Comparison of Ab Interno XEN Gelatin Stent vs Trabeculectomy with Mitomycin C: A Retrospective Study.

AIM: To compare outcomes of ab interno XEN gelatin stent (Allergan, Dublin, Ireland) implantation vs trabeculectomy with mitomycin C (MMC). MATERIALS AND METHODS: A retrospective review was conducted of eyes that underwent standalone XEN implantation or trabeculectomy with MMC at a single institution from 2014 to 2019. Intraocular pressure (IOP), visual acuity, glaucoma medications, complications, and postoperative interventions were evaluated. The primary endpoint was the reduction in IOP at 6 months postoperatively. Secondary endpoints included the incidence of postoperative intervention and complications. RESULTS: One hundred and seventy-nine eyes were included who underwent XEN (n = 90) or trabeculectomy (n = 89). The mean age was 74.5 ± 7.6 and 68.1 ± 8.2 years old for the XEN and trab groups, respectively (p < 0.001). Baseline IOP for XEN was 17.8 ± 6.0 vs 20.4 ± 9.0 mm Hg for the trab group (p = 0.03). At 6 months, mean IOP for XEN group was 13.5 ± 5.9 mm Hg, representing a 24.1% IOP reduction from baseline (p < 0.001) while mean for trab group was 10.8 ± 4.8 representing a 47% IOP reduction from baseline (p < 0.001). The mean IOP was 2.7 mm Hg lower in trab compared to the XEN group at 6 months (p < 0.003). The number of medications was reduced in both groups from 2.9 ± 1.1 and 3.1 ± 0.9 to 1.1 ± 2.3 and 0.8 ± 1.4 by 6 months postoperatively for XEN and trab groups, respectively (p < 0.001). Complication rates were low for both groups. The needling rate was 30% in XEN vs 7.9% in the trab group (p < 0.001), and 46.1% of eyes in the trab group underwent laser suture lysis. Additionally, IOP reduction and complication rates were similar following XEN in eyes receiving <40 or ≥40 µg of MMC. CONCLUSION: XEN implantation produces a substantial reduction in IOP with a favorable safety profile comparable to trabeculectomy. Careful postoperative bleb management is critical to obtain optimum outcomes, and higher MMC doses appear safe and may reduce needling rates. CLINICAL SIGNIFICANCE: This study confirms the safety and efficacy of XEN gelatin stent implantation in comparison to trabeculectomy with MMC. HOW TO CITE THIS ARTICLE: Sharpe R, Pham G, Chang P. Comparison of A b I nterno XEN Gelatin Stent vs Trabeculectomy with Mitomycin C: A Retrospective Study. J Curr Glaucoma Pract 2020;14(3):87-92.

Solar-powered air quality monitor applied under subtropical conditions in Hong Kong: Performance evaluation and application for pollution source tracking.

Air monitoring is desirable in many places to understand dynamic pollution trends and sources and improve knowledge of population exposure. While highly miniaturized low cost sensor technology is quickly evolving, there is also a need for the advancement of mid-tier systems that are closer to reference-grade technologies in their longevity and performance, but also feature compactness that requires less significant infrastructure. This project evaluated the performance of a prototype solar-powered air monitoring system known as a Village Green Project (VGP) system with wireless data transmission that was deployed on a school rooftop in Hong Kong and operated for over one year. The system provided highly time-resolved and long-term data utilizing mid-tier cost ozone, PM2.5 and meteorological instruments. It operated with very minimal maintenance but shading by a nearby building reduced solar radiation, thus battery run time, over the 16-months measurement period, approximately 330,000 1-min observations were recorded (data completeness of ~62%). The monitoring data were evaluated by comparison with a nearby Hong Kong Environment Protection Department (EPD) station and exhibited good performance for 1-h resolution (R 2 = 0.74 for PM2.5 and R 2 = 0.76 for ozone). Furthermore as a demonstration, a nonparametric regression (NPR) model was applied for identifying the location of pollution source, combining air pollution and meteorological measurements. In addition, based on the high time-resolution wind data, local-scale back-trajectories were calculated as an input for receptor-oriented Nonparametric Trajectory Analysis (NTA) model. The combination of the VGP air monitoring system and NTA model identified apparent local sources in urban area. The demonstration was largely successful and operational improvements are clearly suggested to insure better siting and configurations to insure adequate power and air flow.

Efficacy of selective laser trabeculoplasty following incisional glaucoma surgery.

AIM: To evaluate the efficacy of selective laser trabeculoplasty (SLT) in glaucomatous eyes with previous incisional glaucoma surgery. METHODS: A retrospective cohort of eyes that underwent SLT at a single institution from 2013-2015 were followed for 1y. Reduction in intraocular pressure (IOP) following SLT was evaluated in eyes with prior trabeculectomy with ExPress mini shunt (Alcon, Ft Worth, TX, USA), Ahmed valve (New World Medical, Cucamonga, CA, USA), or combined phacoemulsification-trabeculectomy. A control group was included with eyes without prior surgery that underwent SLT. Success was defined as >20% drop in IOP from pre-SLT baseline. RESULTS: One-hundred and six eyes were included with 53 in both the prior glaucoma surgery (PGS) and no prior glaucoma surgery (NPGS) groups. Mean pre-SLT IOP was 19.2±4.3 and 20.6±6.0 mm Hg for PGS and NPGS groups, respectively (P=0.17). Both groups produced statistically significant IOP reductions at 1 and 6mo (P<0.04). At 6mo, mean IOP reduction reached 7.3% and 10.8% for the PGS and NPGS groups, respectively (P=0.42). Overall, 27.9% and 31.7% of eyes in PGS and NPGS groups met success criteria at 1y (P=0.70). In the PGS group, eyes with baseline IOP ≥21 mm Hg had IOP reductions of 18.1% (P<0.001), 16.7% (P<0.01), and 8.4% (P=0.31) compared to eyes with baseline IOP <21 mm Hg who had IOP reductions of 2.3% (P=0.39), 3.4% (P=0.19), and 1.1% (P=0.72) at 1, 6mo, and 1y, respectively. CONCLUSION: SLT is efficacious in eyes with prior incisional glaucoma surgery and results in similar IOP reductions compared to eyes without PGS. A larger IOP reduction is observed following SLT in eyes with higher pre-SLT IOP.

SPONTANEOUS CLOSURE OF A MACULAR HOLE AFTER FOUR FAILED VITRECTOMIES IN THE SETTING OF NF-1.

PURPOSE: To present the case of a patient who developed spontaneous closure of an idiopathic macular hole after four failed attempts at surgical closure. METHODS: This is a retrospective case review of the medical record of a single patient. No statistical analysis was performed. The patient is a 71-year-old white woman with neurofibromatosis Type 1 who presented to the retina clinic of one of the authors. RESULTS: The patient underwent four vitrectomies with long acting gas by two surgeons over the course of 2 years. After each surgery, the hole either did not close or it closed and then reopened within 1 year. Five months after the last surgery (1 year after the hole last reopened), the patient presented with improved vision and spontaneous closure of the macular hole. The hole has remained closed since then. CONCLUSION: This case demonstrates that spontaneous closure of a macular hole, associated with excellent visual recovery, can occur after multiple surgical failures. We propose that enhanced scar formation due to neurofibromatosis Type 1 was responsible for both the numerous failures following initially successful surgery (centrifugal traction) and for the spontaneous closure (centripetal traction).

Highly Functionalized Tricyclic Oxazinanones via Pairwise Oxidative Dearomatization and N-Hydroxycarbamate Dehydrogenation: Molecular Diversity Inspired by Tetrodotoxin.

Benzenoids in principle represent attractive and abundant starting materials for the preparation of substituted cyclohexanes; however, the synthetic tools available for overcoming the considerable aromatic energies inherent to these building blocks limit the available product types. In this paper, we demonstrate access to heretofore unknown heterotricyclic structures by leveraging oxidative dearomatization of 2-hydroxymethyl phenols with concurrent N-hydroxycarbamate dehydrogenation using a common oxidant. The pairwise-generated, mutually reactive species then participate in a second stage acylnitroso Diels-Alder cycloaddition. The reaction chemistry of the derived [2.2.2]-oxazabicycles, bearing four orthogonal functional groups and three stereogenic centers, is shown to yield considerable diversity in downstream products. The methodology allows for the expeditious synthesis of a functionalized intermediate bearing structural and stereochemical features in common with the complex alkaloid tetrodotoxin.

Comparison of Outcomes of Resident-performed Ahmed Valve Implantation vs Trabeculectomy.

AIMS: To compare outcomes of resident-performed Ahmed valve surgery vs trabeculectomy in a Veteran Affairs medical facility. MATERIALS AND METHODS: A retrospective cohort of 103 eyes in 91 patients receiving Ahmed valve (valve) or trabeculectomy (trab) performed at a Veterans Administration Medical Center by residents in their third year of training. The primary outcomes included intraocular pressure (IOP), treatment failure, and complications over 1 year. RESULTS: Of 103 eyes, 44 received valve and 59 received trab. Primary open-angle glaucoma was primary diagnosis more often in trab, while neovascular glaucoma predominated in the valve group (p < 0.001). Preoperative mean IOP was 35.1 ± 11.8 and 24.5 ± 7.1 mm Hg for valve and trabeculectomy respectively (p < 0.001), but at 1 year the IOP difference between groups was not statistically significant (p = 0.064). Overall, 11 (25.0%) and 11 (18.6%) eyes met any criteria for failure for valve and trab respectively. At 1 year, 22.5% of valves had IOP > 21 mm Hg vs only 4.3% of trab (p = 0.02). Complications were infrequent. There were no intraoperative complications for valve, whereas five for trab. Most common immediate complication for valve was hyphema. Both groups had low rates of choroidal effusions and reoperation. CONCLUSION: Ahmed valve implantation and trabeculectomy produce significant reductions in IOP when performed by residents-in-training. Valves tend to be used more frequently in patients with secondary glaucoma. Although complication profiles differ between procedures, both are safe and well tolerated when performed by resident physicians. CLINICAL SIGNIFICANCE: This study provides support for evidence-based patient counseling that supervised, resident-performed Ahmed valve implantation and trabeculectomy are indeed safe and effective. How to cite this article: Sharpe RA, Kammerdiener LL, Wannamaker KW, Fan J, Sharpe ED. Comparison of Outcomes of Resident-performed Ahmed Valve Implantation vs Trabeculectomy. J Curr Glaucoma Pract 2016;10(2):60-67.

Effects of Age and Implanted Ear on Speech Recognition in Adults with Unilateral Cochlear Implants.

The objective of this study was to examine how age and implanted ear contribute to functional outcomes with cochlear implantation (CI). A retrospective review was performed on 96 adults who underwent unilateral CI. Older adults with right-ear implants had higher Hearing in Noise Test (HINT) scores at 1 year by 10.3% (p = 0.06). When adjusted to rationalized arcsine units (rau), right-ear HINT scores in older adults were higher by 12.1 rau (p = 0.04). Older adults had an 8.9% advantage on the right side compared to the left in post- versus preimplant scores for consonant-vowel nucleus-consonant words (p = 0.05). No significant differences were observed for younger adults. In conclusion, although adults of all ages experience improvements in speech perception following CI, there might be a subtle but consistent right-ear advantage in older adults.

Community Air Sensor Network (CAIRSENSE) project: evaluation of low-cost sensor performance in a suburban environment in the southeastern United States.

Advances in air pollution sensor technology have enabled the development of small and low-cost systems to measure outdoor air pollution. The deployment of a large number of sensors across a small geographic area would have potential benefits to supplement traditional monitoring networks with additional geographic and temporal measurement resolution, if the data quality were sufficient. To understand the capability of emerging air sensor technology, the Community Air Sensor Network (CAIRSENSE) project deployed low-cost, continuous, and commercially available air pollution sensors at a regulatory air monitoring site and as a local sensor network over a surrounding ∼ 2 km area in the southeastern United States. Collocation of sensors measuring oxides of nitrogen, ozone, carbon monoxide, sulfur dioxide, and particles revealed highly variable performance, both in terms of comparison to a reference monitor as well as the degree to which multiple identical sensors produced the same signal. Multiple ozone, nitrogen dioxide, and carbon monoxide sensors revealed low to very high correlation with a reference monitor, with Pearson sample correlation coefficient (r) ranging from 0.39 to 0.97, 0.25 to 0.76, and 0.40 to 0.82, respectively. The only sulfur dioxide sensor tested revealed no correlation (r < 0.5) with a reference monitor and erroneously high concentration values. A wide variety of particulate matter (PM) sensors were tested with variable results - some sensors had very high agreement (e.g., r = 0.99) between identical sensors but moderate agreement with a reference PM2.5 monitor (e.g., r = 0.65). For select sensors that had moderate to strong correlation with reference monitors (r > 0.5), step-wise multiple linear regression was performed to determine if ambient temperature, relative humidity (RH), or age of the sensor in number of sampling days could be used in a correction algorithm to improve the agreement. Maximum improvement in agreement with a reference, incorporating all factors, was observed for an NO2 sensor (multiple correlation coefficient R2 adj-orig = 0.57, R2 adj-final = 0.81); however, other sensors showed no apparent improvement in agreement. A four-node sensor network was successfully able to capture ozone (two nodes) and PM (four nodes) data for an 8-month period of time and show expected diurnal concentration patterns, as well as potential ozone titration due to nearby traffic emissions. Overall, this study demonstrates the performance of emerging air quality sensor technologies in a real-world setting; the variable agreement between sensors and reference monitors indicates that in situ testing of sensors against benchmark monitors should be a critical aspect of all field studies.

A Scalable Protocol for the Regioselective Alkylation of 2-Methylcyclohexane-1,3-dione with Unactivated sp3 Electrophiles.

A method for the C-selective alkylation of 2-methylcyclohexane-1,3-dione with unactivated sp3 electrophiles is accomplished via alkylation and subsequent deprotection of the derived ketodimethyl hydrazones. The present method provides a high-yielding entry to dialkyl cycloalkanones that cannot be accessed via direct alkylation of 2-methylcyclohexane-1,3-dione. The title reaction may be useful in the scalable preparation of terpene and steroidal building blocks in the arena of natural product synthesis.

Asymmetric Total Synthesis of the Indole Diterpene Alkaloid Paspaline.

An enantioselective synthesis of the indole diterpenoid natural product paspaline is disclosed. Critical to this approach was the implementation of stereoselective desymmetrization reactions to assemble key stereocenters of the molecule. The design and execution of these tactics are described in detail, and a thorough analysis of observed outcomes is presented, ultimately providing the title compound in high stereopurity. This synthesis provides a novel template for preparing key stereocenters in this family of molecules, and the reactions developed en route to paspaline present a series of new synthetic disconnections in preparing steroidal natural products.

Field assessment of the Village Green Project: an autonomous community air quality monitoring system.

Continuous, long-term, and time-resolved measurement of outdoor air pollution has been limited by logistical hurdles and resource constraints. Measuring air pollution in more places is desired to address community concerns regarding local air quality impacts related to proximate sources, to provide data in areas lacking regional air monitoring altogether, or to support environmental awareness and education. This study integrated commercially available technologies to create the Village Green Project (VGP), a durable, solar-powered air monitoring park bench that measures real-time ozone, PM2.5, and meteorological parameters. The data are wirelessly transmitted via cellular modem to a server, where automated quality checks take place before data are provided to the public nearly instantaneously. Over 5500 h of data were successfully collected during the first ten months of pilot testing in Durham, North Carolina, with about 13 days (5.5%) of downtime because of low battery power. Additional data loss (4-14% depending on the measurement) was caused by infrequent wireless communication interruptions and instrument maintenance. The 94.5% operational time via solar power was within 1.5% of engineering calculations using historical solar data for the location. The performance of the VGP was evaluated by comparing the data to nearby air monitoring stations operating federal equivalent methods (FEM), which exhibited good agreement with the nearest benchmark FEMs for hourly ozone (r(2) = 0.79) and PM2.5 (r(2) = 0.76).

A global and local desymmetrization approach to the synthesis of steroidal alkaloids: stereocontrolled total synthesis of paspaline.

A stereocontrolled total synthesis of the indole diterpenoid natural product paspaline is described. Key steps include a highly diastereoselective enzymatic desymmetrization, substrate-directed epoxidation, Ireland-Claisen rearrangement, and diastereotopic group selective C-H acetoxylation to assemble the target with excellent stereofidelity. The route and results described herein outline complementary conceptual disconnections in the arena of steroid natural product synthesis.

Preparation and biological evaluation of synthetic and polymer-encapsulated congeners of the antitumor agent pactamycin: insight into functional group effects and biological activity.

The synthesis and biological analysis of a number of novel congeners of the aminocyclopentitol pactamycin is described. Specific attention was paid to the preparation of derivatives at crucial synthetic branch points of the parent structure, and biological assays revealed a number of insights into the source of pactamycin's biological activity. Additionally, the encapsulation of pactamycin and select derivatives into the PRINT© nanoparticle technology was investigated as a proof-of-concept, and evidence of bioactivity modulation through nanoparticle delivery is demonstrated. This work has provided heretofore unrealized access to a large number of novel compounds for further evaluation.

Assessment of cardiovascular disease risk factors in the coastal region of South Carolina.

OBJECTIVE: To assess risk factors for cardiovascular disease, barriers to health care, and desired health care education topics for Hispanics in the coastal region of South Carolina known as the Lowcountry. METHODS: 174 Hispanic adults were surveyed at visits at the Mexican consulate using a novel interview instrument. The prevalence of cardiovascular risk factors was compared to the Behavioral Risk Factor Surveillance System (BRFSS), an annual telephone survey, to evaluate the validity of the survey instrument. RESULTS: Results are comparable to the BRFSS telephone study of the Hispanics in the same area. However, participants in our study were older (Age > 35 = 41.4% vs. 34.9%) and reported fewer years of formal education (higher level education = 12.9% vs. 44.2%). Cost of care (72.8%) and language barriers (46.8%) were the main difficulties reported in obtaining health care access. The main educational topics of interest were diabetes (61.5%), hypertension (43.7%), stress (42.5%), and cardiac disease (40.2%). CONCLUSION: Our study supports the evidence that there is a demand and need for cardiovascular disease and diabetes education among Hispanics. Our study also shows that a large proportion of Hispanics experience barriers to health care. and that large telephone studies may underrepresent higher risk Hispanic populations.

Asymmetric synthesis of the aminocyclitol pactamycin, a universal translocation inhibitor.

An asymmetric total synthesis of the aminocyclopentitol pactamycin is described. The title compound is delivered in 15 steps from 2,4-pentanedione. Critical to this approach was the exploitation of a complex symmetry-breaking reduction strategy to assemble the C1, C2, and C7 relative stereochemistry within the first four steps of the synthesis. Multiple iterations of this reduction strategy are described, and a thorough analysis of stereochemical outcomes is detailed. In the final case, an asymmetric Mannich reaction was developed to install a protected amine directly at the C2 position. Symmetry-breaking reduction of this material gave way to a remarkable series of stereochemical outcomes leading to the title compound without recourse to nonstrategic downstream manipulations. This synthesis is immediately accommodating to the preparation of structural analogs.

Enantioselective synthesis of pactamycin, a complex antitumor antibiotic.

Medicinal application of many complex natural products is precluded by the impracticality of their chemical synthesis. Pactamycin, the most structurally intricate aminocyclopentitol antibiotic, displays potent antiproliferative properties across multiple phylogenetic domains, but it is highly cytotoxic. A limited number of analogs produced by genetic engineering technologies show reduced cytotoxicity against mammalian cells, renewing promise for therapeutic applications. For decades, an efficient synthesis of pactamycin amenable to analog derivatizations has eluded researchers. Here, we present a short asymmetric total synthesis of pactamycin. An enantioselective Mannich reaction and symmetry-breaking reduction sequence was designed to enable assembly of the entire carbon core skeleton in under five steps and control critical three-dimensional (stereochemical) functional group relationships. This modular route totals 15 steps and is immediately amenable for structural analog synthesis.

A formal synthesis of (-)-cyanolide A featuring a stereoselective Mukaiyama aldol reaction and oxocarbenium reduction.

The formal synthesis of the marine natural product (-)-cyanolide A is presented. The synthetic strategy is centered on two acyclic diastereoselective reactions and a single cyclic reaction with modest to excellent dr based on an initial stereocenter. Most notable is a highly stereoselective oxocarbenium reduction based on a "mismatched" reactive conformer to afford the ß-C-glycoside subunit leading to an efficient synthesis of the diolide aglycon in 12 overall steps.

Primary intraocular lymphoma: a review.

Primary intraocular lymphoma (PIOL) is a rare, non-Hodgkin lymphoma considered to be a subtype of primary central nervous system lymphoma. We describe a 65-year-old woman who presented to the Hematology/Oncology Clinic at Scripps Clinic, La Jolla, California, who was diagnosed with bilateral PIOL without systemic disease. She enjoyed a 16-month remission but ultimately recurred in the brain. We reviewed the literature and present a discussion of the diagnostic criteria for PIOL and current strategies for treating PIOL in immunocompetent patients.

Very long-term eradication of minimal residual disease in patients with hairy cell leukemia after a single course of cladribine.

Cladribine induces protracted remissions in patients with hairy cell leukemia (HCL). However, many long-term responders ultimately relapse. We sought to determine whether long-term complete responders subsequent to a single 7-day course of cladribine were without minimal residual disease (MRD) and potentially cured of HCL. From the 358-person Scripps Clinic cladribine database, we identified 19 patients in continuous and complete hematologic response (median age, 75 years; median time from diagnosis, 18 years; and median time from cladribine, 16 years). Nine of 19 (47%) patient samples had no evidence of residual disease; 7 of 19 (37%) samples had MRD; and 3 of 19 (16%) had morphologic evidence of HCL in hematoxylin and eosin-stained bone marrow sections. These results indicate that HCL is potentially curable after cladribine treatment. In addition, patients with MRD and even gross morphologic disease can live many years without manifesting hematologic relapses.

The impact of prolonged continuous wakefulness on resident clinical performance in the intensive care unit: a patient simulator study.

OBJECTIVE: To evaluate the impact of prolonged continuous wakefulness on resident performance under controlled experimental conditions. DESIGN: Experimental within-subjects comparison. SETTING: High-fidelity patient simulator. PARTICIPANTS: Twelve residents in an Internal Medicine Program at various stages of training (range, 1-35 mos). MEASUREMENTS: Performance was studied during 26 hrs of continuous wakefulness at four time points (8:00-10:00 am, 2:00-4:00 pm, 2:00-4:00 am, and 8:00-10:00 am the next day) using high-fidelity patient simulation. At each session, residents managed eight simulated dysrhythmias according to advanced cardiac life support protocols (advanced cardiac life support scenarios) and then managed a simulated critically ill patient (e.g., patient with meningitis) to test more complicated clinical decision-making (complex scenario). The frequency of previously defined major medical errors (i.e., action or inaction that likely would have resulted in significant harm in a real patient) was assessed by a scorer blinded to the time of the session. For each complex scenario, a global score between 0 and 100 was also given for overall performance. The impact of wakefulness on performance was assessed by using longitudinal mixed-effects models. RESULTS: For the complex scenarios, the mean number of errors increased from 0.92 +/- 0.90 in the first session to 1.58 +/- 0.79 in the fourth session (p = .09), and mean global score decreased from 56.8 +/- 14.6 to 49.6 +/- 12.6 (p = .02). For the advanced cardiac life support scenarios, the mean number of major errors committed in the advanced cardiac life support scenarios decreased during the study period (p = .01). However, essentially all of the improvement occurred between the first and second time points, suggesting that a substantial learning effect accounted for the findings. CONCLUSIONS: During prolonged continuous wakefulness of medical residents, clinical performance in the management of a simulated critically ill patient deteriorates. The practice of scheduling residents for extended work shifts (>24 hrs) should be reconsidered.