Excellent Dielectric Properties and Finite Element Simulation of Al-Epoxy Composites with Constructed Ultrathin Al2O3 Parallel-Plate Microcapacitors.

Metal-polymer dielectric composites show promising potential as embedded capacitors, whereas it remains a great challenge to achieve a high dielectric constant (εr) and low dielectric loss (tan δ) simultaneously. This work demonstrates a strategy for overcoming this challenge. Al nanoparticles with self-passivated ultrathin Al2O3 shells are compacted under the uniaxial pressure (P), and Al-epoxy composites are prepared by curing the liquid epoxy monomer that infiltrates into Al compacts. The contacting regions between adjacent Al nanoparticles are flattened and enlarged during the compacting process, so that the ultrathin Al2O3 parallel-plate microcapacitors are constructed by the insulating Al2O3 shells and conductive Al cores. The composite with P of 100 MPa and Al volume fraction (υAl) of 53.7% exhibits the εr of 189 at 10 kHz, which is much higher than the εr (48-102) of 0-3 type Al-polymer composites with similar υAl and even higher than the highest εr (160) reported in the Al-polymer composite with υAl > 80%. Furthermore, the present composites show low tan δ (<0.03) and good frequency and temperature stability of εr. The finite element simulation proves that the construction and enlargement of ultrathin Al2O3 parallel-plate microcapacitors dramatically increase the electric energy stored in Al2O3 and therefore greatly improve the εr.

Fabrication of a facial prosthesis for a 13-year-old child by using a point-and-shoot three-dimensional scanner and CAD/CAM technology.

Patients cannot wear ocular prostheses after undergoing orbital exenteration. They require a facial prosthesis to obtain a more favorable appearance, which greatly affects their social life and psychological health. In addition, conventional prosthesis-making processes require substantial time and expense. The economic burden is particularly heavy on children, who may require many prosthesis replacements as they mature. We report a method of fabricating a facial prosthesis by three-dimensional (3D) facial scanning and 3D printed for a 13-year-old girl who underwent partial orbital exenteration for malignant ciliary body medulloepithelioma 2 years ago. The patient's facial contour was captured with a hand-held, point-and-shoot 3D scanner. A facial prosthesis was designed using a mirror image technique with 3D modeling software and 3D printed. The prosthesis was then postprocessed and cast in silicone rubber. An ocular prosthesis was integrated into the facial prosthesis. The prosthesis was retained by prosthetic adhesives. This digitally assisted, impression-free method may lower the cost and effort of making facial prostheses and improve patient comfort, especially for children.

Equivalent legibility font size for traditional Chinese character compared to early treatment diabetic retinopathy study near visual acuity.

PURPOSES: To investigate the legibility of a standardized logarithmic print size of traditional Chinese (TC) characters and compare it with Early Treatment Diabetic Retinopathy Study (ETDRS) near chart. MATERIALS AND METHODS: A total of 1243 commonly used TC characters were chosen and divided into three groups according to its stroke complexity: Group A with 2-9 strokes, Group B with 10-17 strokes, and Group C with 18-25 strokes. For each group of characters, near charts were created using randomly chosen characters arranged in decreasing logarithmic size. In a well-illuminated room, healthy controls were fully corrected to test both ETDRS near chart and our set of TC near charts. The smallest legible font sizes (SLFS) in TC near charts were recorded and analyzed. RESULTS: Forty-two healthy eyes (21 participants) (age 29 ± 8.9 years old) were included. The mean near best-corrected visual acuity (nBCVA) in ETDRS chart was 0.06 ± 0.05 logMAR. We found that the mean SLFS in TC charts (0.33 ± 0.09 logMAR) was significantly larger than the nBCVA in ETDRS chart (P < 0.001). The SLFS of Group B and the SLFS of Group C was significantly larger than that of Group A (P < 0.001). CONCLUSION: According to our results, to recognize TC characters, normal-sight readers need a 0.22-0.30 logMAR (1.7-2.0 fold) enlargement of the acuity size measured by ETDRS near chart. The low-stroke TC charts may provide a new method to assess the postsurgical outcomes for comparable functional visual acuity in reading TC characters.

Obtaining Greatly Improved Dielectric Constant in BaTiO3-Epoxy Composites with Low Ceramic Volume Fraction by Enhancing the Connectivity of Ceramic Phase.

Ceramic-polymer dielectric composites show promising potential as embedded capacitors, whereas it is a great challenge to obtain a high dielectric constant (εr) at a low ceramic volume fraction (Vc). This work demonstrates a strategy for overcoming this challange. By employing a high sintering temperature (Ts) and introducing porogen, BaTiO3 ceramics with both great connectivity and high porosity are obtained, and the composites with improved εr at a low Vc are prepared after curing the epoxy monomer, which is infiltrated into the porous ceramic bodies. For the composite with a Ts of 1300 °C and a Vc of 38.1%, the εr is as high as 466.8 at 1 kHz, which is improved by about nine times compared to the 0-3 counterpart with a higher Vc of 60.8%. Furthermore, the composite exhibits low dielectric loss and good frequency and temperature stability of εr, indicating the great potential for practical applications. Finite element simulation shows that the enhanced connectivity of BaTiO3 increases the electric field intensity in high-εr BaTiO3 dramatically and therefore plays a key role in the dielectric response of the composite. This work not only sheds light on the high-εr ceramic-polymer composites but also deepens the understanding on the relationship between their properties and microstructures.

Debulking Surgery Combined with Low-Dose Oral Prednisolone and Azathioprine for Intractable IgG4-Related Orbital Disease: A Case Report.

A case of intractable IgG4-related orbital disease (IgG4-ROD) was successfully treated by debulking surgery combined with low-dose prednisolone and azathioprine as maintenance therapy. A 64-year-old man visited our clinic with progressive bilateral upper eyelid swelling and right eye fullness of a year's duration. He was previously treated with systemic corticosteroids for the IgG4-ROD and experienced a partial clinical response but relapsed upon prednisolone cessation. The patient underwent debulking surgery of the right lacrimal gland and right upper eyelid. His post-operative medication was oral prednisolone (5 mg) every other day and 50 mg azathioprine per day. The patient's right eye remained asymptomatic during the 18 months of follow-up. Debulking surgery combined with low-dose prednisolone and azathioprine, as a maintenance therapy, is an effective and alternative treatment for the long-term control of intractable IgG4-ROD.

An Association Rule Analysis of Combined Acupoints for the Treatment of Patients with Dry Eye Disease.

BACKGROUND: Dry eye disease (DED) has a higher incidence in old age and is seen predominantly in females worldwide. Neurosensory abnormalities, ocular surface inflammation and damage, film instability, and hyperosmolarity are major and proven pathologies responsible for a poor quality of life. Tear breakup time and Schirmer's I test are predominantly used for the evaluation of primary outcomes in patients undergoing conventional treatment. A previous meta-analysis of some relevant studies proved that combination of acupoints could be more effective than single acupoint treatment. OBJECTIVES: The present study aimed to undertake association rule mining and examined the potential kernel acupoint combination in DED treatment constructed from the extracted randomized controlled trials (RCTs) based on a previous meta-analysis. METHODS: We summarized 32 acupoints as binary data from the 12 eligible RCTs and analyzed them based on the Apriori algorithm. RESULTS: TE23, BL2, ST2, ST1, EX-HN5, BL1, LI4, ST36, SP6, and KI3 were the 10 most frequently selected acupoints. The major associated rules in combination of acupoints were {TE23, LI4} ≥ {ST1} and {TE23, ST1} ≥ {LI4}, as inferred from 23 association rules. CONCLUSIONS: For acupuncture treatment of DED, combined TE23, LI4, and ST1 acupoints could be settled as the kernel of acupoint combination.

Broad-band, reversible nonreciprocal light transmission based on a single nanocavity.

We present a general yet simple method for achieving broad-band, high-contrast-ratio, and reversible all-optical diodes. The mechanism is based on the controllable photonic transitions inside a nonlinear nanocavity, triggered by only one pulse. We demonstrate that the interaction between the signal, pump pulse, and the cavity mode plays a crucial role in dynamically controlling the nonreciprocal light transmissions. Using this mechanism, we show that the nonreciprocal light transmission can be controllably reversed without changing the signal light's wavelength or power, with a broad operation bandwidth over 7.5nm and a transmission contrast rate over 20dB. This approach provides a promising avenue in flexible manipulation of on-chip all-optical signal processing.

Long-Term Results of Autologous Auricular Cartilage Graft Applied in Anophthalmic Orbits Unable to Wear Prosthesis.

In anophthalmic patients, shallow lower fornices make wearing ocular prostheses impossible and maintaining normal social activities difficult. This study retrospectively investigated the long-term surgical outcomes of autologous auricular cartilage grafting for contracted orbits. From 1995 to 2013, 29 anophthalmic contracture sockets with inadequate lower fornices and poor prosthesis retention presented to Chang Gung Memorial Hospital in Linkou, Taiwan, were treated using this surgical method. The success rate, aesthetic outcome, recurrence, and complications were analyzed. Among the 29 patients, 15 were women, 14 were men, their mean age was 45 years, and the mean follow-up time was 52 months (range = 6-159 months). Satisfactory lid position was achieved in 25 cases (86%), and lower fornix retraction recurred in four cases (14%). Neither donor site morbidity nor auricular deformity was noted during the follow-up period. Therefore, an auricular cartilage graft can be used successfully as a compatible spacer for anophthalmic patients with shallow lower fornices and prosthesis-fitting problems in long-term follow-up.

Klebsiella pneumoniae Orbital Cellulitis: Clinical Manifestations and Outcomes in a Tertiary Medical Center in Taiwan.

PURPOSE: To report six cases of Klebsiella pneumoniae orbital cellulitis without preceding endophthalmitis. METHOD: Retrospective chart review. RESULTS: We reported four females and two males admitted to our hospital for Klebsiella pneumoniae orbital cellulitis proven by computed tomographies and bacterial cultures from May 1995 to March 2017. Proptosis, conjunctival congestion, and chemosis and limitation of ocular motility were present in all six patients. Four patients had decreased visual acuities, and three of them recovered completely after treatment. The origin of the infection was sinus in four patients, skin wound in one patient, and sepsis presumably caused by a dental procedure in one patient. Three of all six patients had underlying diabetes mellitus. Two patients had orbital cellulitis before they were diagnosed of diabetes during hospital stay. CONCLUSION: Diabetes may be a risk factor of Klebsiella pneumoniae orbital cellulitis, especially for those of nonsinus origin.

The healing effect of the collagen-glycosaminoglycan copolymer on corneal thinning.

BACKGROUND: To study the healing processes of partial thickness wounds in the adult rabbit cornea after grafting a porous collagen-glycosaminoglycan copolymer matrix (CG). METHODS: In this study, the regeneration of surgically-induced rabbit corneal defect implanted with CG was investigated. The corneal partial thickness wound was created by 7.5 mm trephine. The wound was implanted with CG. Effects on wound healing was analyzed using clinical data on epithelial migration and corneal thickness, and histological data on collagen and alpha smooth muscle actin distribution. RESULTS: Compared with control group, CG induced a relatively severe inflammatory reaction in grafted cornea until the CG matrix was completely degraded. The new vessel ingrowth and stromal regeneration maintained the corneal thickness. The grafted cornea was significantly thicker (P < 0.001) than the control group. On day 90, the corneal opacity score of the control group was one and the grafted cornea was two. CONCLUSION: CG copolymer matrix can successfully repair the damaged corneal stroma by injury, and regain its thickness. However, CG matrix induced inflammatory healing process thus causing mild corneal haziness and neovascularization.

Early Versus Late Canalicular Laceration Repair Outcomes.

PURPOSE: To determine whether delayed repair of traumatic canalicular laceration affects the final outcome. DESIGN: Retrospective case series. METHODS: The medical records of 334 patients who underwent primary traumatic canalicular laceration repair were retrospectively reviewed. Patients were divided into 2 groups according to the surgical timing within 48 hours (early) or after 48 hours (delayed). The anatomic results were compared between these 2 groups. The causes of delayed repair and the mean operation time were also analyzed. RESULTS: There were 23 failed cases among 301 patients (7.6%) who had a repair within 48 hours and 3 failed cases among 33 patients (9.1%) who had a repair after 48 hours (P = .732). The mean operation time was 62 minutes in the early group and 66.3 minutes in the delayed group, which showed no significant difference (P = .371). The major cause of delayed surgery was traumatic brain injury, followed by facial or orbital fracture, long bone fracture, and chest injury. CONCLUSIONS: Delayed canalicular repair in unstable patients did not lead to poor results. An elective scheduling surgery, instead of an urgent repair, is feasible for an experienced surgeon.

Malignant Ciliary Body Medulloepithelioma With Brain and Parotid Metastasis.

A 12-year-old girl with malignant ciliary medulloepithelioma and parotid metastasis was treated with semi-exenteration of the orbit and external beam radiotherapy. She had brain metastasis 7 months later and was treated with salvage chemotherapy. The patient was disease free at 11 months of follow-up. In aggressive cases, exenteration combined with radiotherapy and chemotherapy are necessary for disease control. [J Pediatr Ophthalmol Strabismus. 2017;54:e18-e22].

Factors Associated With Surgical Outcomes in Congenital Ptosis: A 10-Year Study of 319 Cases.

PURPOSE: To evaluate the 10-year results of surgery for congenital ptosis and identify factors associated with excellent outcomes and recurrence. DESIGN: Retrospective, interventional case series. METHODS: A retrospective analysis was conducted of 319 patients who underwent surgical correction at a tertiary medical center for congenital ptosis. The main outcome measures were postoperative surgical outcomes and recurrence rates. Excellent lid height was assessed as a marginal reflex distance (MRD) greater than 3 mm. Recurrence was defined as a lid height less than 50% of the initial postoperative lid height. RESULTS: The overall surgical success rate was 97.2%. On multivariate analysis, 3 factors were significantly associated with a greater probability of achieving excellent lid height: treatment using levator muscle resection (LMR) (adjusted odds ratio [OR], 1.76; P = .04), better preoperative MRD (adjusted OR, 2.21; P < .001), and absence of Marcus Gunn (jaw-winking) syndrome (adjusted OR, 0.12; P = .01). For recurrence, 7 significant risk factors were identified: children less than 1 year old (adjusted OR, 4.92; P = .02), poorer preoperative MRD (adjusted OR, 0.64; P = .04), poorer postoperative MRD (adjusted OR, 0.32; P < .001), treatment with frontalis suspension (FS) (adjusted OR, 5.86; P < .001), wound infection (adjusted OR, 9.45; P = .02), postoperative entropion (adjusted OR, 11.25; P = .003), and conjunctival prolapse (adjusted OR, 7.10; P = .03). Kaplan-Meier analysis showed that the 1-, 5-, and 10-year recurrence-free rates were 97.3% ± 1.2%, 80.5% ± 4.4%, and 76.7% ± 5.6%, respectively, for the LMR group and 90.9% ± 3.1%, 42.9% ± 8.1%, and 20.8% ± 10.1%, respectively, for the FS group (P < .001, log-rank test). CONCLUSIONS: Surgical treatment of congenital ptosis had a high success rate. Identifying the risk factors and taking appropriate measures may result in better surgical outcomes and less recurrence. Our retrospective study showed that the likelihood of achieving excellent outcomes with lower recurrence rates was higher with LMR than with FS. However, a prospective randomized study is necessary to clarify their efficacy.

Correction of involutional entropion with retractor redirection.

The study aims to report the surgical outcome of a retractor redirection procedure for involutional entropion repair for Asians. The study included all cases diagnosed with involutional entropion and significant ocular irritation who presented from 2008 to 2012. Sixty-seven eyelids in 54 patients were included in this study. All cases were operated on by one surgeon and had a minimum of 12-months follow-up. Success was defined as cases showing no recurrence of entropion with forceful eyelid squeezing postoperatively. A retrospective chart review was performed to assess the success rate, recurrences and complications of the procedure. During a mean follow-up period of 26.2 months (range, 12-53 months), 5 patients died during the study period. Two eyelids (3%) of one patient had a recurrence at 34 months postoperatively. One eyelid (1.5%) with a significant horizontal laxity developed postoperative ectropion and required a secondary horizontal shortening procedure. No other postoperative complications or dissatisfaction were reported. The retractor redirection procedure aims to repair the retractors and prevent orbicularis muscle overriding via inserting the retractors to the anterior lamellae. It yields a long-term success rate of 95.5% and is an effective technique for correcting involutional entropion.

Expression of retinoic acid-binding proteins and retinoic acid receptors in sebaceous cell carcinoma of the eyelids.

BACKGROUND: Sebaceous cell carcinoma of the eyelid is a malignant tumor. However, the pathoetiology of sebaceous cell carcinoma is not clear. Retinoic acid (RA) signaling is essential for skin epidermal differentiation including the eyelids. In this study, we investigate the expression of ß-catenin, RA-binding proteins and RA receptors in sebaceous cell carcinoma of the eyelid and try to estimate their influence on its pathoetiology. METHODS: Retrospective, noncomparative, consecutive interventional case series. Sixteen cases of eyelid sebaceous gland carcinoma who received tumor excision at our hospital between 2001 and 2011 were included. Immunohistochemical staining for ß-catenin, cellular retinoic acid binding protein 1 (CRABP1), cellular retinoic acid binding protein 2 (CRABP2), fatty acid-binding protein 5 (FABP5), retinoic acid receptors (RAR-α, -ß, -γ), and retinoid X receptors (RXR-α, -ß, -γ) was performed on tissue samples obtained from tumor excision. RESULTS: Of the 16 sebaceous cell carcinoma cases reviewed, six were male and 10 female. The mean follow-up period was 6.7 ± 3.66 years (range, 0.3-13 years). Of these 16 cases, the expression of ß-catenin was significantly increased in sebaceous cell carcinoma cases. CRABP1 was similarly expressed in the sebaceous cell carcinoma and control groups. CRABP2 and FABP5 were expressed in hair follicles of lid skin in both groups, whereas the CRABP2 and FABP5 were aberrantly expressed in the tumor cells of the sebaceous glands. Notably, the expression of retinoic acid receptor (RAR-ß) and retinoid X receptors (RXR-ß, -γ) was significantly upregulated in sebaceous cell carcinoma of the eyelids. CONCLUSIONS: Our findings indicate that retinoic acid signaling is related to the pathogenesis of sebaceous cell carcinoma of the eyelids.

Use of extraocular muscle flaps in the correction of orbital implant exposure.

PURPOSES: The study is to describe a new surgical technique for correcting large orbital implant exposure with extraocular muscle flaps and to propose a treatment algorithm for orbital implant exposure. METHODS: In a retrospective study, seven patients with orbital implant exposure were treated with extraocular muscle flaps. All data were collected from patients in Chang Gung Memorial Hospital, Taiwan during 2007-2012. All surgeries were performed by one surgeon (Y.J.T). Patient demographics, the original etiology, details of surgical procedures, implant types, and follow-up interval were recorded. Small exposure, defined as exposure area smaller than 3 mm in diameter, was treated conservatively first with topical lubricant and prophylactic antibiotics. Larger defects were managed surgically. RESULTS: Seven patients consisting of two males and five females were successfully treated for orbital implant exposure with extraocular muscle flaps. The average age was 36.4 (range, 3-55) years old. Five patients were referred from other hospitals. One eye was enucleated for retinoblastoma. The other six eyes were eviscerated, including one for endophthalmitis and five for trauma. Mean follow-up time of all seven patients was 19.5 (range, 2-60) months. No patient developed recurrence of exposure during follow-up. All patients were fitted with an acceptable prosthesis and had satisfactory cosmetic and functional results. CONCLUSIONS: The most common complication of orbital implant is exposure, caused by breakdown of the covering layers, leading to extrusion. Several methods were reported to manage the exposed implants. We report our experience of treating implant exposure with extraocular muscle flaps to establish a well-vascularized environment that supplies both the wrapping material and the overlying ocular surface tissue. We believe it can work as a good strategy to manage or to prevent orbital implant exposure.

Analysis of visual outcomes and complications following levator resection for unilateral congenital blepharoptosis without strabismus.

BACKGROUND: It is challenging to manage congenital blepharoptosis, especially unilateral, because symmetry is difficult to achieve under general anesthesia and age at which the ptosis should be corrected is still controversial. The aim of our study is to analyze visual and surgical outcomes after levator resection for unilateral congenital blepharoptosis. METHODS: Charts of patients with unilateral congenital blepharoptosis who underwent levator resection at the Chang Gung Memorial Hospital from 1991 through 2000 were reviewed. The resultant database was interrogated for demographic data, severity, surgical timing, visual outcomes, surgical outcomes, and complications. RESULTS: Eighty-four children underwent levator resection for unilateral congenital blepharoptosis: 16.7% of these patients had amblyopia and 84.5% had surgical success following levator resection. Severe ptosis (p = 0.0288, p < 0.05) and surgery at less than 2 years of age (p = 0.0126, p < 0.05) were the important factors contributing to surgical failure. Age at surgery (p = 0.0058, p < 0.01) and amblyogenic ametropia (p = 0.0001, p < 0.001) were found to be significantly associated with the postoperative visual results. CONCLUSION: The levator resection provides satisfactory results both in function and cosmesis in patients with unilateral congenital blepharoptosis. Amblyogenic ametropia is the leading cause of amblyopia in the patients with unilateral isolated congenital blepharoptosis. However, patients with unilateral congenital blepharoptosis should have cycloplegic refraction as early as possible, and their visual status monitored until visual maturity.

To explore the neonatal nurses' beliefs and attitudes towards caring for dying neonates in Taiwan.

(1) To explore attitudes and beliefs of neonatal nurses toward nursing care for dying neonates; (2) to estimate the influence of neonatal nurses' personal and professional characteristics on their attitudes towards end-of life care for dying infants. A cross-sectional design was used. A questionnaire was used to collect data from 80 neonatal nurses. Research setting was four level III NICUs at four medical centers around the central region of Taiwan. Research participants were neonatal nurses who had worked for at least 1 year in one of level III NICUs and had been directly involved with the care of dying infants. Research participants were 80 neonatal nurses (response rate 100 %). Research findings identified eight barriers hindering neonatal palliative care practice. These barriers were insufficient communication due to the lack of an in-service educational program; the lack of available counseling help for neonatal clinicians; inability to express personal opinions, values and beliefs towards neonatal palliative care; insufficient staffing; the lack of unit policies/guidelines for supporting palliative care; the technological imperative; parental demands and personal beliefs about death and previous experience caring for dying infants. Further studies are needed to explore each barrier and to provide in-service neonatal palliative care educational programs that are needed to decrease these barriers.

Comparing pericanalicular sutures with direct canalicular wall sutures for canalicular laceration.

PURPOSE: To determine whether a statistically significant difference exists between direct canalicular wall sutures (DCs) and pericanalicular sutures (PCs) in the repair of traumatic canalicular lacerations. METHODS: The medical records of 63 patients who underwent primary repairs for traumatic canalicular lacerations were retrospectively reviewed. Patients were divided in 2 groups according to the suturing techniques used: the DC group (n = 41) and the PC group (n = 22). Anatomic results were compared between these 2 groups. A successful result was determined by attempted irrigation and probing of the injured canaliculus at the last follow-up visit. RESULTS: There were 6 failed procedures among the patients who underwent pericanalicular repair and 1 failed procedure among the patients who underwent direct canalicular wall repair (p = 0.024). CONCLUSIONS: These data support the higher success rates in patients treated with direct canalicular repair compared with pericanalicular repair.

Orbital blow-out fractures in children: characterization and surgical outcome.

BACKGROUND: Trapdoor-type orbital fractures usually associated with marked motility restriction are common in the pediatric age group. We reviewed the characterization and surgical outcomes of orbital blow-out fracture in children. METHOD: This is a retrospective review study. From Jan. 1997 to Dec. 2006, 75 patients under 18 years of age with orbital blow-out fractures were seen in the department of ophthalmology, Chang Gung Memorial Hospital. The medical records and computed tomography scans of these patients were reviewed. RESULTS: Forty-one patients were identified whose records were adequate to compare data. The mean age of the patients was 12.7 years and the mean duration of follow-up was 6.5 months. The most common causes of injury were assault (43.9%) and motor vehicle accidents (29.3%). Ninety-five percent of the patients had diplopia and ninety-three percent had extraocular muscle limitation. The incidence of trapdoor fracture in pediatric orbital fracture was 68.3%. Orbital blow-out fractures in these children most frequently involved the isolated orbital floor. The average time to surgical intervention was 23 days after injury; 53.8% patients received immediate (0-2 days) or early (3- 14 days) repair. Improvement from preoperative supraduction limitation was statistically significant in the immediate (0-2 days), early (3-14 days) and delayed (15-30 days) surgical groups. CONCLUSION: Orbital blow-out fractures in our pediatric patients were usually the result of assault or motor vehicle accident. Surgical repair within one month of injury led to better improvement and more complete resolution of ocular motility limitation and diplopia than late repairs.