Angle stability and outflow in dual blade ab interno trabeculectomy with active versus passive chamber management.

PurposeTo compare intraoperative angle stability and postoperative outflow of two ab interno trabeculectomy devices that excise the trabecular meshwork with or without active aspiration and irrigation. We hypothesized that anterior segment optical coherence tomography (AS-OCT) allows for a quantitative comparison of intraoperative angle stability in a microincisional glaucoma surgery (MIGS) pig eye training model.MethodsTwelve freshly enucleated porcine eyes were measured with AS-OCT at baseline, at the beginning of the procedure and at its conclusion to determine the anterior chamber depth (ACD) and the nasal angle α in degrees. The right and left eye of pairs were randomly assigned to an active dual blade goniectome (aDBG) and a passive dual blade goniectome (pDBG) group, respectively. The aDBG had irrigation and aspiration ports while the pDBG required surgery under viscoelastic. We performed the procedures using our MIGS training system with a standard, motorized ophthalmic operating microscope. We estimated outflow by obtaining canalograms with fluorescent spheres.ResultsIn aDBG, the nasal angle remained wide open during the procedure at above 90° and did not change towards the end (100±10%, p = 0.9). In contrast, in pDBG, ACD decreased by 51±19% to 21% below baseline (p<0.01) while the angle progressively narrowed by 40±12% (p<0.001). Canalograms showed a similar extent of access to the outflow tract with the aDBG and the pDBG (p = 0.513). The average increase for the aDBG in the superonasal and inferonasal quadrants was between 27 to 31% and for the pDBG between 15 to 18%.ConclusionAS-OCT demonstrated that active irrigation and aspiration improved anterior chamber maintenance and ease of handling with the aDBG in this MIGS training model. The immediate postoperative outflow was equally good with both devices

Development of an X-band Photoinjector at SLAC

As part of a National Cancer Institute contract to develop a compact source of monoenergetic X-rays via Compton backscattering, we have completed the design and construction of a 5.5 cell Photoinjector operating at 11.424 GHz. Successful completion of this project will result in the capability of generating a monoenergetic X-ray beam, continuously tunable from 20 - 85 KeV. The immediate goal is the development of a Photoinjector producing 7 MeV, 0.5 nC, sub-picosecond electron bunches with normalized RMS emittances of approximately 1 pi-mm-mR at repetition rates up to 60 Hz. This beam will then be further accelerated to 60 MeV using a 1.05 m accelerating structure. This Photoinjector is somewhat different than the traditional 1.5 cell design both because of the number of cells and the symmetrically fed input coupler cell. Its operating frequency is also unique. Since the cathode is non-removable, cold-test tuning was somewhat more difficult than in other designs. We will present results of "bead-drop" measurements used in tuning this structure. Initial beam measurements are currently in progress and results will be presented as well as results of RF conditioning to high gradients at X-band. Details of the RF system, emittance-compensating solenoid, and cathode laser system as well as PARMELA simulations will also be presented.Comment: 3 pages, 6 figures, 1 Table, LINAC 200

Glaucoma surgery calculator: limited additive IOP effect of phacoemulsification on Ab Interno Trabeculectomy

Purpose: To compare reduction of intraocular pressure (IOP) after Trabectome in pseudophakic patients and Trabectome combined with phacoemulsification (Trabectome-phaco) in phakic patients. Methods: Cases were excluded if patients were followed for less than 12 months, diagnosed with neovascular glaucoma, or required additional glaucoma surgery within 12 months after Trabectome or Trabectome-phaco. Missing data such as type of glaucoma, gender, or age was imputed by generating 5 similar but non-identical datasets. Groups were matched using Coarsened Exact Matching based on age, gender, type of glaucoma, race, preoperative number of glaucoma medications and baseline IOP. Linear regression was used to examine IOP reduction after surgery. Results: A total of 612 cases were included in the study with 248 Trabectome cases and 364 Trabectome-phaco cases. Baseline IOP was found to be statistically significant. An average of 0.73±0.03 mmHg IOP reduction is associated with an increment of 1 mmHg in baseline IOP. Type of surgery was not statistically significant after adjusting for baseline IOP, age, baseline number of glaucoma medications and type of glaucoma. Conclusion: Patients with higher baseline IOP are expected to have a greater IOP reduction

Fat storage-inducing transmembrane (FIT or FITM) proteins are related to lipid phosphatase/phosphotransferase enzymes

Fat storage-inducing transmembrane (FIT or FITM) proteins have been implicated in the partitioning of triacylglycerol to lipid droplets and the budding of lipid droplets from the ER. At the molecular level, the sole relevant interaction is that FITMs directly bind to triacyglycerol and diacylglycerol, but how they function at the molecular level is not known.Saccharomyces cerevisiaehas two FITM homologues: Scs3p and Yft2p. Scs3p was initially identified because deletion leads to inositol auxotrophy, with an unusual sensitivity to addition of choline. This strongly suggests a role for Scs3p in phospholipid biosynthesis. Looking at the FITM family as widely as possible, we found that FITMs are widespread throughout eukaryotes, indicating presence in the last eukaryotic common ancestor. Protein alignments also showed that FITM sequences contain the active site of lipid phosphatase/phosphotransferase (LPT) enzymes. This large family transfers phosphate-containing headgroups either between lipids or in exchange for water. We confirmed the prediction that FITMs are related to LPTs by showing that single amino-acid substitutions in the presumptive catalytic site prevented their ability to rescue growth of the mutants on low inositol/high choline media when over-expressed. The substitutions also prevented rescue of other phenotypes associated with loss of FITM in yeast, including mistargeting of Opi1p, defective ER morphology, and aberrant lipid droplet budding. These results suggest that Scs3p, Yft2p and FITMs in general are LPT enzymes involved in an as yet unknown critical step in phospholipid metabolism

Isotopic and Petrologic Investigation, and a Thermomechanical Model of Genesis of Large-Volume Rhyolites in Arc Environments: Karymshina Volcanic Complex, Kamchatka, Russia

The Kamchatka Peninsula of eastern Russia is currently one of the most volcanically active areas on Earth where a combination of >8 cm/yr subduction convergence rate and thick continental crust generates large silicic magma chambers, reflected by abundant large calderas and caldera complexes. This study examines the largest center of silicic 4-0.5 Ma Karymshina Volcanic Complex, which includes the 25 × 15 km Karymshina caldera, the largest in Kamchatka. A series of rhyolitic tuff eruptions at 4 Ma were followed by the main eruption at 1.78 Ma and produced an estimated 800 km3 of rhyolitic ignimbrites followed by high-silica rhyolitic post-caldera extrusions. The postcaldera domes trace the 1.78 Ma right fracture and form a continuous compositional series with ignimbrites. We here present results of a geologic, petrologic, and isotopic study of the Karymshina eruptive complex, and present new Ar-Ar ages, and isotopic values of rocks for the oldest pre- 1.78 Ma caldera ignimbrites and intrusions, which include a diversity of compositions from basalts to rhyolites. Temporal trends in δ18O, 87Sr/86Sr, and 144Nd/143Nd indicate values comparable to neighboring volcanoes, increase in homogeneity, and temporal increase in mantle-derived Sr and Nd with increasing differentiation over the last 4 million years. Data are consistent with a batholithic scale magma chamber formed by primarily fractional crystallization of mantle derived composition and assimilation of Cretaceous and younger crust, driven by basaltic volcanism and mantle delaminations. All rocks have 35–45% quartz, plagioclase, biotite, and amphibole phenocrysts. Rhyolite-MELTS crystallization models favor shallow (2 kbar) differentiation conditions and varying quantities of assimilated amphibolite partial melt and hydrothermally-altered silicic rock. Thermomechanical modeling with a typical 0.001 km3/yr eruption rate of hydrous basalt into a 38 km Kamchatkan arc crust produces two magma bodies, one near the Moho and the other engulfing the entire section of upper crust. Rising basalts are trapped in the lower portion of an upper crustal magma body, which exists in a partially molten to solid state. Differentiation products of basalt periodically mix with the resident magma diluting its crustal isotopic signatures. At the end of the magmatism crust is thickened by 8 km. Thermomechanical modeling show that the most likely way to generate large spikes of rhyolitic magmatism is through delamination of cumulates and mantle lithosphere after many millions of years of crustal thickening. The paper also presents a chemical dataset for Pacific ashes from ODDP 882 and 883 and compares them to Karymshina ignimbrites and two other Pleistocene calderas studied by us in earlier works