CT and MRI findings of acute calculous cholecystitis and its complications in Singapore: A pictorial review.

INTRODUCTION: Acute cholecystitis (AC) is a common problem encountered in surgical practice. This occurs due to obstruction of the cystic duct by calculi resulting in inflammation of the gallbladder. Increasingly, contrast enhanced computed tomography (CECT) and Magnetic Resonance Imaging (MRI) scans are being used for assessment. While the imaging features of AC are well recognized and extensively described in the literature, radiological features of the rarer complications related to AC such as pseudoaneurysm formation and gallbladder volvulus are less well known. We aim to describe these rarer findings in our pictorial review, to better educate the clinician and radiologist, such that timely diagnoses can be reached, and relevant management can be affected. METHODS: A collection of cases showing the common acute gallbladder pathologies and complications such as acute cholecystitis, gangrenous cholecystitis, emphysematous cholecystitis, haemorrhagic cholecystitis, Mirizzi's syndrome, gallbladder perforation and abscess formation, were collected between July 2016 and March 2018 at two different medical institutions in Singapore. In addition, rarer cases of gallbladder volvulus and vascular complications such as cystic artery pseudoaneurysms and vessel erosions, were also followed up. RESULTS: The CT and MRI imaging features of these conditions were discussed, with key diagnostic imaging features emphasized. CONCLUSION: Acute gallbladder pathologies are commonly encountered in day-to-day radiology practice. Knowledge of the rarer gallbladder pathologies and their key imaging features will help the radiologist, in particular, the on call radiologist in training, improve diagnostic accuracy and allow for timely management.

Dialysis disequilibrium syndrome: A preventable fatal acute complication.

Dialysis disequilibrium syndrome (DDS) is a neurological disorder with varying severity that is postulated to be associated with cerebral oedema. We described a case of DDS resulting in irreversible brain injury and death following acute haemodialysis. A 13-year-old male with no past medical history and weighing 30kg, presented to hospital with severe urosepsis complicated by acute kidney injury (Creatinine 1422mmol/L; Urea 74.2mmol/L, Potassium 6.3mmol/L, Sodium 137mmol/L) and severe metabolic acidosis (pH 6.99, HC03 1.7mmol/L). Chest radiograph was normal. Elective intubation was done for respiratory distress. Acute haemodialysis performed due to refractory metabolic acidosis. Following haemodialysis, he became hypotensive which required inotropes. His Riker's score was low with absence of brainstem reflexes after withholding sedation. CT Brain showed generalised cerebral oedema consistent with global hypoxic changes involving the brainstem. The symptoms of DDS are caused by water movement into the brain causing cerebral oedema. Two theories have been proposed: reverse osmotic shift induced by urea removal and a fall in cerebral intracellular pH. Prevention is the key to the management of DDS. It is important to identify high risk patients and haemodialysis with reduced dialysis efficacy and gradual urea reduction is recommended. Patients who are vulnerable to DDS should be monitored closely. Low efficiency haemodialysis is recommended. Acute peritoneal dialysis might be an alternative option, but further studies are needed.

L-arginine promotes gut hormone release and reduces food intake in rodents.

AIMS: To investigate the anorectic effect of L-arginine (L-Arg) in rodents. METHODS: We investigated the effects of L-Arg on food intake, and the role of the anorectic gut hormones glucagon-like peptide-1 (GLP-1) and peptide YY (PYY), the G-protein-coupled receptor family C group 6 member A (GPRC6A) and the vagus nerve in mediating these effects in rodents. RESULTS: Oral gavage of L-Arg reduced food intake in rodents, and chronically reduced cumulative food intake in diet-induced obese mice. Lack of the GPRC6A in mice and subdiaphragmatic vagal deafferentation in rats did not influence these anorectic effects. L-Arg stimulated GLP-1 and PYY release in vitro and in vivo. Pharmacological blockade of GLP-1 and PYY receptors did not influence the anorectic effect of L-Arg. L-Arg-mediated PYY release modulated net ion transport across the gut mucosa. Intracerebroventricular (i.c.v.) and intraperitoneal (i.p.) administration of L-Arg suppressed food intake in rats. CONCLUSIONS: L-Arg reduced food intake and stimulated gut hormone release in rodents. The anorectic effect of L-Arg is unlikely to be mediated by GLP-1 and PYY, does not require GPRC6A signalling and is not mediated via the vagus. I.c.v. and i.p. administration of L-Arg suppressed food intake in rats, suggesting that L-Arg may act on the brain to influence food intake. Further work is required to determine the mechanisms by which L-Arg suppresses food intake and its utility in the treatment of obesity.

1-Year clinical outcomes of diabeticpatients treated with everolimus-elutingbioresorbable vascular scaffolds: a pooled analysis of the ABSORB and the SPIRIT trials

Objectives The aim of this study was to evaluate 1-year clinical outcomes of diabetic patients treatedwith the Absorb bioresorbable vascular scaffold (BVS).Background Clinical outcomes of diabetic patients after BVS implantation have been unreported.Methods This study included 101 patients in the ABSORB Cohort B trial and the first consecutive 450patients with 1 year of follow-up in the ABSORB EXTEND trial. A total of 136 diabetic patients werecompared with 415 nondiabetic patients. In addition, 882 diabetic patients treated with everolimuselutingmetal stents (EES) in pooled data from the SPIRIT trials (SPIRIT FIRST [Clinical Trial of the AbbottVascular XIENCE V Everolimus Eluting Coronary Stent System], SPIRIT II [A Clinical Evaluation of the XIENCEV Everolimus Eluting Coronary Stent System], SPIRIT III [Clinical Trial of the XIENCE V Everolimus ElutingCoronary Stent System (EECSS)], SPIRIT IV Clinical Trial [Clinical Evaluation of the XIENCE V EverolimusEluting Coronary Stent System]) were used for the comparison by applying propensity score matching.The primary endpoint was a device-oriented composite endpoint (DoCE), including cardiac death, targetvessel myocardial infarction, and target lesion revascularization at 1-year follow-up.Results The cumulative incidence of DoCE did not differ between diabetic and nondiabetic patientstreated with the BVS (3.7% vs. 5.1%, p » 0.64). Diabetic patients treated with the BVS had a similarincidence of the DoCE compared with diabetic patients treated with EES in the matched study group(3.9% for the BVS vs. 6.4% for EES, p » 0.38). There were no differences in the incidence of definite orprobable scaffold/stent thrombosis (0.7% for both diabetic and nondiabetic patients with the BVS; 1.0%for diabetic patients with the BVS vs. 1.7% for diabetic patients with EES in the matched study group).Conclusions In the present analyses, diabetic patients treated with the BVS showed...

Characteristic corrosion resistance of nanocrystalline TiN films prepared by high density plasma reactive magnetron sputtering.

Nanocytalline TiN films were deposited on non-alkali glass and Al substrates by reactive DC magnetron sputtering (DCMS) with an electromagnetic field system (EMF). The microstructure and corrosion resistance of the TiN-coated Al substrates were estimated by X-ray diffraction (XRD), scanning electron microscopy (SEM) and electrochemical methods. All the TiN films shows that they have a (111) preferred orientation at room temperature. TiN films deposited on Al substrate using only DCMS 400 W showed a sheet resistance of 3.22 x 10-1 omega/symbol see texts (resistivity, 3.22 x 10-5 omegacm). On the other hand, a relatively low sheet resistance of 1.91 x 10-1 omega/symbol see text (1.91 x 10-5 omegacm) was obtained for the dense nanocrystalline TiN film deposited on Al substrate using DCMS 375 W+ EMF 25 W, indicating that the introduction of an EMF system enhanced the electrical properties of the TiN film. TiN films deposited on Al substrate at 400 degreesC had a (200) preferred orientation with the lowest sheet resistance of 1.28x10-1 omega/symbol see texts (1.28 x 10-5 omegacm) which was attributed to reduced nano size defects and an improvement of the crystallinity. Potentiostatic and Potentiodynamic tests with a TiN-coated Al showed good corrosion resistance (l/corr, = 2.03 microA/cm2, Ecorr = -348 mV) compared to the uncoated Al substrate (/corr = 4.45 microA/cm2, Ecorr = -650 mV). Furthermore, EMF system showed that corrosion resistance of the TiN film also was enhanced compared to DCMS only. For the TiN film deposited on Al substrate at 400 degreesC, corrosion current and potential was 0.63 micro/cm2 and -1.5 mV, respectively. This improved corrosion resistance of the TiN film could be attributed to the densification of the film caused by enhancement of nitrification with increasing high reactive nitrogen radicals.

Guidelines for management of androgenetic alopecia based on BASP classification--the Asian Consensus Committee guideline.

BACKGROUND: Androgenetic alopecia (AGA), or pattern hair loss, is a common disorder in both Asian men and women. There are several guidelines for the treatment of AGA which are suitable for Caucasian patients; however, each of these has some limitations. Furthermore, in comparison with Caucasian patients, Asian patients with AGA have different types of hair loss and family histories which may alter the treatment response. There is currently no published AGA guideline for Asian patients. OBJECTIVES: The Asian Consensus Committee for Androgenetic Alopecia aimed to develop an algorithmic guideline, based on the basic and specific (BASP) classification, for the treatment of AGA especially in Asian patients. METHODS: The committee collaborated extensively on reviewing available literature on AGA treatment in order to formulate an algorithmic guideline on AGA management. RESULTS: Previously published guidelines based on pre-existing classifications of AGA cannot easily classify the patterns of AGA that are more frequently seen in Asians. The BASP classification not only facilitates the development of a unified and simplified algorithm, but also overcomes the disadvantages of previously reported classification systems. CONCLUSIONS: The proposed treatment guideline for AGA based on the BASP classification may be useful for dermatologists in their approach to treating Asian patients with AGA in clinical practice. Ideally, clinicians should try to utilize this guideline consistently in their practice to monitor treatment response with the goal of enhancing successful outcomes. This will help boost patients' confidence and self-esteem, thus improving patient' compliance with the prescribed treatments.

Accuracy of preoperative CT for local staging in colorectal carcinomas.

INTRODUCTION: This study aimed to determine the accuracy of computed tomography (CT) in the evaluation of local tumour invasion and regional lymphadenopathy in colorectal carcinomas. METHODS: A total of 99 consecutive patients who had undergone a contrast-enhanced CT within two weeks prior to surgery with histopathological confirmation of colorectal carcinoma were selected. Intravenous contrast-enhanced CT was performed with a 5-7 mm collimation. Axial images were retrospectively and independently reviewed by two radiologists (R1 and R2) who were blinded to the surgical findings and histopathology. The readers assessed the primary tumour according to modified CT staging criteria. The radiological assessment was then compared with the surgical findings and histopathology for accuracy and inter-observer agreement. RESULTS: At histopathology, the T-stage of the tumours was T2 in five, T3 in 62 and T4 in 32 patients, and the N-stage was N0 in 36, N1 in 28 and N2 in 35 patients. The accuracy of CT for T-stage and N-stage for the two readers was 45.5 percent and 60.6 percent (kappa is 0.30) and 33.3 percent and 45.4 percent (kappa is 0.23), respectively. The understaging and overstaging by R1 and R2 was 40.4 percent, 21.2 percent and 14.1 percent, 17.2 percent for T-stage and 22.2 percent, 37.4 percent and 32.3 percent, 28.3 percent for N-stage. The accuracy of serosal invasion for R1 and R2 (tumour perforates the visceral peritoneum or directly involves the adjacent organs) was 63.6 percent and 66.7 percent (kappa is 0.51), respectively. The understaging and overstaging by R1 and R2 for serosal invasion was 24.1 percent, 12.1 percent and 20.1 percent, 12.1 percent, respectively. CONCLUSION: Our study results show that the accuracy for CT staging of colorectal carcinomas for T-stage and in particular, serosal invasion, is moderate, but it is relatively low for N-stage.

Hand-assisted laparoscopic abdomino-perineal resection utilizing the planned end colostomy site.

BACKGROUND: Aim of the study was to determine the feasibility and outcomes of utilizing the planned end colostomy site for placing the hand-assist device in performing hand-assisted laparoscopic abdominoperineal resections (HAL APR) in patients with low rectal cancer. METHODS: Patients with low rectal cancers not suitable for a sphincter salvage proctectomy were recruited. HAL APR was performed by placing the hand-assist device over the planned colostomy site. Standard total mesorectal excision (TME) was performed, and the specimen was delivered via the perineal incision. Patient data and perioperative variables were obtained from the institution colorectal cancer database and analyzed. RESULTS: Six patients underwent HAL APR from November 2004 to January 2006. Mean operative time was 213 min with no conversions or intraoperative complications. One patient developed post-operative ileus which resolved spontaneously. There were no other morbidities or mortalities. Mean hospitalization was 6.8 days. After a mean follow-up of 13.3 months, one patient developed a parastomal hernia which was subsequently repaired during liver resection for liver metastases. No other long-term complications occurred. CONCLUSION: HAL APR with the hand device placed at the planned stoma site is technically feasible. Without creating an additional incision, the operation is oncologically comparable and renders similar short-term outcomes as SL methods, maintaining the benefits of a minimally invasive approach.

Molecular dynamics simulation of ZnO nanowires: size effects, defects, and super ductility.

Molecular dynamics simulations of ZnO nanowires under tensile loading were performed and compared with simulations of TiO(2) wires to present size-dependent mechanical properties and super ductility of metal oxide wires. It is shown that while large surface-to-volume ratio is responsible for their size effects, ZnO and TiO(2) wires displayed opposite trends. Although the stiffness of both wires converged monotonically to their bulk stiffness values as diameter increases, bulk stiffness represented the upper bound for ZnO nanowires as opposed to the lower bound for TiO(2) wires. ZnO nanowires relaxed to either completely amorphous or completely crystalline states depending on wire thickness, whereas a thin amorphous shell is always present in TiO(2) nanowires. It was also found that when crystalline ZnO nanowires are stretched, necking initiated at localized amorphous regions to eventually form single-atom chains which can sustain strains above 100%. Such large elongations are not observed in TiO(2) nanowires. Using the analogy of a clothesline, an explanation is offered for the necessary conditions leading to super ductility.

Numerical investigations into the tensile behavior of TiO(2) nanowires: structural deformation, mechanical properties, and size effects.

The mechanisms governing the tensile behavior of TiO(2) nanowires were studied by molecular dynamics simulations. Nanowires below a threshold diameter of about 10 A transformed into a completely disordered structure after thermodynamic equilibration, whereas thicker nanowires retained their crystalline core. Initial elastic tensile deformation was effected by the reconfiguration of surface atoms while larger elongations resulted in continuous cycles of Ti-O bond straightening, bond breakage, inner atomic distortion, and necking until rupture. Nanowires have much better mechanical properties than bulk TiO(2). Nanowires below the threshold diameter exhibit extraordinarily high stiffness and toughness and are more sensitive to strain rate.

Hand-assisted laparoscopic colectomy versus standard laparoscopic colectomy: a cost analysis.

OBJECTIVE: There is a relative dearth of literature comparing hand-assisted (HALC) to standard (SLC) laparoscopic colectomies. HALC seems beneficial in terms of shorter operative times and lower conversion rates, but this is counterbalanced by a greater inflammatory response, larger incisions and higher direct costs. Nevertheless, these results are not consistent throughout existing studies and there are to date no detailed cost comparisons. Our hypothesis was that HALC would not incur significantly higher institutional costs compared with standard laparoscopic techniques. METHOD: Patients undergoing either SLC or HALC between August 2004 and September 2006 were retrospectively reviewed. All patients were managed using a standard protocol. Outcomes assessed included operative times, conversion rates, pain scores, time to resolution of ileus, length of stay and complications. Total costs were calculated from the day of surgery. Statistical analyses included chi(2), Fisher's exact test, the Mann-Whitney U-test or nonparametric bootstrapping method. RESULTS: Seventy-three patients underwent SLC while 101 had HALC. Demographics and indications for surgery in both groups were similar; the majority were performed for colorectal cancers. Operative times were shorter (147.5 vs 172.5 min, P < 0.05) and complication rates lower (28.7%vs 45.2%, P < 0.025) for HALC. There was no significant difference in the other clinical outcomes. Operative costs and cost of consumables were higher for HALC (US$4024.2 vs US$3568.1, P = 0.01 and US$1724.7 vs US$1302.7, P < 0.001, respectively). However, total costs were not significantly different (HALC US$8999.8, SLC US$7910.7, P = 0.11). CONCLUSION: Institutional costs are not significantly higher for HALC compared with SLC.

The academic environment: the students' perspective.

Dental education is regarded as a complex, demanding and often stressful pedagogical procedure. Undergraduates, while enrolled in programmes of 4-6 years duration, are required to attain a unique and diverse collection of competences. Despite the major differences in educational systems, philosophies, methods and resources available worldwide, dental students' views regarding their education appear to be relatively convergent. This paper summarizes dental students' standpoint of their studies, showcases their experiences in different educational settings and discusses the characteristics of a positive academic environment. It is a consensus opinion that the 'students' perspective' should be taken into consideration in all discussions and decisions regarding dental education. Moreover, it is suggested that the set of recommendations proposed can improve students' quality of life and well-being, enhance their total educational experience and positively influence their future careers as oral health physicians. The 'ideal' academic environment may be defined as one that best prepares students for their future professional life and contributes towards their personal development, psychosomatic and social well-being. A number of diverse factors significantly influence the way students perceive and experience their education. These range from 'class size', 'leisure time' and 'assessment procedures' to 'relations with peers and faculty', 'ethical climate' and 'extra-curricular opportunities'. Research has revealed that stress symptoms, including psychological and psychosomatic manifestations, are prevalent among dental students. Apparently some stressors are inherent in dental studies. Nevertheless, suggested strategies and preventive interventions can reduce or eliminate many sources of stress and appropriate support services should be readily available. A key point for the Working Group has been the discrimination between 'teaching' and 'learning'. It is suggested that the educational content should be made available to students through a variety of methods, because individual learning styles and preferences vary considerably. Regardless of the educational philosophy adopted, students should be placed at the centre of the process. Moreover, it is critical that they are encouraged to take responsibility for their own learning. Other improvements suggested include increased formative assessment and self-assessment opportunities, reflective portfolios, collaborative learning, familiarization with and increased implementation of information and communication technology applications, early clinical exposure, greater emphasis on qualitative criteria in clinical education, community placements, and other extracurricular experiences such as international exchanges and awareness of minority and global health issues. The establishment of a global network in dental education is firmly supported but to be effective it will need active student representation and involvement.

An evaluation of the value of group education in recently diagnosed diabetes mellitus.

Diabetic patients have a 12% to 25% lifetime risk of developing foot complications leading to significant morbidity and mortality. The objective of this study was to assess the effectiveness of group education in improving patient awareness of foot care. The authors evaluated the effect of group size and areas in which knowledge seemed to be most affected. Patients attending a 2-hour teaching session between November 2005 and March 2006 were recruited. Patients filled in an 18-part questionnaire before and after the teaching session to assess knowledge. Fifty-nine patients recently diagnosed with diabetes mellitus or foot complications were recruited for 7 sessions. Analysis of the data showed a statistically significant improvement in foot care knowledge after the teaching session compared with before (69% to 85%, P < .001). Patients in the smaller group (n < 10) had significantly higher scores compared with the bigger groups (n > 10; P < .025). These data show the benefit of group education about foot care for patients with diabetes. Smaller groups benefited more than larger ones did, which could be attributed to the sizes allowing for better interaction between the tutor and patient. As patient knowledge is variable from individual to individual, smaller teaching sessions may allow patients to address specific concerns.

Diffuse sclerosing variant of papillary carcinoma of the thyroid: ultrasound features with histopathological correlation.

AIM: To evaluate the ultrasound (US) features of the diffuse sclerosing variant of papillary carcinoma (DSVPC) of the thyroid, with histopathological correlations. MATERIALS AND METHODS: The US and histopathological findings of six patients with surgically proven DSVPC of the thyroid were retrospectively assessed. RESULTS: Most of cases showed diffuse, scattered microcalcifications with or without associated masses and underlying heterogeneous hypoechogenicity at the site of the DSVPC in the thyroid. At ultrasound, scattered microcalcifications and heterogeneous hypoechogenicity seen in the DSVPC correlated to psammoma bodies and lymphocytic infiltration at histopathological review. CONCLUSION: DSVPC of the thyroid usually manifested as diffuse scattered microcalcifications and associated suspicious mass on ultrasound. These findings are not specific for the DSVPC of the thyroid. However, in relatively young patients with suspicious masses associated with underlying diffuse scattered microcalcifications on US, the possibility of DSVPC should be included in differential diagnosis.

Design and fabrication of a double-axicon for generation of tailorable self-imaged three-dimensional intensity voids.

We propose a new design for fabrication of a highly power-efficient double axicon to generate self-imaged three-dimensional intensity voids along the propagation of a beam. The conventional conical structure of an axicon is modified and shaped like an axiconlike structure with a double-gradient surface profile. The gradient conical surfaces generate Bessel beams with varying radial wave vectors that are superimposed and interfere to generate a sequence of three-dimensional intensity voids. The proposed element was fabricated using electron-beam lithography, and experimental verification of the design is reported.

High-power efficient multiple optical vortices in a single beam generated by a kinoform-type spiral phase plate.

We propose using a solitary kinoform-type spiral phase plate structure to generate an array of vortices located in a single beam. Kinoform-type spiral surfaces allow each wavelength component of the phase modulation value to be wrapped back to its 2 pi equivalent for optical vortices of high charge. This allows the surface-relief profiles of high-charge vortices to be microfabricated with the same physical height as spiral phase plates of unity-charged optical vortices. The m-charged optical vortex obtained interacts with the inherent coherent background, which changes the propagation dynamics of the optical vortex and splits the initial m charge into /m/ unity-charged optical vortices within the same beam. Compared to a hologram, a multistart spiral phase plate is more efficient in the use of available spatial frequencies and beam energy and also is computationally less demanding. Furthermore, using microfabrication techniques will allow for greater achievable tolerances in terms of smaller feature sizes.

Optical vortex beam shaping by use of highly efficient irregular spiral phase plates for optical micromanipulation.

Optical dark traps such as Laguerre-Gaussian beams, modulated optical vortices, and high-order Bessel beams have been used in the micromanipulation of microparticles. Such optical traps are highly versatile, as they are able to trap both high- and low-index microparticles as well as to set them into rotation by use of the orbital angular momentum of light. Holography has been widely used to modulate the shape of an optical vortex for new optical traps. We show that, by designing the shape of a spiral phase plate and using electron-beam lithography for fabrication, one can modulate the amplitude and the phase of an optical vortex with respect to the specific shape of the spiral phase plate as required. Furthermore, to the best of our knowledge this is the first report of transferring orbital angular momentum from a spiral phase plate to an absorptive microparticle in an experiment. Hence, with this technique, optical dark traps can easily be designed and fabricated.

Optimized polarization-selective computer-generated hologram with fewer phase combinations.

Normally, to incorporate two binary conventional computer-generated holograms (CGHs) into a single polarization-selective computer-generated hologram (PSCGH), the respective pixels of the conventional CGHs will result in 4 different combinations of the phase values. Thus, the 4 phase combinations have to be realized by 4 types of pixel structures in a PSCGH. In this paper, we propose a method to reduce the PSCGH's 4 phase combinations to 3 using an optimization approach. The PSCGH's first-order diffraction efficiency is 30% and the contrast ratio is 28 after the optimization.

Cost-effective fabrication of microlenses on hybrid sol-gel glass with a high-energy beam-sensitive gray-scale mask.

A negative-tone inorganic-organic hybrid SiO(2):TiO(2) glass is investigated for fabrication of refractive microlenses. This sol-gel material enjoys an advantage over materials used in conventional photoresist-based fabrication techniques in that it lends itself to a single-step etching-free process. The application of a high-energy beam-sensitive (HEBS) mask provides a reliable and simple method for fabrication of three-dimensional micro-optical elements with a single UV exposure. The technique of using the sol-gel material with the HEBS gray-scale mask has considerable potential for low-cost mass production of continuous-phase-level diffractive optical elements and micro-optical structures.

Single-step fabrication of continuous surface relief micro-optical elements in hybrid sol-gel glass by laser direct writing.

A negative tone hybrid sol-gel material was applied to the fabrication of continuous surface relief micro-optical elements by laser direct writing lithography. The hybrid sol-gel glass was synthesized as UV photosensitive material and used for the fabrication of micro-optical elements with continuous surface relief profile. The surface profile was directly controlled by the UV exposure dosage and the exposed areas were crosslinked and converted into sol-gel glass with relief structures. The UV exposure dosage was realized by an acousto-optic modulator (AOM) in the laser direct writing system. Characterization results indicated that the thickness of the sol-gel glass has a linear response to the AOM values ranging from 3.25 to 5.5. The sol-gel thin film was measured to have a refractive index of 1.52 and the maximum thickness of 2 microm. For various designs of diffractive optical elements within the visible wavelength, the sol-gel film enables us to achieve an arbitrary phase change between 0 and 2 pi with the linear AOM exposure range. As an example, a blazed grating with a period of 45 microm and height of 1.17 microm was fabricated in the sol-gel glass using direct laser writing method.