Evolving Techniques in Partial Endothelial Keratoplasty: A Comprehensive Literature Review

Individuals with endothelial disorders such as Fuchs’ corneal dystrophy and bullous keratopathy require corneal transplantation of the diseased corneal tissue once their endothelial cell density has decreased significantly. In the past century, penetrating keratoplasty (PK) or full corneal transplantation has been the most widely used procedure to treat endothelial dysfunction. However, endothelial keratoplasty (EK) has replaced PK as it has lower post-operative complications. EK consists of Descemet’s stripping endothelial keratoplasty (DSEK) and Descemet’s membrane endothelial keratoplasty (DMEK). This study consists of a literature review on the advantages and disadvantages of DMEK and DSEK and their post-operative complications. Patients who undergo the DMEK procedure experience lower rates of graft rejection, more frequent re-bubbling and follow-up appointments, and faster visual recovery period. Patients who undergo the DSEK procedure have higher rates of graft rejection, longer visual recovery period, and less re-bubbling rates and follow-up appointments. Surgical techniques for repairing endothelial dysfunction are evolving, but we need larger long-term studies to prove that new techniques are superior to the current surgical techniques

No association between cortical lesions and leptomeningeal enhancement on 7-Tesla MRI in multiple sclerosis

Background: Autopsy data suggest a causative link between meningeal inflammation and cortical lesions (CLs) in multiple sclerosis (MS). Objective: To use leptomeningeal enhancement (LME) and CLs on 7-Tesla (7T) magnetic resonance imaging (MRI) to investigate associations between meningeal inflammation and cortical pathology. Methods: Forty-one participants with MS underwent 7T MRI of the brain. CLs and foci of LME were quantified. Results: All MS participants had CLs; 27 (65.8%) had >1 focus of LME. Except for hippocampal CL count (ρ = 0.32 with spread/fill-sulcal pattern LME, p = 0.042), no significant correlations were seen between LME and CLs. Mean cortical thickness correlated with the number of LME foci (ρ = –0.43, p = 0.005). Participants with relapsing–remitting multiple sclerosis (RRMS) showed no correlation with neocortical CLs, but significant correlations were seen between LME and hippocampal lesion count (ρ = 0.39, p = 0.030), normalized cortical gray matter (GM) volume (ρ = –0.49, p = 0.005), and mean cortical thickness (ρ = –0.59, p < 0.001). Conclusion: This study supports a relationship between LME and cortical GM atrophy but does not support an association of LME and neocortical CLs. This may indicate that meningeal inflammation is involved with neurodegenerative inflammatory processes, rather than focal lesion development

Extraction and molecular detection of viral dsRNA from different infected plants

Extraction of viral double stranded RNA (dsRNA) from infected plants is helpful in identification of the viruses involved in infection. To date, there have been several methods developed to isolate dsRNA; however, type of the plant and virus is determinative in extraction efficiency. In this study we extracted dsRNA from different woody and herbaceous plants through a modified method which reduces the costs and time of extraction procedure. This method is based on different affinity of nucleic acids for the cellulose CF-11 in1X STE (Sodium chloride Tris EDTA) buffer containing 16 % ethanol. There is no phenol treatment or mini columns used in the isolation procedure. Extracted dsRNAs were identified by ribonuclease treatment and RT-PCR (Reverse Transcriptase-Polymerase Chain Reaction). We have applied the procedure on five different hosts representing Amaranthaceae, Vitaceae, Fabaceae and Rosaceae infected with four different viruses representing Secoviridae and Bromoviridae.&nbsp

The Long Term Use of Benzodiazepines and the Treatment of Anxiety

Purpose: The purpose of this article is to review the long term use of benzodiazepines in the treatment of anxiety. Method: A PubMed literature search was conducted with search terms benzodiazepine, long term use and anxiety. Free full text articles option was selected and they were to be published between 2015 to present. The four pertinent articles that were retrieved and served as the basis for this clinical review. Results: Literature shows extensive alternative options with lower side effect profiles. Special populations, like children and pregnant women, are seen to use benzodiazepines as a short course but long term use is not recommended. Withdrawal is a large hindrance in the use of benzodiazepines. Overall, it is not recommended to use benzodiazepines as long term treatment for anxiety disorders. Conclusion: Benzodiazepines are a widely used medication in the treatment of anxiety with many potential benefits. When used in the long term setting there are several problematic features that lead to poor health outcomes and it is not recommended as long term treatment. The use of long term benzodiazepines shows impairment in neurocognitive activities, respiratory function and mental health outcomes. There is still research that needs to be done in order to determine the extent of these outcomes and what age groups are most affected. Further research can include practice adjustments in the prescription of benzodiazepines

Genetiske faktorer som leder til utviklingen av schizofreni: En oppsummert oversikt over dagens kunnskap om genetikken bak schizofreni

BAKGRUNN: Schizofreni er en alvorlig nevroutviklingsforstyrrelse som rammer ca. 1 % av befolkningen. Genetiske risikofaktorer regnes med å utgjøre 60-80 % av risikoen. Likevel er fortsatt ikke de genetiske risikofaktorene og underliggende nevrobiologiske mekanismene fullt ut forstått. Denne oppgaven har som formål å syntetisere en oversikt over den foreliggende evidensen på genetiske risikofaktorer og deres rolle i etiopatogenesen til schizofreni. MATERIALE OG METODE: Et litteratursøk ble utført 30.08.2016 på MEDLINE-databasen gjennom PubMed-portalen, med søkeordene «schizophrenia», «genes» og «risk», begrenset til oversiktsartikler i engelsk publisert de siste fem årene. Deretter ble artikler valgt ut til oppgaven dersom de eksplisitt handlet om schizofreni, enten alene eller i sammenheng med andre sykdommer og undersøker ett eller flere spesifikke gener eller loci assosiert med schizofreni hos mennesker. RESULTATER: Søket ga 200 treff, hvor 60 artikler møtte kriteriene. Den største genomvide assosiasjonsstudien (GWAS) til dags dato har identifisert 108 gener med genomvid signifikant assosiasjon til schizofreni. Etterfølgende studier har forkastet et betydelig antall historiske kandidatgener fra før-GWAS-tiden, men med mulighet for fremtidig inklusjon ettersom utvalgene suksessivt øker. Nåværende funn antyder en konvergens mot tre hovedmekanismer som kan spille en sentral etiopatogenetisk rolle: forstyrrelser i glutamaterg nevrotransmisjon og synaptisk plastisitet, unormal kalsiumkanal-funksjon, og mutasjoner i MHC-regionen og immundysfunksjon. Andre gener med signifikans spiller sentrale roller i nevrogenese, nevroplastisitet, synapsefunksjon og/eller nevronal signalering. FORTOLKNING: Innføringen av storskala GWAS, gjort mulig med teknologiske nyvinninger og samarbeid i forskningsgruppe-konsortier, har forbedret kvaliteten på genetiske studier betydelig. Definitive konklusjoner kan ikke trekkes enda, men enda større GWAS og mer avanserte sekvenseringsteknikker vil videre avdekke mer av de underliggende genetiske og nevrobiologiske mekanismene bak schizofreni

Total Knee Arthroplasty and Bariatric Surgery : Patients, Outcomes and Surgeons

Osteoarthritis (OA) is the most common disorder of the joint, affecting over 500million people globally, and is one of the most demanding disabilities worldwide.One of the most prominent risk factors for developing OA is obesity. Clinically, the most common site of OA is the knee. Obesity has been associated with worseoutcomes after Total Knee Arthroplasty (TKA) and patients with obesity have beenshown to have an increased risk of revision after TKA. Obesity is further associatedwith several comorbidities as well as psychological problems, including depression and low self-esteem. Treatment of obesity using lifestyle modifications often results in insufficient weight loss. The most effective method of achieving weight loss in patients with obesity and counteracting morbid obesity with its relatedcomorbidities is Bariatric Surgery (BS). Consequently, BS before TKA may reduce the risk of revision after TKA. Thus, this thesis evaluates risk of revision, pain,Activity in Daily Life function (ADL), and weight change after TKA in patients with prior BS compared to patients without prior BS. Additionally, the thesis aims toidentify the criteria and practices used by Swedish centers and knee arthroplasty surgeons when performing knee arthroplasty in patients who have obesity. Data were extracted from the Swedish Knee Arthroplasty Registry and Scandinavian Obesity Registry to identify patients with BS and TKA in Papers I–III. In Paper IV, a survey was created and sent to all the Swedish centers performing knee arthroplasty. No benefit in risk of revision for all reasons or in outcome regarding pain and ADL after TKA were found in patients with prior BS compared to patients without prior BS. This was also seen when comparing to patients with BS following TKA for riskof revision for all reasons. However, when adjusting for Body Mass Index (BMI) prior to TKA, the risk of revision due to suspected or verified infection was higher in patients with BS prior to TKA than in patients without BS. Additionally, no statistically significant difference in 1-year or 2-years postoperative weight change depending on the sequence of surgery was found. Paper IV indicated that most knee arthroplasty surgeons in Sweden inform their patients with obesity regarding risksof knee arthroplasty. Furthermore, most centers that perform knee arthroplasties inSweden have an upper BMI limit.

Total Knee Arthroplasty and Bariatric Surgery : Patients, Outcomes and Surgeons

Osteoarthritis (OA) is the most common disorder of the joint, affecting over 500million people globally, and is one of the most demanding disabilities worldwide.One of the most prominent risk factors for developing OA is obesity. Clinically, the most common site of OA is the knee. Obesity has been associated with worseoutcomes after Total Knee Arthroplasty (TKA) and patients with obesity have beenshown to have an increased risk of revision after TKA. Obesity is further associatedwith several comorbidities as well as psychological problems, including depression and low self-esteem. Treatment of obesity using lifestyle modifications often results in insufficient weight loss. The most effective method of achieving weight loss in patients with obesity and counteracting morbid obesity with its relatedcomorbidities is Bariatric Surgery (BS). Consequently, BS before TKA may reduce the risk of revision after TKA. Thus, this thesis evaluates risk of revision, pain,Activity in Daily Life function (ADL), and weight change after TKA in patients with prior BS compared to patients without prior BS. Additionally, the thesis aims toidentify the criteria and practices used by Swedish centers and knee arthroplasty surgeons when performing knee arthroplasty in patients who have obesity. Data were extracted from the Swedish Knee Arthroplasty Registry and Scandinavian Obesity Registry to identify patients with BS and TKA in Papers I–III. In Paper IV, a survey was created and sent to all the Swedish centers performing knee arthroplasty. No benefit in risk of revision for all reasons or in outcome regarding pain and ADL after TKA were found in patients with prior BS compared to patients without prior BS. This was also seen when comparing to patients with BS following TKA for riskof revision for all reasons. However, when adjusting for Body Mass Index (BMI) prior to TKA, the risk of revision due to suspected or verified infection was higher in patients with BS prior to TKA than in patients without BS. Additionally, no statistically significant difference in 1-year or 2-years postoperative weight change depending on the sequence of surgery was found. Paper IV indicated that most knee arthroplasty surgeons in Sweden inform their patients with obesity regarding risksof knee arthroplasty. Furthermore, most centers that perform knee arthroplasties inSweden have an upper BMI limit.

A MIXED INTEGER-PROGRAMMING MODEL FOR PERIODIC ROUTING OF SPECIAL VESSELS IN OFFSHORE OIL INDUSTRY

In order to maintain the production of offshore oil wells, National Iranian Oil Company periodically services facilities and equipment located in oil wellheads with mobile wellhead servants. It also gives technical supports to oil wellheads and mobile wellhead servants with supporter vessels. Due to supply limitations, there are fewer special vessels (namely supporter vessels and mobile wellhead servants) compared to the number of oil wellheads. Failure to service oil wellheads by special vessels and also failure to technically support mobile wellhead servants by supporter vessels based on a predetermined plan, will lead to considerable loss in production performance of oil wells and hence higher costs. Finding best plan to service oil wellheads considering traveling and shortage costs, we propose a mixed integer programming model and a heuristic algorithm for the problem. Computational results on both simulated and real life instances are reported and performance of the proposed algorithm is evaluated. &nbsp

Information and BMI limits for patients with obesity eligible for knee arthroplasty : the Swedish surgeons’ perspective from a nationwide cross-sectional study

Background: In the past decades, the incidence of obesity has increased worldwide. This disease is often accompanied with several comorbidities and therefore, surgeons and anesthesiologists should be prepared to provide optimal management for these patients. The aim of this descriptive cross-sectional study was to map the criteria and routines that are used by Swedish knee arthroplasty surgeons today when considering patients with obesity for knee arthroplasty. Methods: A survey including 21 items was created and sent to all the Swedish centers performing knee arthroplasty. The survey included questions about the surgeons’ experience, hospital routines of preoperative information given and the surgeons’ individual assessment of patients with obesity that candidates for knee arthroplasty. Descriptive statistics were used to present the data. Results: A total of 203 (64%) knee surgeons responded to the questionnaire. Almost 90% of the surgeons claimed to inform their patients with obesity that obesity has been associated with an increased risk of complications after knee arthroplasty. Seventy-nine percent reported that they had an upper BMI limit to perform knee arthroplasty, a larger proportion of the private centers had a BMI limit compared to public centers. The majority of the centers had an upper BMI limit of 35. Conclusion: The majority of the knee arthroplasty surgeons in Sweden inform their patients with obesity regarding risks associated with knee arthroplasty. Most centers that perform knee arthroplasties in Sweden have an upper BMI limit