Transpedicular screw fixation has been accepted worldwide since Harrington et al. first placed pedicle screws through the isthmus. In vivo and in vitro studies indicated that pedicle screw insertion ...accuracy could be significantly improved with image-assisted systems compared with conventional approaches. The O-arm is a new generation intraoperative imaging system designed without compromise to address the needs of a modern OR like no other system currently available. The aim of our study was to check the accuracy of O-arm based and S7-navigated pedicle screw implants in comparison to free-hand technique described by Roy-Camille at the lumbar and sacral spine using CT scans. The material of this study was divided into two groups, free-hand group (group I) (30 patients; 152 screws) and O-arm group (37 patients; 187 screws). The patients were operated upon from January to September 2009. Screw implantation was performed during PLIF or TLIF mainly for spondylolisthesis, osteochondritis and post-laminectomy syndrome. The accuracy rate in our work was 94.1% in the free-hand group compared to 99% in the O-arm navigated group. Thus it was concluded that free-hand technique will only be safe and accurate when it is in the hands of an experienced surgeon and the accuracy of screw placement with O-arm can reach 100%.
The PM is believed to be one facet of the cellular mechanisms involved in adaptation to saline conditions. Alterations in the PM components in response to salinity are therefore anticipated to ...contribute to plant salt tolerance. The review provides a comprehensive overview of the recent findings describing the crucial roles of the PM components in plant acclimation to salt stress. The responses of the PM proteins and lipids to salinity in contrasting species/cultivars were therefore discussed. The relationship between alterations in the lipids and proteins of the PM and tolerance to salt stress is also addressed. Several lines of evidence were presented demonstrating correlation of modifying the PM composition with adaptation of plants to high salinity. Even if contradictory results have been observed, the roles of the PM lipids and proteins appeared to be of great importance for tolerance to high salinity. Despite the promising results, more research should be carried out at the molecular level to further evaluate the roles of some of the PM components in salt tolerance.
In this study, the volatile compound profiles of gurum seed oil were determined using two methods: supercritical CO2 extraction (SFE) and the screw press process (SPP). For volatile compounds ...extraction and identification, headspace solid-phase micro-extraction (HS-SPME) and GC–MS were used, respectively. A total number of 56 volatile compounds were revealed and identified in oil extracted by SFE, while only 40 compounds were detected in extracted oil by SPP. Acids, aldehydes, esters, ketones, furans, and other components were present in the highest ratio in oil extracted by SFE. In contrast, alcohols and alkenes were found in the highest proportion in oil extracted by SPP. In this study, it was observed that SFE showed an increase in the amounts of volatile compounds and favorably impacted the aroma of gurum seed oil. The results reveal that different extraction methods significantly impact the volatile components of gurum seed oil, and this study can help evaluate the quality of the oil extracted from gurum seeds.
We aimed to assess the efficacy of the injections of platelet rich plasma (PRP) for the treatment of severe dry eye disease (DED).
In this retrospecitve interventional clinincal study, we included 28 ...eyes of 14 patients with severe DED who were diagnosed with Sjogren syndrome. Each patient received unilateral lacrimal gland injection of PRP at days 0, 30, 60 and 90 days while the other eye served as control group who received preservative free eye drops. We objectively assessed parameters at baseline, 1 month, 2 months and 3 months including ocular surface analyzer (OSA) namely; noninvasive tear breakup times (NIBUT), tear meniscus height (TMH), lipid layer thickness (LLT) in addition to the Schirmer test I, corneal fluorescein staining (CFS) and meiboscore. The mean age was 43.4 ± .7.85 years. Comparing different parameters, baseline data showed non-significant difference between injected eye group and control group. After 1 and 3 months of follow up, there were significant differences between both groups regarding NITBUT, TMH, LLT, CFS and Schirmer test, with p < 0.001 in favor of PRP group.
Injection of PRP in lacrimal gland is simple, safe, and effective technique in treatment of severe dry eye; proved by improvement of tear film parameters through subjective and objective assessment. Further studies are needed to standardize the technique and to confirm these results.
Aim The aim of this study was to evaluate the use of autologous serum (AS) eye drops versus lacrimal gland injection of platelet-rich plasma (PRP) in the treatment of severe dry-eye disease (DED). ...Setting and design This is a prospective comparative interventional study that was carried out at Eye Tech Centre, Alexandria, Egypt. Patients and methods The study included 40 eyes of 20 patients with severe DED. They were randomized into two groups: group A received lacrimal gland injection of PRP transcutaneously into the external one-third of the orbital rim at a depth of 4 mm to the superior area on days 0, 30, 60, and 90, while group B received AS eye drops five times daily for the duration of the study. Both groups received preservative-free artificial tears eye drops (hyaluronic acid) —three to five times daily for the study duration. The patients were followed up for 12 weeks after the first injection or the initiation of AS eye drops for the subjective changes in symptoms and in ocular surface parameters. Results The patients’ age ranged from 46 to 71 years (mean=56.0±8.2 years). Both groups showed a significant improvement of dry-eye symptoms (P<0.05) using the Ocular Surface Disease Index scoring with group B having more significant improvement of symptoms compared with group A patients after 3 months of follow-up (P<0.05). Schirmer’s test I showed a statistically significant improvement in both groups over the follow-up period (P<0.05), with no statistically significant difference between the two groups after 3 months (P>0.05). The other ocular surface parameters, using the ocular surface analyzer, including the noninvasive tear breakup time, tear-meniscus height, and lipid-layer thickness, showed significant improvement in both groups (P<0.001), while the meibomian gland loss area showed no statistically significant change throughout the follow-up period, with no statistically significant difference between the two groups after 3 months (P>0.05). Conclusions Both AS and lacrimal gland injection of PRP proved the safety and efficacy in the treatment of severe DED and were comparable. More studies are needed to confirm these results.
Aim The aim of this study was to report the experience of performing bilateral levator disinsertion followed by bilateral frontalis sling among patients having unilateral Marcus-Gunn jaw winking and ...ptosis (MGJWP). Setting and design This is a retrospective study that was conducted at Elsafwa Eye Centre, Alexandria, Egypt. Patients and methods The medical records of 24 patients with significant unilateral MGJWP were retrospectively reviewed. Full ophthalmological examination included external eye examination, extraocular muscle motility testing, best-corrected visual acuity, margin reflex distance (MRD) in mm, levator muscle excursion in mm, and amount of jaw winking in mm. All patients in the study had significant winking phenomenon. Bilateral levator disinsertion followed by bilateral frontalis sling was performed. Postoperatively, the patients were examined for MRD in both eyelids, amount of wink, degree of lagophthalmos, eyelid contour, patient satisfaction, and presence of complications or undercorrection. Results More than 2 mm of winking was considered cosmetically unacceptable to the patient and/or the parents. Postoperative follow-up periods ranged from 6 to 52 months, with an average of 16.9 months. After bilateral levator myotomy and bilateral frontalis advancement flap, 22 eyelids (91.66%) showed complete resolution of jaw winking and 2 eyelids (8.33%) showed mild winking (2 mm or less). Surgery was redone in two patients (8.33%) for undercorrected ptosis after 6 months of follow-up, whereas two patients (8.33%) had contour problem in the operated ptotic eyelid. All patients had immediate postoperative lagophthalmos that totally resolved in all patients after 6-month follow-up. Conclusion Bilateral levator muscle disinsertion followed by bilateral frontalis suspension using frontalis muscle advancement flap is an effective surgical technique for the treatment of unilateral MGJWP, resulting in satisfactory symmetrical outcome and resolution of jaw winking and ptosis in most of the cases.
Clarias gariepinus, weighing 119.18 ± 5.21 g, were exposed to 0%, 20%, 40%, and 60% of the LC50 lead nitrate, Pb(NO3)2, which represents the following treatments 0 (control), 16, 32, and 48 mg/l, ...respectively, for a period of 10 and 20 days. The results showed that the bioaccumulation of Pb(NO3)2 in gills were significantly increased (p < 0.05) after 10 days having 0.17 ± 0.07, 5.05 ± 1.04, 6.01 ± 0.82, and 9.61 ± 1.76 mg/100 g wet weight, respectively, for the treatments. However, after 20 days these values increased ((0.17 ± 0.07, 4.34 ± 1.27, 10.83 ± 0.97, and 19.18 ± 2.40 mg/100 g) for 0%, 20%, 40%, and 60% of LC50 Pb(NO3)2 respectively. There was an increase with each increasing concentration level of Pb(NO3)2 as compared with that of the control group. The accumulation of Pb(NO3)2 in the liver, showed a significant increase (p < 0.05) with the increasing period of exposed and Pb concentration with LC50 values ranging between 3.32 ± 0.91 and 4.42 ± 0.78 after 10 days as compared with that of the control group 0.08 ± 0.02 mg/100 g wet weight. Although white muscles and skin displayed lower values of bioaccumulation than gills and liver after 10 days, after 20 days the results were slightly more increased in the white muscles than in the skin. However, the observed pattern of increase was the same compared to that of the control group. Therefore, hematological parameters, such as red blood cells (RBCs), hemoglobin (Hb), and hematocrit (Hct) showed significant (p < 0.05) concentration-dependent decreases in fish exposed to Pb(NO3)2 during both periods. However, the values of white blood cells (WBCs) showed a significant reduction when levels of Pb concentration increased. Hepatic enzyme activities of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) displayed a significant increase with increasing concentrations and exposure time.
To assess the value of the flash visual evoked potential (FVEP) in determining final visual prognosis in patients with indirect traumatic optic neuropathy (TON).
We included 30 patients diagnosed ...with indirect TON. Within one week of the onset of the trauma, visual acuity was recorded, pupillary reactions were assessed, FVEP was performed in both eyes. The amplitudes (N1p1 and N2P2) and the latency of P2 for each eye were recorded and amplitude ratio of N2P2 between the affected and normal eye was calculated. In follow-up visits, the cases underwent a complete ophthalmic examination, assessment of visual acuity, pupillary reaction, and FVEP.
The study included 22 males (73.3%) and 8 females (26.7%). The right eye was involved in 16 patients (53.3%) and left eye was involved in 14 cases (46.7%). According to the findings of FVEP, there was a direct correlation between final visual acuity and initial amplitude of N1p1 and N2P2 and negative correlation with latency of P2 wave. In 20 patients in whom the N1P1 and N2P2 amplitude was within the normal range and amplitude ratio of N2P2 of normal and fellow eye was at least 0.5 and the P2 implicit time was less than 140 ms, they achieved better visual outcome and visual acuity improved in the affected eye. In other 10 patients in whom the N1P1 and N2P2 amplitude was below normal range and the N2P2 amplitude ratio between the normal and the affected eye was less than 0.5 and the P2 implicit time was more than 140 ms, the visual acuity in the affected eye was less than 0.01 and these patients achieved less or no improvement in their visual function.
Cases with TON usually present with severe loss of vision. FVEP is highly predictive of final visual outcome in patients having indirect TON given that the other eye is normal to be used as the patients' internal control. More studies are needed to confirm these results.
A Prospective randomised controlled study was done to determine statistical difference between the standard microsurgical discotomy (MC) and a minimally invasive microscopic procedure for disc ...prolapse surgery by comparing operation duration and clinical outcome. Additionally, the transferability of the results was determined by a bicentric design. The microscopic assisted percutaneous nucleotomy (MAPN) has been advocated as a minimally invasive tubular technique. Proponents have claimed that minimally invasive procedures reduce postoperative pain and accelerate the recovery. In addition, there exist only a limited number of well-designed comparison studies comparing standard microdiscotomy to a tubular minimally invasive technique that support this claim. Furthermore, there are no well-designed studies looking at the transferability of those results and possible learning curve phenomena. We studied 100 patients, who were planned for disc prolapse surgery at two centres 50 patients at the developing centre (index) and 50 patients at the less experienced (transfer) centre. The randomisation was done separately for each centre, employing a block-randomisation procedure with respect to age and preoperative Oswestry score. Operation duration was chosen as a primary outcome parameter as there was a distinguished shortening observed in a preliminary study at the index centre enabling a sound case number estimation. The following data were compared between the two groups and the centres with a 12-month follow-up: surgical times (operation duration and approach duration), the clinical results, leg and back pain by visual analogue scale, the Oswestry disability index, length of hospital stay, return to work time, and complications. The operation duration was statistically identical for MC (57.8 ± 20.2 min) at the index centre and for MAPN (50.3 ± 18.3 min) and MC (54.7 ± 18.1 min) at the transfer centre. The operation duration was only significantly shorter for the MAPN technique at the index centre with 33.3 min (SD 12.1 min). There was a huge clinical improvement for all patients regardless of centre or method revealed by a repeated measures ANOVA for all follow-up visits Separate post hoc ANOVAs for each centre revealed that there was a significant time–method (MAPN vs. MC) interaction at the index centre (
F
= 3.75,
P
= 0.006), whereas this crucial interaction was not present at the transfer centre (
F
= 0.5,
P
= 0.7). These results suggest a slightly faster clinical recovery for the MAPN patients only at the index centre. This was due to a greater reduction in VAS score for back pain at discharge, 8-week and 6-month follow up (
P
< 0.002). The Oswestry-disability scores reached a significant improvement compared to the initial values extending over the complete follow-up at both centres for both methods without revealing any differences for the two methods in either centre. There was no difference regarding complications. The results demonstrate that a shorter operation duration and concomitant quicker recovery is comprehensible at an experienced minimally invasively operating centre. These advantages could not be found at the transfer centre within 25 minimally invasive procedures. In conclusion both procedures show equal mid term clinical results and the same complication rate even if the suggested advantages for the minimally invasive procedure could not be confirmed for the transfer centre within the framework of this study.
This study aimed to compare ocular surface parameter changes in active and inactive thyroid eye disease (TED) patients and controls.
This is an observational clinical study that included 60 eyes ...divided into three groups following clinical activity score (CAS) assessment. The first group (Group A) comprised 20 eyes with active TED (CAS score ≥3/7), while the second group (Group B) comprised 20 eyes with inactive TED (CAS score <3/7) and the third group (Group C) comprised 20 eyes of controls without dry eye manifestations. The palpebral fissure height, degree of proptosis, degree of lagophthalmos, ocular surface disease index (OSDI), Schirmer test without anesthesia, corneal fluorescein staining (CFS), non-invasive tear break-up time (NITBUT), tear meniscus height (TMH), lipid layer thickness (LLT), meiboscore, meibomian gland dysfunction (MGD), and thyroid antibodies were assessed and data were compared between study participants.
The mean OSDI was 40.0 ±5.80 in Group A, which significantly differed from Group B with a mean of 26.5 ±5.10 (p=0.02). There were significant differences between the two groups regarding palpebral fissure height (p=0.02), amount of proptosis (p=0.008), and degree of lagophthalmos (p=0.001). Similarly, active TED patients had more decreased tear secretion than inactive TED patients (p=0.012). Moreover, active TED patients showed a significant increase in Meibomian gland loss areas in both upper and lower eyelids compared with inactive TED patients (p=0.001). Corneal fluorescein staining also revealed a statistically significant difference between the studied groups (p=0.0001).
This study showed differences regarding ocular surface parameter changes between both active and inactive TED and compared to controls. Further studies are needed to confirm these results.
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