Multifractal nature of ocular aberration dynamics of the human eye

Ocular monochromatic aberrations display dynamic behavior even when the eye is fixating on a stationary stimulus. The fluctuations are commonly characterized in the frequency domain using the power spectrum obtained via the Fourier transform. In this paper we used a wavelet-based multifractal analytical approach to provide a more in depth analysis of the nature of the aberration fluctuations. The aberrations of five subjects were measured at 21 Hz using an open-view Shack-Hartmann sensor. We show that the aberration dynamics are multifractal. The most frequently occurring Hölder exponent for the rms wavefront error, averaged across the five subjects, was 0.31 ± 0.10. This suggests that the time course of the aberration fluctuations is antipersistant. Future applications of multifractal analysis are discussed

Исследование коррозионных свойств биосовместимых покрытий на основе титана, осажденных методом реактивного магнетронного распыления

В работе изучались свойства Ti-O-N покрытий, нанесенных на стальные подложки методом реактивного магнетронного напыления, такие как коррозионная стойкость, термическая устойчивость, а так же диффузионные процессы в физиологических растворах. Методами инфракрасной спектроскопии и атомно-эмиссионного анализа была установлена химическая инертность пленки, а так же потенциальная биологическая активность в виду обнаружения оксида азота в модельных растворах после контакта с покрытиями Ti-O-N.The properties of Ti-O-N coatings deposited on steel substrates by the method of reactive magnetron sputtering, such as corrosion resistance, thermal stability, as well as diffusion processes in physiological solutions were studied. By the methods of infrared spectroscopy and atomic emission analysis, the chemical inertness of the film was established, as well as the potential biological activity in the form of detection of nitrogen oxide in model solutions after contact with Ti-O-N coatings

Does transient increase in axial length during accommodation attenuate with age?

Background: The aim was to profile transient accommodative axial length (AXL) changes from early adulthood to advanced presbyopia and to determine whether any differences exist between the responses of myopic and emmetropic individuals. Methods: Ocular biometry was measured by the LenStar biometer (Haag-Streit, Switzerland) in response to 0.00, 3.00 and 4.50 D accommodative stimuli in 35 emmetropes and 37 myopes, aged 18 to 60 years. All results were corrected to reduce errors arising from the increase in crystalline lens thickness with accommodation. Accommodative responses were measured sequentially by the WAM 5500 Auto Ref/Keratometer (Grand Seiko, Japan). Results: AXL increased significantly with accommodation (p<0.001), with a mean corrected AXL elongation of 2 ± 18 µm and 8 ± 16 µm observed at 3.00 D and 4.50 D, respectively. The magnitude of accommodative AXL change was not dependent on refractive error classification (p=0.959), however a significant reduction in the magnitude and variance of AXL change was evident after 43-44 years of age (p<0.002). Conclusion: The negative association between transient AXL elongation and age, in combination with reduced variance of data after age 43-44 years, is consistent with a significant increase in posterior ocular rigidity, which may be influential in the development of presbyopia

Sensitivity of Chaos Measures in Detecting Stress in the Focusing Control Mechanism of the Short-Sighted Eye

yesWhen fixating on a stationary object, the power of the eye’s lens fluctuates. Studies have suggested that changes in these so-called microfluctuations in accommodation may be a factor in the onset and progression of short-sightedness. Like many physiological signals, the fluctuations in the power of the lens exhibit chaotic behaviour. A breakdown or reduction in chaos in physiological systems indicates stress to the system or pathology. The purpose of this study was to determine whether the chaos in fluctuations of the power of the lens changes with refractive error, i.e. how short-sighted a subject is, and/or accommodative demand, i.e. the effective distance of the object that is being viewed. Six emmetropes (EMMs, non-short-sighted), six early-onset myopes (EOMs, onset of short-sightedness before the age of 15), and six late-onset myopes (LOMs, onset of short-sightedness after the age of 15) took part in the study. Accommodative microfluctuations were measured at 22 Hz using an SRW-5000 autorefractor at accommodative demands of 1 D (dioptres), 2 D, and 3 D. Chaos theory analysis was used to determine the embedding lag, embedding dimension, limit of predictability, and Lyapunov exponent. Topological transitivity was also tested for. For comparison, the power spectrum and standard deviation were calculated for each time record. The EMMs had a statistically significant higher Lyapunov exponent than the LOMs ( 0.64±0.330.64±0.33 vs. 0.39±0.20 D/s0.39±0.20 D/s ) and a lower embedding dimension than the LOMs ( 3.28±0.463.28±0.46 vs. 3.67±0.493.67±0.49 ). There was insufficient evidence (non-significant p value) of a difference between EOMs and EMMs or EOMs and LOMs. The majority of time records were topologically transitive. There was insufficient evidence of accommodative demand having an effect. Power spectrum analysis and assessment of the standard deviation of the fluctuations failed to discern differences based on refractive error. Chaos differences in accommodation microfluctuations indicate that the control system for LOMs is under stress in comparison to EMMs. Chaos theory analysis is a more sensitive marker of changes in accommodation microfluctuations than traditional analysis methods

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

The effect of image resolution of display types on accommodative microfluctuations

PURPOSE: To determine whether accommodative microfluctuations (AMFs) are affected by the image resolution of the display type being observed. The effect of refractive error is also examined. METHODS: Twenty participants, (10 myopes and 10 emmetropes) observed a target on four different displays: paper, smartphone, e‐reader and visual display unit screen (VDU), whilst their accommodative responses were measured using a continuous recording infrared autorefractor. The accommodative response and AMF measures comprising low frequency components (LFC), high frequency components (HFC) and the root mean square (RMS) of the AMFs were analysed. RESULTS: A significant increase in LFC power was observed for the paper stimulus when compared to the VDU and smartphone conditions. Myopes demonstrated a significantly higher LFC and mean accommodative response compared to emmetropes across the four displays. A significant difference in the mean AR between the displays with the lowest and highest resolution was found. A higher mean AR was found with higher resolution of the image. The HFC and RMS accommodation were not affected by display type. CONCLUSION: The mean accommodative response and the mean LFC power appear to respond differently depending on the type of display in use. Higher resolution devices showed a reduced lag of accommodation to the accommodative demand; however, this may cause a lead of accommodation in myopes for higher resolution display types