A Case of Lepromatous Leprosy (Lucio's Phenomenon) Presenting as Periorbital Edema.

Despite low prevalence of leprosy worldwide, new cases continue to present and require swift evaluation and diagnosis to prevent complications. Here, we describe a case of lepromatous leprosy with Lucio's phenomenon initially presenting with facial and periorbital edema. A 38-year-old Brazilian woman presented to the emergency department with facial swelling and erythema, initially treated as cellulitis. Due to rapid worsening despite broad-spectrum antibiotics, she underwent soft tissue exploration and biopsy due to concern for necrotizing fasciitis. During her course, she also developed retiform purpura of bilateral upper and lower extremities. Periorbital and lower extremity pathological specimens ultimately revealed acid-fast bacilli consistent with Mycobacterium leprae , and the patient improved with multidrug therapy. This case illustrates the diagnostic difficulty of lepromatous leprosy with Lucio's phenomenon, which can initially present with periorbital edema.

The association of moderate-to-vigorous and light-intensity physical activity on static balance in middle-aged and older-aged adults.

BACKGROUND: Falls are the leading cause of injury among adults ≥ 65 years of age. Participation in physical activity (PA) is associated with improved balance, though it is impact in the middle-age population is not well understood. AIM: The purpose of the current study was to examine the influence of PA intensity on static balance in middle-aged and older aged individuals. METHODS: Included were middle-aged adults (40-64 years) and older adults (≥ 65 years) from the 2003-2004 years of the National Health and Nutrition Evaluation Survey. Light physical activity (LPA) and moderate-vigorous physical activity (MVPA) were collected via accelerometer and static balance via the Romberg Test of Standing Balance. RESULTS: No significant odds ratio relationship was found between MVPA or LPA and having good static balance in the middle-aged population; 1.04 (95% CI 0.95, 1.13) p = 0.427 and 1.05 (95% CI 0.97, 1.14) p = 0.182, respectively. Whereas, in older adults, every 60-min increase in LPA was significantly associated with 28% higher odds of good balance (95% CI 1.15, 1.41; p < 0.001), and every 10-min increase in MVPA with 25% higher odds of good balance (95% CI 1.08, 1.45; p = 0.006). DISCUSSION: LPA and MVPA were not associated with good static balance in middle-aged adults, but in older adults LPA was significantly associated with good static balance. CONCLUSION: A significant relationship is found between age and fall risk, which is a major concern in the aging population.

Endothelial Glycocalyx Morphology in Different Flow Regions of the Aqueous Outflow Pathway of Normal and Laser-Induced Glaucoma Monkey Eyes.

Glycocalyx morphology was examined in the trabecular outflow pathway of monkey eyes with and without experimental glaucoma. Laser burns were administered along ~270 degrees of the trabecular meshwork (TM) of one eye (n = 6) or both eyes (n = 2) of each monkey until intraocular pressure remained elevated. Portions of the TM were not laser-treated. Unlasered eyes (n = 6) served as controls. Enucleated eyes were perfused at 15 mmHg to measure the outflow facility, perfused with fluorescein to evaluate the outflow pattern, perfusion-fixed for glycocalyx labeling, and processed for electron microscopy. Coverage and thickness of the glycocalyx were measured in the TM, Schlemm's canal (SC), collector channels (CCs), intrascleral veins (ISVs), and episcleral veins (ESVs) in non-lasered regions and high- and low-flow regions of controls. Compared to controls, laser-treated eyes had decreased outflow facility (p = 0.02). Glycocalyx thickness increased from the TM to ESVs in non-lasered regions and controls (p < 0.05). Glycocalyx coverage was generally greater distally in non-lasered regions (p < 0.05). In lasered regions, TM, SC, and CCs were partly to completely obliterated, and ISVs and ESVs displayed minimal glycocalyx. Whether the glycocalyx is decreased in the trabecular outflow pathway of human glaucomatous eyes warrants investigation.

Descemet's membrane injury due to bullet shockwave trauma.

Purpose: To report a case of corneal edema associated with Descemet membrane (DM) damage likely due to shockwave trauma from a bullet passing by the eye. Observations: A 27-year-old man presented to the emergency department with pain, redness, and severely decreased vision in the left eye immediately following a gun assault. Examination of the eye revealed a temporal conjunctival laceration, corneal edema, hyphema, and vitreous hemorrhage. Bullets were found in the patient's left chest and axilla, and a laceration was present on the bridge of his nose, but no foreign bodies were found in or around the eyes. The intraocular hemorrhage and corneal edema gradually resolved, and it became apparent that there were DM irregularities that possibly represented micro-ruptures. After 7 months, uncorrected visual acuity improved to 20/25, and the cornea was free of edema but had persistent small focal areas of DM thickening and scarring. Conclusions and Importance: This case illustrates that DM and possibly endothelial cell damage can occur due to shockwave injury from high-speed projectiles. In our case of presumed small central DM micro-ruptures, the corneal edema resolved, and the vision significantly improved with topical therapy and observation, suggesting an overall good prognosis from such injuries.

Schlemm's Canal Endothelium Cellular Connectivity in Giant Vacuole and Pore Formation in Different Flow-type Areas: A Serial Block-Face Scanning Electron Microscopy Study.

Glaucoma is associated with increased resistance in the conventional aqueous humor (AH) outflow pathway of the eye. The majority of resistance is thought to reside in the juxtacanalicular connective tissue (JCT) region of the trabecular meshwork and is modulated by the inner wall (IW) endothelial cells of Schlemm's canal (SC). The IW cells form connections with the underlying JCT cells/matrix, and these connections are thought to modulate outflow resistance. Two ways by which AH crosses the IW endothelium are through: 1) the formation of outpouchings in IW cells called giant vacuoles (GVs) and their intracellular pores (I-pores), and 2) intercellular pores between two adjacent IW cells (B-pores). AH outflow is segmental with areas of high-, low-, and non-flow around the circumference of the eye. To investigate whether changes in cellular connectivity play a role in segmental outflow regulation, we used global imaging, serial block-face scanning electron microscopy (SBF-SEM), and 3D reconstruction to examine individual IW cells from different flow areas of ex vivo perfused normal human donor eyes. Specifically, we investigated the differences in cellular dimensions, connections with JCT cells/matrix, GVs, and pores in SC IW cells between high-, low-, and non-flow areas. Our data showed that: 1) IW cell-JCT cell/matrix connectivity was significantly decreased in the cells in high-flow areas compared to those in low- and non-flow areas; 2) GVs in the cells of high-flow areas had significantly fewer connections beneath them compared to GVs in the cells of low- and non-flow areas; 3) Type IV GVs (with I-pores and basal openings) had significantly fewer connections beneath them compared to Type I GVs (no I-pore or basal opening). Our results suggest that a decreased number of cellular connections between the IW and JCT in high-flow areas is associated with increased numbers of GVs with I-pores and larger Type IV GVs observed in previous studies. Therefore, modulating the number of cellular connections may affect the amount of high-flow area around the eye and thereby modulate AH outflow.

Morphological changes to Schlemm's canal and the distal aqueous outflow pathway in monkey eyes with laser-induced ocular hypertension.

Though roughly 30-50% of aqueous outflow resistance resides distal to Schlemm's canal (SC), the morphology of the conventional outflow pathway distal to SC has not been thoroughly evaluated. This study examined the morphological changes along proximal and distal aspects of the conventional aqueous outflow pathway and their association with decreased outflow facility in an experimental model of glaucoma in cynomolgus macaques. Nd:YAG laser burns were made to 270-340 degrees of the trabecular meshwork (TM) of one eye (n = 6) or both eyes (n = 2) of each monkey to induce ocular hypertension. Distinct regions of the TM were left unlasered. Contralateral eyes (n = 5) were not lasered and were utilized as controls. Monkeys were sacrificed ≥58 months after their last laser treatment. All eyes were enucleated and perfused at 15 mmHg for 30 min to measure outflow facility. Two pairs of eyes were also perfused with fluorescein to examine segmental outflow. All eyes underwent perfusion-fixation for 1 h. Anterior segments were cut into radial wedges and processed for light and electron microscopy. Width, height, and cross-sectional area (CSA) of SC were compared between high- and low-flow regions of control eyes, and between non-lasered regions of laser-treated eyes and control eyes. Number and CSA of intrascleral veins (ISVs) were compared between non-lasered and lasered regions of laser-treated eyes and control eyes, and between high- and low-flow regions of control eyes. Scleral collagen fibril diameter was compared between control eyes and lasered and non-lasered regions of laser-treated eyes. Median outflow facility was significantly decreased in laser-treated eyes compared to control eyes (P = 0.02). Median CSA and height of SC were smaller in high-flow regions than low-flow regions of control eyes (P < 0.05). Median width of SC was not significantly different between high- and low-flow regions of control eyes (P > 0.05). Median CSA, width, and height of SC were not different between non-lasered regions and control eyes (P > 0.05). SC was partially or completely obliterated in lasered regions. Median number of ISVs was significantly decreased in lasered regions compared to non-lasered regions (P < 0.01) and control eyes (P < 0.01). Median CSA of ISVs did not differ between these groups (P > 0.05). Median number and CSA of ISVs were not significantly different between high- and low-flow regions of control eyes (P > 0.05). Lasered regions displayed looser scleral stroma and smaller median diameter of collagen fibrils adjacent to the TM compared to non-lasered regions (P < 0.05) and control eyes (P < 0.05). Dense TM, partial to complete obliteration of SC, and a decreased number of patent ISVs may account in part for the decreased outflow facility in monkey eyes with laser-induced ocular hypertension. The significance of changes in scleral structure in laser-treated eyes warrants further investigation.

Relationships between Intraocular Pressure, Effective Filtration Area, and Morphological Changes in the Trabecular Meshwork of Steroid-Induced Ocular Hypertensive Mouse Eyes.

We investigated whether an inverse relationship exists between intraocular pressure (IOP) and effective filtration area (EFA) in the trabecular meshwork (TM) in a steroid-induced ocular hypertensive (SIOH) mouse model and the morphological changes associated with the reduction of EFA. C57BL/6 mice (n = 15 per group) received either 0.1% dexamethasone (DEX) or saline eye drops twice daily for five weeks. IOP was measured weekly. Fluorescent tracers were injected into the anterior chamber to label EFA at the endpoint. Injected eyes were fixed and processed for confocal microscopy. EFA in the TM was analyzed. Light and electron microscopy were performed in high- and low-tracer regions of six eyes per group. The mean IOP was ~4 mm Hg higher in DEX-treated than saline-treated control eyes (p < 0.001) at the endpoint. EFA was reduced in DEX-treated eyes compared to controls (p < 0.01) and negatively correlated with IOP (R2 = 0.38, p = 0.002). Reduced thickness of juxtacanalicular tissue (JCT) and increased abnormal extracellular matrix in the JCT were found to be associated with reduced EFA. Our data confirm the inverse relationship between EFA and IOP, suggesting that morphological changes in the JCT contribute to the reduction of EFA, thus elevating IOP in SIOH mouse eyes.

Five-year outcomes of selective laser trabeculoplasty: A retrospective study.

Introduction: Studies have shown the efficacy of selective laser trabeculoplasty (SLT) to lower intraocular pressure (IOP) as adjuvant therapy during short-term follow-up. However, few studies have assessed the long-term efficacy of SLT on preventing worsening Humphrey visual field (HVF) parameters and thinning of the retinal nerve fiber layer (RNFL) with continued medical therapy. Methods: A retrospective chart review was conducted of 51 eyes of 39 patients with glaucoma treated with SLT at Boston Medical Center between 2012 and 2016 with 3- and 5-year follow-up. Outcome measures included IOP, visual acuity, number of glaucoma medications, number of months to subsequent surgical intervention. HVF outcome measures included mean deviation (MD) and pattern standard deviation (PSD). Optical coherence tomography (OCT) outcome measures included RNFL mean thickness, and superior and inferior thicknesses. Results: Twenty-five eyes received subsequent surgical intervention (mean time to intervention = 33.6 ± 20.0 months). In the eyes that did not receive another intervention, mean IOP was significantly decreased by 3.2 and 3.5 mmHg at 3- and 5-year after SLT, respectively. Mean number of glaucoma medications was significantly increased at 5-year (2.7 ± 1.6; P = 0.04), compared to pre-SLT (2.0 ± 1.1). Mean HVF MD was significantly higher at 5-year (-7.64 ± 6.57 dB) compared to pre-SLT (-5.61 ± 3.90 dB). Mean PSD significantly increased at 3-year (5.30 ± 2.91 dB) and 5-year (6.84 ± 2.62 dB), compared to pre-SLT (4.63 ± 2.70 dB; P = 0.04 and ≤0.01, respectively). On OCT, inferior quadrant RNFL thickness decreased significantly at 5-year (88.5 ± 19.3 µm), compared to pre-SLT (94.0 ± 23.2 µm). Discussion: Although 51% of eyes had IOP controlled at 5-year post-SLT, mean number of glaucoma medications was significantly higher. Also, there was progression of MD and PSD on HVF and inferior quadrant thinning on OCT at 5-year. We found a significant association between age at SLT and risk of subsequent surgical intervention over 5-year follow-up. Our study adds to our understanding of long-term outcomes of adjuvant SLT for glaucoma patients receiving medical therapy.

The Physical Parameters of Tactical Climbing and Performance Characteristics of Naval Special Warfare Operators.

ABSTRACT: Wood, DE and Swain, DP. The physical parameters of tactical climbing and performance characteristics of naval special warfare operators. J Strength Cond Res 35(4): 949-954, 2021-Vertical elevation may be critical for advantage to Special Operation Forces and require strength, power, endurance, and technique. This study sought to (a) study differences in physical capacities of Naval Special Warfare lead climbers from nonlead climbers, (b) compare anthropometrics of lead climbers from nonlead climbers, and (c) catalogue the types and weights of the various climbing systems to assess total system weight to the lead climber's body mass. Climbing surveys were collected and retrospective physical capacity data from 15 SEa, Air and Land lead climbers (age: 31.2 ± 5.1 years; height: 181.4 ± 6.4 cm; mass: 89.4 ± 10.0 kg; body fat: 14.1 ± 3.7%) were compared against previously reported data of 305 nonlead climbers (age: 28.8 ± 5.2 years; height: 177.6 ± 12.0 cm; mass: 85.8 ± 9.7 kg; body fat: 17.3 ± 4.7%). Lead climbers had significantly less body fat percentage (p = 0.017). Lead climbers also performed significantly better on the pro-agility test (p = 0.017) and deadlift (p = 0.002). The total mass reported for the climbing equipment for each tactical scenario was up to 4.9 kg for urban climbing, up to 13.7 kg for alpine climbing, and up to 8.0 kg for maritime climbing. With a typical combat load of 21.4 kg, adding an alpine climbing load exceeds one-third of the lead climbers' own body mass. Strength and conditioning programming for this population should take into consideration the total system weight for testing and training purposes and should also consider climbing-specific strength testing and training to optimize climbing capability.

Morphological factors associated with giant vacuoles with I-pores in Schlemm's canal endothelial cells of human eyes: A serial block-face scanning electron microscopy study.

Increased intraocular pressure (IOP) is the main risk factor for primary open-angle glaucoma and results from impaired drainage of aqueous humor (AH) through the trabecular outflow pathway. AH must pass the inner wall (IW) endothelium of Schlemm's canal (SC), which is a monolayer held together by tight junctions, to exit the eye. One route across the IW is through giant vacuoles (GVs) with their basal openings and intracellular pores (I-pores). AH drainage through the trabecular outflow pathway is segmental. Whether more GVs with both basal openings and I-pores are present in the active flow areas and factors that may influence formation of GVs with I-pores have not been fully elucidated due to limitations in imaging methods. In this study, we applied a relatively new technique, serial block-face scanning electron microscopy (SBF-SEM), to investigate morphological factors associated with GVs with I-pores in different flow areas. Two normal human donor eyes were perfused at 15 mmHg with fluorescent tracers to label the outflow pattern followed by perfusion-fixation. Six radial wedges of trabecular meshwork including SC (2 each from high-, low-, and non-flow areas) were imaged using SBF-SEM (total: 9802 images). Total GVs, I-pores, basal openings, and four types of GVs were identified. Percentages of GVs with I-pores and basal openings and number of I-pores/GV were determined. Overall, 14.4% (477/3302) of GVs had I-pores. Overall percentage of GVs with both I-pores and basal openings was higher in high- (15.7%), than low- (12.6%) or non-flow (7.3%) areas. Of GVs with I-pores, 83.2% had a single I-pore; 16.8% had multiple I-pores (range: 2-6). Additionally, 180 GVs (90 with I-pores and 90 without I-pores) were randomly selected, manually segmented, and three-dimensionally (3D) reconstructed to determine size, shape, and thickness of the cellular lining. Size of GVs (including median volume, surface area, and maximal cross-sectional area) with I-pores (n = 90) was significantly larger than GVs without I-pores (n = 90) using 3D-reconstructed GVs (P ≤ 0.01). Most I-pores (73.3%; 66/90) were located on or close to GV's maximal cross-sectional area with significant thinning of the cellular lining. Our results suggest that larger size and thinner cellular lining of GVs may contribute to formation of GVs with I-pores. More GVs with I-pores and basal openings were observed in high-flow areas, suggesting these GVs do provide a channel through which AH passes into SC and that increasing this type of GV may be a potential strategy to increase aqueous outflow for glaucoma treatment.

Developing a Simulated Online Model That Integrates GNSS, Accelerometer and Weather Data to Detect Parturition Events in Grazing Sheep: A Machine Learning Approach.

In the current study, a simulated online parturition detection model is developed and reported. Using a machine learning (ML)-based approach, the model incorporates data from Global Navigation Satellite System (GNSS) tracking collars, accelerometer ear tags and local weather data, with the aim of detecting parturition events in pasture-based sheep. The specific objectives were two-fold: (i) determine which sensor systems and features provide the most useful information for lambing detection; (ii) evaluate how these data might be integrated using ML classification to alert to a parturition event as it occurs. Two independent field trials were conducted during the 2017 and 2018 lambing seasons in New Zealand, with the data from each used for ML training and independent validation, respectively. Based on objective (i), four features were identified as exerting the greatest importance for lambing detection: mean distance to peers (MDP), MDP compared to the flock mean (MDP.Mean), closest peer (CP) and posture change (PC). Using these four features, the final ML was able to detect 27% and 55% of lambing events within ±3 h of birth with no prior false positives. If the model sensitivity was manipulated such that earlier false positives were permissible, this detection increased to 91% and 82% depending on the requirement for a single alert, or two consecutive alerts occurring. To identify the potential causes of model failure, the data of three animals were investigated further. Lambing detection appeared to rely on increased social isolation behaviour in addition to increased PC behaviour. The results of the study support the use of integrated sensor data for ML-based detection of parturition events in grazing sheep. This is the first known application of ML classification for the detection of lambing in pasture-based sheep. Application of this knowledge could have significant impacts on the ability to remotely monitor animals in commercial situations, with a logical extension of the information for remote monitoring of animal welfare.

Influence of Body Mass on Fitness Performance in Naval Special Warfare Operators.

ABSTRACT: Wood, DE and Swain, DP. Influence of body mass on fitness performance in Naval Special Warfare operators. J Strength Cond Res 35(11): 3120-3127, 2021-U.S. Naval Special Operations Forces have performed some of the U.S. Military's most rigorous missions. The Human Performance Program (HPP) developed a physical performance testing battery to assess and monitor physical fitness. Testing bias relative to body mass has been noted in the past literature, including military physical fitness tests. This retrospective study looked to determine whether there is body mass bias in the HPP fitness assessment and whether an optimum body mass for each fitness test could be determined. Data from 333 subjects (age: 28.4 ± 5.0 years; height: 178.4 ± 6.2 cm; mass: 86.0 ± 9.2 kg) were analyzed to compare body mass with performance on the 8 tests: standing long jump, Pro-Agility test, weighted pull-up, body weight bench press, 1 repetition maximum (1RM) deadlift, 274-m shuttle run, 4.83-km run, and 800-m swim. Linear regression analysis was used to analyze the relationship of body mass to performance; a second-degree polynomial was used to determine best-fit curves for each of the physical fitness tests; analysis of variance was used to examine differences in performance between body mass groups. Significantly better performance for lighter subjects was found in the Pro-Agility test, weighted pull-up, body weight bench press, 274-m shuttle run, and 4.83-km run. Heavier subjects performed better in the 1RM deadlift. Second-degree polynomial regression revealed optimum body mass for the Pro-Agility test, 274-m shuttle run, and 4.83-km run to be 7-16 kg heavier than the lowest body mass. These findings could help professionals better assess and train operators of varying body size.

Outcomes of home parenteral nutrition in 34 patients with intestinal failure from recurrent or progressive peritoneal malignancy of gastro-intestinal tract origin.

OBJECTIVES: To investigate the outcomes of 34 patients with intestinal failure secondary to advanced peritoneal malignancy on home parenteral nutrition (HPN). METHODS: A retrospective analysis of all known patients receiving HPN at any time between January 2012 and the 31st March 2020 registered in a high volume peritoneal malignancy surgical centre database. RESULTS: The median duration of HPN for all patients was 309.5 days (range 31-2198). Overall 11/34 went on to have multivisceral transplants. Of these 5/11 resumed normal oral intake off HPN, 3 died and 3 required ongoing HPN. Average time on HPN for patients with pseudomyxoma peritonei of appendix origin was 338 days (71-2198) compared with 90 days (31-260) in the group with more aggressive tumours. CONCLUSIONS: HPN is feasible and effective in selected patients with pseudomyxoma peritonei as either a bridge to transplant or definitive treatment. As expected, patients with more aggressive tumours fare worse.

Postoperative paralytic ileus after cytoreductive surgery combined with heated intraperitoneal chemotherapy.

BACKGROUND: Patients with peritoneal malignancy treated by cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) are prone to develop postoperative paralytic ileus (POI). POI is associated with significant increase in both morbidity and mortality. CRS and HIPEC commonly result in prolonged POI (PPOI). The objective was to clarify the extent of PPOI in patients treated by CRS and HIPEC for peritoneal malignancy. METHODS: This was a prospective multicenter study including patients operated with CRS and HIPEC at the Department of Surgery, Aarhus University Hospital, Denmark and the Peritoneal Malignancy Institute, Basingstoke, United Kingdom. A total of 85 patients were included over 5 months. Patients prospectively reported parameters of postoperative gastrointestinal function in a diary from post-operative day 1 (POD1) until discharge. PPOI was defined as first defecation on POD6 or later. RESULTS: Median time to first flatus passage was 4 days (range 1-12). Median time to first defecation was 6 days (1-14). Median time to removal of nasojejunal tube was 4 days (3-13) and 7 days (1-43) for nasogastric tube. Forty-six patients (54%) developed PPOI. Patients with PPOI had longer time to first flatus (p<0.0001) and longer time to removal of nasojejunal tube (p=0.001). Duration of surgery correlated to time to first flatus (p=0.015) and time to removal of nasogastric or nasojejunal tube (p<0.0001) but not to time to first defecation (p=0.321). CONCLUSIONS: Postoperative gastrointestinal paralysis remains a common and serious problem in patients treated with CRS and HIPEC.

Macular vessel density versus ganglion cell complex thickness for detection of early primary open-angle glaucoma.

BACKGROUND: To evaluate the macular vessel density (VD) and ganglion cell complex (GCC) thickness in pre-perimetric (PPG) and early perimetric primary open-angle glaucoma (PG) eyes, and to compare the diagnostic ability of the two measurements to discriminate PPG and early PG eyes from healthy eyes. METHODS: Seventy-nine eyes in 72 subjects (31 normal, 26 PPG, and 22 early PG eyes) were included in the consecutive case series. Macular VD and GCC thickness were acquired simultaneously using the 6 × 6 mm2 high-density AngioRetina scanning mode. Diagnostic abilities were assessed using the area under the receiver operating characteristic curve (AUROC). RESULTS: Compared to healthy eyes, whole image VD (wiVD) and GCC thickness were significantly lower in PPG and early PG eyes (all P < 0.025). The percent reduction of wiVD was lower than that of GCC thickness in early PG eyes (P < 0.05), while they were similar in PPG eyes (P > 0.05). Regionally, greater VD attenuation and GCC thinning were identified in the perifovea than in the parafovea in both groups (all P < 0.05). Moreover, the percent reduction of VD was less than that of GCC thickness in the perifoveal region in PPG eyes (P < 0.05). The AUROCs for wiVD and GCC thickness were 0.824 and 0.881, respectively, in PPG eyes (P > 0.05), and 0.918 and 0.977, respectively, in early PG eyes (P > 0.05). CONCLUSIONS: Macular VD and GCC thickness significantly decreased in PPG and early PG eyes. The perifoveal region appeared to be more vulnerable to macular VD attenuation and GCC thinning in early glaucoma. Our results showed that macular VD measurements may be helpful for detecting and understanding early glaucomatous damage.

Towards sensor-based calving detection in the rangelands: a systematic review of credible behavioral and physiological indicators.

Calving is a critical point in both a cow and calf's life, when both become more susceptible to disease and risk of death. Ideally, this period is carefully monitored. In extensive grazing systems, however, it is often not economically or physically possible for producers to continuously monitor animals, and thus, calving frequently goes undetected. The development of sensor systems, particularly in these environments, could provide significant benefits to the industry by increasing the quantity and quality of individual animal monitoring. In the time surrounding calving, cows undergo a series of behavioral and physiological changes, which can potentially be detected using sensing technologies. Before developing a sensor-based approach, it is worthwhile considering these behavioral and physiological changes, such that the appropriate technologies can be designed and developed. A systematic literature review was conducted to identify changes in the dam's behavioral and physiological states in response to a calving event. Articles (n = 104) consisting of 111 independent experiments were assessed following an intensive search of electronic databases. Commonly reported indicators of parturition (n = 38) were identified, and temporal trend graphs were generated for 13 of these changes. The results compare trends in behavioral and physiological changes across a variety of animal-related factors and identifies several reliable indicators of parturition for detection with sensors, namely calf grooming behavior, changes in rumination duration, and lying bouts. This synthesis of literature suggests that variability exists between individuals and thus, combining several calving indicators may result in a more broadly applicable and accurate detection of parturition.

Aerobic Recovery after Radical Prostatectomy: A Case Study.

PURPOSE: This case study examined the recovery after radical prostatectomy (RP) of an endurance-trained 65-yr-old man. METHODS: A maximal incremental exercise test and a 1-h steady-state test were performed just before and 3 months after robotic RP to determine maximal oxygen consumption (V˙O2max) and other cardiorespiratory variables. The patient recorded his training as he prepared for an endurance event that was to occur 3 months after RP, the Norwegian Foot March, a 30-km road march carrying 11.4 kg. RESULTS: In the month before RP, the patient performed 2 to 3 h of vigorous-intensity aerobic exercise per week, fast walking carrying an 11.4-kg pack, with the longest individual session being a 16-km road march. Just before surgery, V˙O2max was 36.7 mL·min·kg, HR during 30 min at 7.2 km·h and 0% grade was 77% of HR reserve (HRR), and during 30 min at 5.3 km·h and 10% grade was 92% HRR. On postsurgery day 44, he did a 19-km road march carrying 11.4 kg, exceeding the training level of the month presurgery. Three months postsurgery, V˙O2max was 42.7 mL·min·kg, and HR during the flat and uphill 30-min sessions at the same absolute intensity as presurgery were 70% and 83% HRR, respectively. He completed the Norwegian Foot March 93 d postsurgery in 4:24:37, with an average HR of 72% HRR. CONCLUSIONS: This case study demonstrates that an aerobically trained prostate cancer patient can return to high-level aerobic training in as little as 7 wk post-RP, and even exceed presurgery fitness. This finding has implications for prognosis given the beneficial effect of vigorous-intensity exercise on prostate cancer progression.

The Role of Schlemm's Canal Endothelium Cellular Connectivity in Giant Vacuole Formation: A 3D Electron Microscopy Study.

Purpose: We investigated whether cellular connectivity between Schlemm's canal (SC) inner wall (IW) endothelium, and juxtacanalicular connective tissue (JCT), and between IW endothelial cells, plays a role in giant vacuole (GV) and pore formation by comparing perfusion- and immersion-fixed eyes. Methods: Normal human donor eyes (n = 4) were either immersion-fixed (0 mm Hg) or perfusion-fixed (15 mm Hg). Trabecular meshwork near SC was imaged using serial block-face scanning electron microscopy. A total of 12 IW cells from each group were 3D-reconstructed from ∼7040 electron micrographs and compared. In each cell, connections between IW cells and JCT cells/matrix were quantified; IW/IW connectivity was measured by cell border overlap length. GV volume, density, shape, and intracellular and paracellular pores were analyzed. Results: The mean number of IW/JCT cell-cell connections per cell significantly decreased (P < 0.01) while the summed GV volume per cell significantly increased (P < 0.01) in perfusion-fixed eyes compared to immersion-fixed eyes. Intracellular pores were observed in 14.6% of GVs in perfusion-fixed eyes and not observed in immersion-fixed eyes. The mean IW/IW overlap length per cell decreased (P < 0.01), and paracellular pores were found only in regions where IW/IW connectivity was minimal (overlap length = 0 µm) in perfusion-fixed eyes and not observed in immersion-fixed eyes. Conclusions: Our data suggest that changes in IW/JCT connectivity may be an important factor in the formation of larger GVs, and decreased IW/IW connectivity may promote paracellular pore formation. Targeting the IW/JCT and IW/IW connectivity may therefore be a potential strategy to regulate outflow resistance and IOP. .

Ammonia Inhalation Does Not Increase Deadlift 1-Repetition Maximum in College-Aged Male and Female Weight Lifters.

Vigil, JN, Sabatini, PL, Hill, LC, Swain, DP, and Branch, JD. Ammonia inhalation does not increase deadlift 1-repetition maximum in college-aged male and female weight lifters. J Strength Cond Res 32(12): 3392-3397, 2018-Ammonia inhalant use by powerlifters and weight lifters is a prevalent practice with little research support for improved performance. The purpose of this study was to investigate the effects of ammonia as a stimulant on athletic performance during a deadlift 1-repetition maximum (1RM) absolute strength test. Subjects (men: n = 10, mean ± SD age = 21 ± 1 year, mass = 72.5 ± 6.8 kg; and women: n = 10, age = 22 ± 5 years, mass = 66.2 ± 8.1 kg) were required to have at least 2 years of resistance training experience while lacking a history of asthma, lightheadedness, fainting, anaphylaxis, sickle cell traits, and other respiratory disorders. After a baseline 1RM test, subjects were paired by 1RM performance and gender, then randomly assigned in a counterbalanced treatment order to control (water) or ammonia trials after a minimum 72-hour recovery period for another 1RM test involving attempts at 100.0, 102.5, 105.0, and 107.5% of the established 1RM value. Testing was then repeated after the minimum rest period for the remaining trial. Results revealed the expected gender main effect for absolute deadlift 1RM (93.0 ± 29.5 [women]; 152.0 ± 29.5 kg [men]; p < 0.001), but no trial main effect (p = 0.874) or gender by trial interaction effect (baseline = 93.0 ± 15.3, 151.8 ± 42.3 kg; water = 92.0 ± 12.5, 150.9 ± 37.8 kg; ammonia = 92.5 ± 16.4, 153.4 ± 37.9 kg) for women and men, respectively (p = 0.559). Within the limitations of this study, there is no support for the practice of ammonia inhalation to improve deadlift 1RM in training or competition.

Do patients undergoing cytoreductive surgery and HIPEC for peritoneal malignancy need parenteral nutrition?

BACKGROUND: To analyse the duration of parenteral nutrition (PN) in patients treated for peritoneal malignancy with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) over a 2 year period at a single UK National referral centre. METHODS: A retrospective analysis of prospective data for all patients (n=321) who underwent CRS and HIPEC for peritoneal malignancy at the Peritoneal Malignancy Institute Basingstoke between April 1, 2013 and March 31, 2015.Duration of PN was compared between primary tumour site (appendix, colorectal, mesothelioma and other); completeness of CRS (complete CRS vs. major tumour debulking) and pre-operative nutritional assessment measures (including Mid Upper Arm Circumference). RESULTS: The median duration of PN was 9 days (range 2-87 days). A total of 13 % of patients had PN for less than 7 days and 6 % for 5 days or less. There was no significant difference in duration of PN between the different tumour sites. Two factors that may increase the duration of PN include having major tumour debulking (MTD) and a baseline MUAC<23.5 cm. CONCLUSIONS: Most patients who underwent CRS and HIPEC for peritoneal malignancy required PN for more than 7 days with poor pre-operative nutritional status and inability to achieve complete cytoreduction predictors of prolonged PN requirements.