. Granger causality analysis is also used to discern these pivotal variables' causal connections. Our empirical analysis reveals a persistent long-term cointegration relationship among the variables, underscoring the enduring nature of their interdependency. Furthermore, our findings highlight Consumption and investment's statistically significant positive impact on economic growth. Notably, the short-term analysis unveils a stable model characterized by an annual adjustment to equilibrium of 100%.Moreover, the Granger causality study demonstrates unidirectional causal linkages between Consumption, investment, and economic growth. These findings hold substantial implications for policy formulation in Saudi Arabia. Policymakers must grasp the ramifications of burgeoning prosperity and evolving private consumption patterns on future environmental outcomes. Achieving sustainable long-term results necessitates equal emphasis on bolstering private Consumption and fostering other facets of economic growth.

Previous studies separately addressed the impact of urban expansion on vegetation cover and thermal conditions, as well as its effect on moisture and drought indicators, using geospatial techniques. Some studies, such as those by Malah et al. (2021) and Niu and Li (2020), focused on assessing urban environmental quality using an environmental quality index without considering urban expansion. Meanwhile, other studies, like those conducted by Indrawati et al. (2020), primarily focused on evaluating urban environ-ments using an integrated environmental index consisting of four indicators (greenness, moisture, drought, and cumulative clustering). The study by Zhu et al. (2019) applied the same integrated environmental index (IEI) and, by comparing it with temperature, re-vealed a negative correlation illustrating the effects of the environmental index on land surface temperature (LST). These two studies could be utilized to construct an index assessing the environmental condition in Riyadh. This is the case in the present study, where the addition of a temperature indicator due to the hot desert nature of the study area created the Urban Environmental Thermal Index to evaluate the urban en-vironment and provide results suitable to this region. It is expected that the present study will align with the findings of previous relevant studies, showing a negative im-pact of urban expansion on urban environmental components.

The four-way reversing valve is a key component determining whether a heat pump air conditioning system can work. Studying the four-way reversing valve is of great significance for improving the performance of the heat pump air conditioning system. In this paper, the control equation of the sliding block movement process is constructed to simulate the reversing process of the four-way reversing valve in fluid mechanics, and a detailed study is carried out from the sliding block speed, sliding block acceleration, sliding block force, refrigerant leakage, and other aspects. Research has shown that optimizing the structure of the slider can greatly improve the working performance of the four-way reversing valve. Increasing the height of the slider not only improves the pressure relief ability of the four-way reversing valve and prevents the slider from being damaged by high-pressure gas impact, but also reduces the leakage of refrigerant during the directional process; When reducing the length of the slider, although it will improve the pressure relief capacity of the four-way reversing valve, it also increases the amount of refrigerant leakage. The research results provide a theoretical basis and improvement direction for designers to improve the performance of four-way reversing valves.

Based on the textured controllable interface effect, the dynamic performances of the textured and ordinary pilot valve are analyzed experimentally, and the influence of the textured controllable interface on the response of pilot valve is studied. Results show that when Pin is small, the textured surface shortens the reciprocating time of valve core, increasing the flow rate, and speeds up the piston stroke of oil cylinder. The valve core actions much more stable and sensitivity. Meanwhile, combined with the theoretical calculation, the operation mechanism of texturing the pilot valve is analyzed. It is concluded that the stress of textured valve core sealing surface is greater than that of ordinary one, and the pressure difference gradually decreases with the increase of Pin, and the flow difference is basically the same as the force on the sealing surface. This indicates that the textured surface improves lubrication characteristics, reduces the friction between components. The textured valve makes the velocity changes gently, and enhances the responsiveness and stability of the valve. Those related results provide a new idea for enhancing the response design of the pilot valve.

Reliability assessment is an important component and tool used for process plants since the facility consists of many loops and instruments attached and operates based on each other availability, thus it requires a statistical method to visualize the reliability. The paper focuses on reliability assessment and prediction based on available statistical models such as normal, log-normal, exponential, and Weibull distribution. This paper also visualizes, which model fits best for assessment and prediction and also considers failure modes caused during a simulation mode process control operation. A simulation model is designed in this paper to observe the failure of the control valve causing stiction to visualize the failure modes and predict the best-fit model for reliability assessment.

Water scarcity, particularly in arid and semi-arid regions, poses a significant challenge to crop production, with drought being a prevalent factor limiting grain production globally. Enhancing agricultural water use efficiency is crucial for managing water resources effectively in these areas. Water resource management involves planning, developing, distributing, and optimizing the use of water resources. Water use efficiency management is also essential for crop growth in arid regions. Various agronomic and irrigation strategies can improve crop water use efficiency and drought tolerance. The primary goal of these strategies is to maximize irrigation efficiencies by applying the precise amount of water needed to restore soil moisture to the desired level. These sustainable practices not only reduce the cost of water and labor for farmers through reduced irrigation but also optimize the use of soil moisture storage. This review paper explores practical techniques to improve water use efficiency, highlighting the role of nutrients in enhancing water use efficiency in crop plants.

Our aim is at three feels: i) study safe haven properties of sectoral CDS; ii) study hedging effectiveness and measure the diversification benefits of introducing them in both Conventional and Islamic stock markets portfolios and iii) compare these results with VSTOXX, Gold and Bitcoin indices. To do this, we estimate time varying hedge ratio using (A)DCC and GOGARCH models and then deduce hedging effectiveness.. We follow the same methodology for each sub-period and each refit to test the effect of bubble crypto currency and COVID-19 pandemic on hedging effectiveness. Empirical results show the superiority of industrial CDS sectoral index to hedge both conventional and Islamic stock markets whether long or short term despite that their performances were reduced slightly during the second and third periods. VSTOXX and Others sectoral CDS indices offers Hedging performances that are generally better than Bitcoin and gold.

Aim: Reporting 3 year outcomes of a community shared care scheme run by specialised independent prescribing (IP) optometrists for stable glaucoma and ocular hypertension (OHT) patients in West Kent, England. Purpose: Shared Care Schemes for glaucoma exist to alleviate the burden on Hospital Eye Services (HES) glaucoma clinics. We studied the effectiveness of community care by highly trained and qualified IP optometrists in terms of disease stability and referral rate into HES.Methods: Retrospective longitudinal review of 200 eyes with stable early to moderate stage glaucoma and OHT followed-up in two specialist optometry practices. Outcome measures included visual field mean deviation (VFMD), intraocular pressure (IOP), changes to treatment and referral rate into HES. Inclusion criteria included all patients with OHT and glaucoma (open angle and primary angle closure) referred for community follow-up. Incomplete data sets were excluded.Results: Mean age 71yrs (range 28 - 93yrs) and equal male: female ratio. n= 159 at year 3. The results for both outcomes showed no significant change from baseline at 12 or 24-month time points. However, a significant change from baseline at 36 months was observed for both outcomes: mean reduction of 0.7 mmHg in IOP, and a mean reduction of 0.3 dB in VFMD. There was a statistically significant change in the number of drops used at 36 months (p=0.001). 11 patients had a change in medication within 3 years. One patient was referred back to HES for uncontrolled IOP and consideration of trabeculectomy.Conclusion: Community follow-up of stable cases of glaucoma and OHT by highly qualified IP optometrists was safe, with stability of disease maintained and few referrals back to HES.

Streptococcus intermedius is frequently associated with brain and liver abscesses, while pleuropulmonary infections are considered rarer. Even less frequent is the association of lung and brain abscess due to this agent with left heart endocarditis. We describe the case of a 40-year-old man with a brain abscess due to S. intermedius and concomitant lung abscess and aortic native valve endocarditis. He was treated with surgical drainage of the brain abscess and a 4-week course of intravenous ceftriaxone, followed by oral amoxicillin/clavulanate, obtaining healing of the lesions without relapse of the infection.

Mesentery was discovered as a new organ in 2017. It is a continuous membranous tissue from the duodenojejunal flexure to the anorectal junction. It has distinct anatomy, physiology, and disease states. Primary mesenteropathies include vascular and non-vascular diseases. Some of them are common, and some of them are rarely seen in clinical practice. Secondary mesenteropathies occur when infection or malignancy in another organ spreads to the mesentery. Each entity has specific diagnostic and treatment protocols.

COVID-19 has substantially influenced healthcare systems, requiring early prognosis for innovative therapies and optimal results, especially in individuals with comorbidities. Healthcare practitioners have used AI systems for investigating, anticipating, and predicting diseases, through means including medication development, clinical trial analysis, and pandemic forecasting. This study proposes the use of AI to predict disease severity in terms of hospital mortality among COVID-19 patients. Methodology: A cross-sectional study was conducted the approval from the Research Ethics Committee of King Abdulaziz University (KAU), Saudi Arabia. The study used sequential sampling approaches to include 50 Real-Time Polymerase Chain Reaction (RT-PCR) positive COVID-19 patients from KAU's coronavirus isolation wards. A pre-designed form was used to collect each patient's demographic information, including age and gender, signs and symptoms, illness severity (mild, moderate, severe), and laboratory findings. Furthermore, the length of the hospital stay and the result, whether the patient recovered or died, were reported. Results: The study involved 50 patients with varying degrees of disease severity, most of whom suffered from fever, fatigue, cough, sore throat, and diarrhoea. Laboratory analysis of COVID-19 patients showed increased white blood cell and platelet counts, with C-reactive protein levels above normal. Elevated LDH levels indicated possible tissue damage, while ferritin levels were elevated. Other enzymes were in the normal range, but bilirubin levels were slightly elevated. Overall, the patient's lab results indicated inflammation and possible blood clot formation. The study evaluated the predictive accuracy for outcomes and mortality of COVID-19 patients based on factors such as CRP, LDH, Ferritin, ALP, Bilirubin, D-dimers, and hospital stay (p-value ≤0.05). The predictive accuracy mortality of patients with COVID-19 using AI showed Hospital stay, D-Dimers ALP, Bilirubin, LDH, CRP, and Ferritin significantly affected hospital mortality. (p ≤ 0.0001). Conclusion: Artificial Intelligence is crucial for identifying early coronavirus infections and monitoring patient conditions. It improves treatment consistency and decision-making via the development of algorithms. AI can track the crisis at various scales, facilitate research, and aid in developing treatment regimens, prevention strategies, and drugs and vaccines. It also aids in monitoring health and facilitating research on the virus.

In this paper, we investigate the behaviour of a relativistic quantum oscillator under the effects of Lorentz symmetry violation determined by a tensor (KF)µναβ out of the Standard Model Extension. We analyze the quantum system under a Coulomb-type radial electric field and a uniform magnetic induced by Lorentz symmetry breaking effects under a Cornell-type potential, and obtain the bound states solution by solving the Klein-Gordon oscillator. We see a quantum effect due to the dependence of the angular frequency of the oscillator on the quantum numbers of the system, and the energy eigenvalues and the wave-function of the oscillator field get modified by the Lorentz symmetry breaking parameters as well as due to the presence of Cornell-type potential.

Magneto-rheological dampers (MR-dampers) are increasingly used in construction applications to reduce the dynamic response of structures to seismic activities or severe wind loading. Sensors attached to the structure will signal the computer to supply the dampers with electric charge that transfers the MR fluid to a near-solid material with different physical and mechanical properties (viscoelastic behavior). Control algorithms govern the fluid to near-solid conversion, which controls the behavior of the damper, and the performance of the structure under the seismic or wind loading event. The successful optimization of control parameters minimize the overall structural response to dynamic forces. The main objective of this research is to change the output behavior of specific floors within a building subjected to seismic excitation by optimizing the MR-dampers control parameters to impact the behavior of a specific floor or number of floors within the building. The adjustment of control parameters to attain this objective was validated in multiple case studies throughout this research. The successful implementation of the research outcome will result in optimized MR-damper design to meet the performance-based criteria of building projects.

Inertial navigation system (INS) is a basic component for obtaining a continuous navigation solution in various applications. The INS navigation solution suffers from a growing error over time. In particular, its navigation solution depends mainly on the quality and grade of the inertial measuring unit (IMU) that provides the INS with both accelerations and angular rates. However, low-cost small micro-electro-mechanical systems (MEMS) suffer from tremendous error sources such as bias, scale factor, scale factor instability, and highly non-linear noise. Therefore, MEMS-IMU measurements lead to drifted solutions when used as a control input to the INS. Accordingly, several approaches have been introduced to model and mitigate the errors associated with IMU. In this paper, a machine learning-based adaptive neuro-fuzzy inference system (ML-ANFIS) is proposed to leverage the performance of low-grade IMUs in two phases. The first phase is training 50% of the low-grade IMU measurements with a high-end IMU to generate a suitable error model. The second phase involved testing the developed model on the remaining low-grade IMU measurements. A real road trajectory was conducted to evaluate the performance of the proposed algorithm. The results show the effectiveness of utilizing the proposed ML-ANFIS algorithm in removing errors and improving the INS solution compared to the traditional one. An improvement of 70% in the 2D-positioning and 92% in the 2D-velocity INS solution is attained when the proposed algorithm was applied compared to the traditional INS solution.

This study tries to focusing on applying information communication technology for economic importance of Mid Oil Company (MDOC), which is among contemporary oil companies in Iraq. Since ICT forms a significant aspect of achieving organizational economic objectives, most of public and private bodies seek to utilize ICT tool and techniques to improve work efficiencies. The emerging growth in ICT has made it process and service automation possible in managing organizational activities. To determine this effect of ICT on organizations, this study formulated statistical research model at MDOC through using fifteen questionnaires, which were distributed on three axes. The outcome of the questionnaire analysis revealed that there is inadequate comprehensive infrastructure to suitably support ICT within the selected organization management. In addition, it revealed that there are no ideal standards to maintain and sustain internet networks. Based on these revelations, the study presents recommendation for the adoption of ICT with the aim of minimizing cost, enhancing communication and managing infrastructure. Also recommends the need to support IT department within an organization, with essential equipment, in terms of man and machine, for better efficiency to employ the key of ICT Impact in Iraqi governmental oil companies.

This study aimed to compare the efficacies and safety of enhanced and standard monofocal intraocular lenses (IOLs) in eyes with early glaucoma. Patients with concurrent cataracts and open-angle glaucoma (OAG) were enrolled. They underwent cataract surgery with IOL implantation. Manifest refraction; monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA); visual field (VF); contrast sensitivity (CS); defocus curves and questionnaires were assessed three months postoperatively. Thirty-four and 38 patients had enhanced and standard monofocal IOLs, respectively. The enhanced monofocal IOL provided better UIVA than the standard monofocal IOL (p = 0.003) but similar UDVA, CDVA and UNVA. The enhanced monofocal IOL had more consistent defocus curves than the standard monofocal IOL, especially at -1 (p = 0.042) and -1.5 (p = 0.026) diopters. The enhanced monofocal IOL provided better satisfaction (p = 0.019) and lower spectacle dependence (p = 0.004) than the standard monofocal IOL for intermediate vision, with similar VF and CS. In conclusion, the enhanced monofocal IOL is recommended for patients with OAG because they provide better intermediate vision, higher satisfaction, and lower dependence on spectacles than standard monofocal IOL, without worsening other visual outcomes.