Adjunctive Local Application of Lidocaine during Scleral Buckling under General Anesthesia

Purpose: To evaluate the effect of local lidocaine application on the incidence of the oculocardiac reflex (OCR) during scleral buckling (SB) for rhegmatogenous retinal detachment (RRD) under general anesthesia. Methods: In a randomized clinical trial, eyes with RRD scheduled for SB under general anesthesia were randomized to adjunctive local application of 1 ml lidocaine 2% versus normal saline to the muscles after conjunctival opening. Surgical stimulation was initiated 5 minutes afterwards. Additionally, 100 mg of lidocaine 2% was added to 50 ml of normal saline in the treatment group which was used for irrigation during surgery; control eyes were irrigated with normal saline. The incidence of the OCR, rate of postoperative nausea/vomiting (PONV), total intravenous (IV) analgesic dose, duration of surgery, and period of hospitalization were compared between the study groups. Results: Thirty eyes of 30 patients including 22 (73.3%) male and 8 (26.7%) subjects with mean age of 49.4΁16.3 years were operated. OCR and PONV occurred less frequently, and total intravenous analgesic dose was significantly lower in the lidocaine group (P < 0.05 for all comparisons). However, no significant difference was noted between the study groups in terms of duration of surgery and period of hospitalization. Conclusion: Adjunctive local application of lidocaine during SB under GA for RRD decreases the rate of OCR and PONV, reduces the intravenous analgesic dose, but does not affect the duration of surgery or hospitalization

Alcohol-assisted versus Mechanical Epithelium Removal in Photorefractive Keratectomy

Purpose: To compare the outcomes and complications of alcohol-assisted versus mechanical corneal epithelial debridement for photorefractive keratectomy (PRK). Methods: This randomized controlled trial included 1,250 eyes of 625 patients undergoing PRK for correction of myopia and myopic astigmatism. Each patient was randomly assigned to alcohol-assisted or mechanical epithelial removal. Results: A total of 658 eyes underwent alcohol-assisted epithelial removal while the epithelium was removed mechanically in 592 eyes. Mean spherical equivalent was ‑4.37}2.3 D in the alcohol group and ‑3.8}1.3 D in the mechanical group (P = 0.78). There was no significant difference in postoperative pain between the study groups (P = 0.22). Uncorrected visual acuity ≥ 20/20 and ≥ 20/40 was achieved in 90.9% versus 93.4% (P = 0.08), and 98.9% versus 99.5% (P = 0.36) of eyes in the alcohol and mechanical groups, respectively. Final refractive error within 1D of emmetropia was achieved in 90% versus 92.2% of eyes in the alcohol and mechanical groups, respectively (P = 0.23). Alcohol-assisted debridement required less time than mechanical debridement (96±18 vs. 118±26 seconds, P=0.035). There was no significant difference between the two groups in terms of early and late postoperative complications. Conclusion: Alcohol-assisted and mechanical epithelium removal are comparable in terms of efficacy and side effects. The method of epithelial debridement in PRK may be left to the surgeon′s choice

Investigation of riprap stability at downstream of spillway flip bucket without and with energy dissipators

ABSTRACTSpillway is one of the most cost-effective energy dissipating structures used in dams which leads to dissipation of flow energy at the end of the structure. Scouring is a phenomenon occurring next to the hydraulic structures, and which can lead to deterioration and even collapse of such structures. One of the methods to control the scouring downstream of a dam is using riprap. In this study it was investigated the stability of riprap based on relative particle diameter downstream of spillways of four different categories of energy dissipators, namely simple flip bucket, dentated flip bucket, simple triangular sill, and dentated triangular sill. The experiments were performed in a rectangular test flume. Ripraps of the same density and of four different diameters were investigated at five discharges at the movement threshold. Results of the study suggested that the relative particle diameter was an important factor in stability of the riprap. Besides, in all of the four aforementioned spillways, the stability number at the movement threshold was found to decrease with increase in the relative particle diameter. For all of the relative particle diameters, use of dentates led to an increase in the stability number 11% and 7% in spillways with simple flip bucket and triangular sill respectively. Also, a formula for estimating relative particle diameter was proposed. The correlation coefficient of the results yielded by this formula and the laboratory results was found to be 0.9 and 0.6 for the spillway with simple flip bucket and the other three types of the spillways respectively

Experimental investigation on the effect of different slot shapes and configurations on scour dimension downstream of flip buckets

Flip buckets at the end of a spillway can dissipate the flood discharge energy. Compared to other energy dissipators, this is a cost-effective structure. The formation of a scour hole downstream of a flip bucket is a topic of interest among hydraulic engineers. The current study investigated scouring downstream of a flip bucket under two major scenarios: (i) free conditions, and (ii) slotted conditions with rectangular and triangular slots configured differently under four different discharge rates. In total, 20 experiments were conducted in this study. Results showed that the use of a deflector slot greatly affected the scour extent and depth, resulting in a greater scour reduction (53%) in the labyrinth rectangular slotted bucket compared to the solid bucket. The results were compared to empirical equations, and a high correlation was observed between them. In comparison, the Taraimovich equation produced more accurate results in control experiments, and the Damle-A and Damle-B equations produced more accurate results in experiments corresponding to labyrinth rectangular and triangular slotted buckets

Artiflex versus STAAR® implantable contact lenses for correction of high myopia

Purpose : To compare two phakic intraocular lenses, Artiflex and STAAR® implantable contact lens (ICL), in high myopia. Setting : Isfahan Ophthalmology Clinic, Iran. Materials and Methods : In a randomized, prospective clinical trial study, 40 eyes of 20 patients who came to Isfahan ophthalmology clinic to correct their refractive error were examined. Artiflex was inserted in 20 eyes and ICL in the other 20 eyes. After 1 year, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), contrast sensitivity, intraocular pressure (IOP), and specular microscopy of corneal endothelium were assessed in both the groups. Results : In this study, there was no statistical difference between UCVA, BCVA, IOP, cataract incidence, contrast sensitivity, and specular microscopy, 1 year after surgery. 40% of eyes in the Artiflex group developed anterior chamber cell and flare reaction 1 year postoperatively, but no patient in the ICL group developed the same. So, there is obvious difference in the rate of anterior chamber cell and flare reaction between these two groups. Conclusion : These two lenses have similar outcomes except in the incidence rate of anterior chamber cell and flare reaction that is greater in the Artiflex group. So, these two lenses are safe with predictable outcome in treating high myopia

Biomaterial-based delivery platforms for transdermal immunotherapy

Nowadays, immunotherapy is one of the most essential treatments for various diseases and a broad spectrum of disorders are assumed to be treated by altering the function of the immune system. For this reason, immunotherapy has attracted a great deal of attention and numerous studies on different approaches for immunotherapies have been investigated, using multiple biomaterials and carriers, from nanoparticles (NPs) to microneedles (MNs). In this review, the immunotherapy strategies, biomaterials, devices, and diseases supposed to be treated by immunotherapeutic strategies are reviewed. Several transdermal therapeutic methods, including semisolids, skin patches, chemical, and physical skin penetration enhancers, are discussed. MNs are the most frequent devices implemented in transdermal immunotherapy of cancers (e.g., melanoma, squamous cell carcinoma, cervical, and breast cancer), infectious (e.g., COVID-19), allergic and autoimmune disorders (e.g., Duchenne’s muscular dystrophy and Pollinosis). The biomaterials used in transdermal immunotherapy vary in shape, size, and sensitivity to external stimuli (e.g., magnetic field, photo, redox, pH, thermal, and even multi-stimuli-responsive) were reported. Correspondingly, vesicle-based NPs, including niosomes, transferosomes, ethosomes, microemulsions, transfersomes, and exosomes, are also discussed. In addition, transdermal immunotherapy using vaccines has been reviewed for Ebola, Neisseria gonorrhoeae, Hepatitis B virus, Influenza virus, respiratory syncytial virus, Hand-foot-and-mouth disease, and Tetanus