Initial experience using a femtosecond laser cataract surgery system at a UK National Health Service cataract surgery day care centre

© 2019 The Author(s). This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/OBJECTIVES: To describe the initial outcomes following installation of a cataract surgery laser system.SETTING: National Health Service cataract surgery day care unit in North London, UK.PARTICIPANTS: 158 eyes of 150 patients undergoing laser-assisted cataract surgery.INTERVENTIONS: Laser cataract surgery using the AMO Catalys femtosecond laser platform.PRIMARY AND SECONDARY OUTCOME MEASURES: PRIMARY OUTCOME MEASURE: intraoperative complications including anterior and posterior capsule tears.SECONDARY OUTCOME MEASURES: docking to the laser platform, successful treatment delivery, postoperative visual acuities.RESULTS: Mean case age was 67.7±10.8 years (range 29-88 years). Docking was successful in 94% (148/158 cases), and in 4% (6/148 cases) of these, the laser delivery was aborted part way during delivery due to patient movement. A total of 32 surgeons, of grades from junior trainee to consultant, performed the surgeries. Median case number per surgeon was 3 (range from 1-20). The anterior capsulotomy was complete in 99.3% of cases, there were no anterior capsule tears (0%). There were 3 cases with posterior capsule rupture requiring anterior vitrectomy, and 1 with zonular dialysis requiring anterior vitrectomy (4/148 eyes, 2.7%). These 4 cases were performed by trainee surgeons, and were either their first laser cataract surgery (2 surgeons) or their first and second laser cataract surgeries (1 surgeon).CONCLUSIONS: Despite the learning curve, docking and laser delivery were successfully performed in almost all cases, and surgical complication rates and visual outcomes were similar to those expected based on national data. Complications were predominately confined to trainee surgeons, and with the exception of intraoperative pupil constriction appeared unrelated to the laser-performed steps.Peer reviewe

Switchgrass storage effects on the recovery of carbohydrates after liquid hot water pretreatment and enzymatic hydrolysis

Perennial grasses that would be used for bioenergy and bioproducts production will need to be stored for various periods of time to ensure a continual feedstock supply to a bioprocessing facility. The effects of storage practices on grass composition and the response of grasses to subsequent bioprocesses such as pretreatment and enzymatic hydrolysis needs to be understood to develop the most efficient storage protocols. This study examined the effect of outdoor storage of round switchgrass bales on composition before and after liquid hot water pretreatment (LHW) and enzymatic hydrolysis. This study also examined the effect of washing LHW pretreated biomass prior to enzymatic hydrolysis. It was determined that switchgrass composition after baling was stable. As expected, glucan and lignin contents increased after LHW due to decreases in xylan and galactan. Washing biomass prior to enzymatic hydrolysis reduced saccharification, especially in samples from the interior of the bale, by at least 5%

Biological Systems Engineering

The present work studied the optimization of aeration rate, agitation rate and oxygen transfer and the use of various batch fermentation strategies for xylanase production from a recombinant Aspergillus nidulans strain in a 3 L stirred tank reactor. Maximum xylanase production of 1250 U/mL with productivity of 313 U/mL/day was obtained under an aeration rate of 2 vvm and an agitation rate of 400 rpm using batch fermentation. The optimum volumetric oxygen transfer coefficient (kLa) for efficient xylanase production was found to be 38.6 h1. Fed batch mode and repeated batch fermentation was also performed with kLa was 38.6 h1. Xylanase enzyme productivity increased to 327 with fed batch fermentation and 373 U/mL/ day with repeated batch fermentation. Also, maximum xylanase activity increased to 1410 U/mL with fed batch fermentation and 1572 U/mL with repeated batch fermentation

Platinum(II) phosphonate complexes derived from endo-8-camphanylphosphonic acid

The reactions of cis-[PtCl₂L₂] [L = PPh₃, PMe₂Ph or L₂ = Ph₂P(CH₂)₂PPh₂ (dppe)] with endo-8-camphanylphosphonic acid (CamPO₃H₂) and Ag₂O in refluxing dichloromethane gave platinum(II) phosphonate complexes [Pt(O₃PCam)L₂]. The X-ray crystal structure of [Pt(O₃PCam)(PPh₃)₂]•₂CHCl₃ shows that the bulky camphanyl group, rather than being directed away from the platinum, is instead directed into a pocket formed by the Pt and the two PPh₃ ligands. This allows the O₃P–CH₂ group to have a preferred staggered conformation. The complexes were studied in detail by NMR spectroscopy, which demonstrates non-fluxional behaviour for the sterically bulky PPh₃ and dppe derivatives, which contain inequivalent phosphine ligands in their ³¹P NMR spectra. These findings are backed up by theoretical calculations on the PPh₃ and PPhMe₂ derivatives, which show, respectively, high and low energy barriers to rotation of the camphanyl group in the PPh₃ and PPhMe₂ complexes. The X-ray crystal structure of CamPO₃H₂ is also reported, and consists of hydrogen-bonded hexameric aggregates, which assemble to form a columnar structure containing hydrophilic phosphonic acid channels surrounded by a sheath of bulky, hydrophobic camphanyl groups

Corn Fiber as a Biomass Feedstock for Production of Succinic Acid

The selection of an economical carbon source is a fundamental parameter to establish a successful industrial succinic acid (SA) bioprocess. In this work, corn fiber (CF), a renewable and an inexpensive source of carbohydrates, was successfully used for bioproduction of SA. Optimized liquid hot water (LHW) pretreatment followed by enzymatic hydrolysis were used to obtain corn fiber hydrolysate (CFH). Results in batch fermentation with Actinobacillus succinogenes showed that a control solution mimicking CFH produced 28.7 g/L of SA with a yield of 0.67 g SA/g sugars, while fermentation of CFH produced 27.8 g/L of SA with a yield of 0.61 g SA/g sugars. It was found that culture pH was a critical factor affecting SA production. In sodium acetate buffered media, SA was the major end-product with lower levels of acetic acid (AA) and formic acid (FA). When unbuffered media was used, lactic acid (LA) and ethanol were also detected

Comparative analyses of Campylobacter concisusstrains reveal the genome of the reference strain BAA-1457 is not representative of the species

<p>Abstract</p> <p>Background</p> <p>Several studies have shown that significant genotypic heterogeneity exists among <it>Campylobacter concisus </it>strains. Recently, the genome of <it>C. concisus </it>UNSWCD, isolated from a patient with Crohn's disease, was sequenced.</p> <p>Results</p> <p>In this study, comparative analyses were performed between strain UNSWCD and BAA-1457, isolated from a patient with acute gastroenteritis. Searches between <it>C. concisus </it>UNSWCD and BAA-1457 showed that 76% of genes were homologues, whereas those between <it>C. jejuni </it>strains showed 90-91% to be homologues, indicating substantial variation exists within these two <it>C. concisus </it>genomes. More specific bidirectional homology searches identified 1593 genes that are shared between these strains, and 115 and 281 genes unique to UNSWCD and BAA-1457, respectively. Significantly, differences in the type of flagellin glycosylation pathways between the two strains were identified and confirmed by PCR. The protein profiles of UNSWCD, BAA-1457 and a further six strains of <it>C. concisus </it>were compared and analyzed bioinformatically, and this differentiated the strains into four clades. BAA-1457 was found to be highly divergent (average similarity: 56.8%) from the other seven strains (mean average similarity ± standard deviation: 64.7 ± 1.7%). Furthermore, searches for homologues of the 1593 proteins found to be common between UNSWCD and BAA-1457 were conducted against all available bacterial genomes, and 18 proteins were found to be unique to <it>C. concisus</it>, of which 6 were predicted to be secreted, and may represent good markers for detection of this species.</p> <p>Conclusions</p> <p>This study has elucidated several features that may be responsible for the heterogeneity that exists among <it>C. concisus </it>strains, and has determined that the strain BAA-1457 is genetically atypical to other <it>C. concisus </it>strains and is not a good candidate reference strain.</p

Heterologous expression and functional characterization of a GH10 endoxylanase from \u3ci\u3eAspergillus fumigatus\u3c/i\u3e var. \u3ci\u3eniveus\u3c/i\u3e with potential biotechnological application

Xylanases decrease the xylan content in pretreated biomass releasing it from hemicellulose, thus improving the accessibility of cellulose for cellulases. In this work, an endo-β-1,4-xylanase from Aspergillus fumigatus var. niveus (AFUMN-GH10) was successfully expressed. The structural analysis and biochemical characterization showed this AFUMN-GH10 does not contain a carbohydrate-binding module. The enzyme retained its activity in a pH range from 4.5 to 7.0, with an optimal temperature at 60°C. AFUMN-GH10 showed the highest activity in beechwood xylan. The mode of action of AFUMNGH10 was investigated by hydrolysis of APTS-labeled xylohexaose, which resulted in xylotriose and xylobiose as the main products. AFUMN-GH10 released 27% of residual xylan from hydrothermally-pretreated corn stover and 14% of residual xylan from hydrothermally-pretreated sugarcane bagasse. The results showed that environmentally friendly pretreatment followed by enzymatic hydrolysis with AFUMN-GH10 in low concentration is a suitable method to remove part of residual and recalcitrant hemicellulose from biomass

Association of 6-Minute Walk Performance and Physical Activity With Incident Ischemic Heart Disease Events and Stroke in Peripheral Artery Disease.

BackgroundWe determined whether poorer 6-minute walk performance and lower physical activity levels are associated with higher rates of ischemic heart disease (IHD) events in people with lower extremity peripheral artery disease (PAD).Methods and resultsFive hundred ten PAD participants were identified from Chicago-area medical centers and followed prospectively for 19.0±9.5 months. At baseline, participants completed the 6-minute walk and reported number of blocks walked during the past week (physical activity). IHD events were systematically adjudicated and consisted of new myocardial infarction, unstable angina, and cardiac death. For 6-minute walk, IHD event rates were 25/170 (14.7%) for the third (poorest) tertile, 10/171 (5.8%%) for the second tertile, and 6/169 (3.5%) for the first (best) tertile (P=0.003). For physical activity, IHD event rates were 21/154 (13.6%) for the third (poorest) tertile, 15/174 (8.6%) for the second tertile, and 5/182 (2.7%) for the first (best) tertile (P=0.001). Adjusting for age, sex, race, smoking, body mass index, comorbidities, and physical activity, participants in the poorest 6-minute walk tertile had a 3.28-fold (95% CI 1.17 to 9.17, P=0.024) higher hazard for IHD events, compared with those in the best tertile. Adjusting for confounders including 6-minute walk, participants in the poorest physical activity tertile had a 3.72-fold (95% CI 1.24 to 11.19, P=0.019) higher hazard for IHD events, compared with the highest tertile.ConclusionsSix-minute walk and physical activity predict IHD event rates in PAD. Further study is needed to determine whether interventions that improve 6-minute walk, physical activity, or both can reduce IHD events in PAD

No Evidence for Lyman-alpha Emission in Spectroscopy of z > 7 Candidate Galaxies

We present Gemini/GNIRS spectroscopic observations of 4 z-band (z~7) dropout galaxies and VLT/XSHOOTER observations of one z-band dropout and 3 Y-band (z~8-9) dropout galaxies in the Hubble Ultra Deep Field, which were selected with Wide Field Camera 3 imaging on the Hubble Space Telescope. We find no evidence of Lyman-alpha emission with a typical 5-sigma sensitivity of 5X10^-18erg/cm^2/s, and we use the upper limits on Lyman-alpha flux and the broad-band magnitudes to constrain the rest-frame equivalent widths for this line emission. Accounting for incomplete spectral coverage, we survey 3.0 z-band dropouts and 2.9 Y-band dropouts to a Lyman-alpha rest-frame equivalent width limit > 120Ang (for an unresolved emission line); for an equivalent width limit of 50Ang the effective numbers of drop-outs surveyed fall to 1.2 z-band drop-outs and 1.5 Y-band drop-outs. A simple model where the fraction of high rest-frame equivalent width emitters follows the trend seen at z=3-6.5 is inconsistent with our non-detections at z=7-9 at the ~ 1-sigma level for spectrally unresolved lines, which may indicate that a significant neutral HI fraction in the intergalactic medium suppresses the Lyman-alpha line in z-drop and Y-drop galaxies at z > 7.Comment: Accepted for publication in MNRA

Randomised, single-masked non-inferiority trial of femtosecond laser-assisted versus manual phacoemulsification cataract surgery for adults with visually significant cataract : the FACT trial protocol

The study is supported by a grant from the National Institute for Health (NIHR) Health and Technologies Assessment (HTA) programme (reference 13/04/46). The corneal endothelial cell counter used at the Moorfields St Ann's Hospital site was purchased by a grant from the Special Trustees of Moorfields Eye Hospital (reference ST1503D).Introduction Cataract is one of the leading causes of low vision in the westernised world, and cataract surgery is one of the most commonly performed operations. Laser platforms for cataract surgery are now available, the anticipated advantages of which are broad and may include better visual outcomes through greater precision and reproducibility, and improved safety. FACT is a randomised single masked non-inferiority trial to establish whether laser-assisted cataract surgery is as good as or better than standard manual phacoemulsification. Methods and analysis 808 patients aged 18 years and over with visually significant cataract will be randomised to manual phacoemulsification cataract surgery (standard care) or laser-assisted cataract surgery (intervention arm). Outcomes will be measured at 3 and 12 months after surgery. The primary clinical outcome is uncorrected distance visual acuity (UDVA, logMAR) at 3 months in the study eye recorded by an observer masked to the trial group. Secondary outcomes include UDVA at 12 months, corrected distance visual acuity at 3 and 12 months, complications, endothelial cell loss, patient-reported outcome measures and a health economic analysis conforming to National Institute for Health and Care Excellence standards. Ethics and dissemination Research Ethics Committee Approval was obtained on 6 February 2015, ref: 14/LO/1937. Current protocol: v2.0 (08/04/2015). Study findings will be published in peer-reviewed journals. Trial registration number: ISRCTN: 77602616.Publisher PDFPeer reviewe