Development of surgical techniques for implantation of a wireless intraocular epiretinal retina implant in Göttingen minipigs

Background

The aim of this study was to develop surgical methods for the implantation of a wireless intraocular epiretinal retina implant (EPI RET3) in Göttingen minipigs. This animal model resembles closely the anatomical conditions in humans, and is thus suitable for investigating the EPI RET3 implant as designed for the application in humans.

Methods

Phacoemulsification and vitrectomy was performed on the right eye of 16 Göttingen minipigs under general anesthesia. The implants, consisting of a receiver module and an electrode array connected via a flexible micro cable, were inserted through a corneoscleral incision. The receiver module was placed into the sulcus ciliaris and the electrode array was fixed onto the retina temporal to the optic disc with a retinal tack. Minipigs were monitored for intra- and postoperative ocular complications. Follow-up times were 3 (seven minipigs) and 12 weeks (nine minipigs).

Results

Implantation was successfully performed in all 16 minipigs. The complete implantation surgery required on average 2 hours. Intraoperative findings were a minor hemorrhage of the anterior chamber angle in two eyes, one minor iris hemorrhage, and one minor punctiform retinal hemorrhage, which were all reversible. Postoperatively, the corneoscleral incision showed good wound healing in all eyes. Intraocular reactions included mainly fibrin exudation (six eyes) and formation of iris synechiae with the receiver module of the implants (three eyes).

Conclusions

The performed implantation procedures of the intraocular EPI RET3 implant are feasible and reproducible within an acceptable surgical time. The development of inflammatory responses is a specific predisposition of the minipig following any intraocular intervention; nevertheless, the surgical techniques should be further improved to minimize procedure-related reactions. Our results provide a step towards the application of the EPI RET3 system in clinical studies.

     

Applications of wavefront technology

This review of wavefront technology looks at 2 major aspects. The first is the basics and principles of the optics of the eye, how to decompose the wavefront in a more adequate way for interpretation, and how these aberrations affect the visual acuity. It also addresses the diversity and complexity of wavefront sensors; how these devices transform the principles into clinically useful data, with the advantages and limitations of each system. The second major aspect is the clinical uses of the technology: wavefront-guided and newer and enhanced profiles related to wavefront as well as the limitations of the technology. Finally, recent innovations made possible by wavefront technology that are not limited to refractive surgery are reviewed. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.     

Bacterial Analysis of Peri-implantitis and Chronic Periodontitis in Iranian Subjects

Chronic periodontitis (CP) and peri-implantitis (PI) are multifactorial diseases of tooth and implant supporting apparatus. Bacterial invasion and consequent host immune response seem to play a role in relevant pathogenesis. The structural differences between tooth and implant pose preferential biofilm colonization. This study was aimed to compare the prevalence of bacteria in CP and PI. Clinical and radiographic examination performed over 69 individuals referred to Shahid Beheshti Dental School (Tehran, Iran) and four groups categorized: CP (n=22), HP (n=21), PI (n=13) and HI (n=13). The mean age was 45.6 years, 55% of participants were female and 45% were male. Bacterial samples were collected by paper point method and transferred to Institute of Odontology, University of Gothenburg (Gothenburg, Sweden) for checkerboard DNA-DNA hybridization. Kruskal-Wallis and Mann-Whitney U tests were used to compare distribution of bacteria in four groups. Significant differences were observed for T. forsythia, P. intermedia, C. rectus, P. endodontic, P. gingivalis, T. denticola and P. tannerae (P<0.05). The most prevalent bacteria in CP and PI were T. forsythia and P. gingivalis, respectively. In conclusion, bacterial prevalence differs significantly between tooth and implant. The most prevalent bacteria in Iranian subpopulation do not necessarily bear a resemblance to other populations. The type of implant surface may influence the biofilm. Other studies should be conducted to corroborate these findings.     

Fate and transport evaluation of potential leaching risks from cadmium telluride photovoltaics

Fate and transport analysis has been performed to evaluate potential exposures to cadmium (Cd) from cadmium telluride (CdTe) photovoltaics (PV) for rainwater leaching from broken modules in a commercial building scenario. Leaching from broken modules is modeled using the worst-case scenario of total release of Cd, and residential screening levels are used to evaluate potential health impacts to on-site workers and off-site residents. A rooftop installation was considered rather than a ground-mount installation because rainwater runoff is concentrated via building downspouts in a rooftop installation rather than being dispersed across large areas in a ground-mount installation. Fate and transport of Cd from leachate to soil are modeled using equilibrium soil/soil-water partitioning. Subsequent migration to ambient air as windblown dust is evaluated with a screening Gaussian plume dispersion model, and migration to groundwater is evaluated with a dilution-attenuation factor approach. Exposure point concentrations in soil, air, and groundwater are one to six orders of magnitude below conservative (residential soil, residential air, drinking water) human health screening levels in both a California and southern Germany (Baden-Württemberg) exposure scenario. Potential exposures to Cd from rainwater leaching of broken modules in a commercial building scenario are highly unlikely to pose a potential health risk to on-site workers or off-site residents.     

The use of weekly text messaging over 6 months was a feasible method for monitoring the clinical course of low back pain in patients seeking chiropractic care

ObjectiveThis study critically evaluates a new method of collecting frequent data using mobile phones and text messages. Fluctuating conditions such as low back pain (LBP) need frequent monitoring to describe the clinical course in detail and to account for individual and subgroup variations.Study Design and SettingIn this multicentre prospective observational study, 262 subjects with nonspecific LBP were followed with weekly text messages for 6 months, with the question “How many days this previous week has your low back pain been bothersome?” The text replies were instantly recorded in a data file to be merged with baseline and follow up data (age, gender, pain intensity, duration, and self- rated health) collected through ordinary questionnaires. The response rate, user-friendliness, and compliance of this method were evaluated.ResultsThe mean response rate for the text messages throughout the study was 82.5% and was unaffected by season. The method was found to be user friendly. Dropout was not affected by age and gender, but compliance was possibly somewhat affected by outcome.ConclusionWeekly text messages are a useful method of data collection to examine the clinical course of LBP in the primary care sector.     

Report of the NIH Task Force on Research Standards for Chronic Low Back Pain

Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum dataset to describe research participants (drawing heavily on the PROMIS methodology); reporting “responder analyses” in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement.PerspectiveA task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.     

Veno-occlusive disease of the liver after allogeneic bone marrow transplantation: possible association with graft-versus-host disease.

Acute veno-occlusive disease of the liver developed in seven of 29 patients undergoing bone marrow transplantation for treatment of leukemia, aplastic anemia, or disseminated carcinomatosis. All seven died despite successful marrow engraftment. Hepatic failure was the principal cause of death in four and contributory in three. The veno-occlusive disease did not relate to the nature of the pretransplant immunosuppressive regimen, since it occurred in patients receiving irradiation alone, chemotherapy alone, or both. Twenty-two of the patients were autopsied. Among these, the lesion was found in seven of 11 in whom a graft-versus-host reaction developed but in none of the 11 without such a reaction who had received similar pretransplant immunosuppression (P less than 0.025). Hence, acute veno-occlusive disease of the liver appears to be a complication of allogeneic bone marrow transplantation related to the development of a graft-versus-host reaction.