Functional and Anatomical Outcomes of Anti-Vascular Endothelial Growth Factor Treatment for Exudative Age-Related Macular Degeneration with or without Obstructive Sleep Apnea.

(1) To investigate the functional and anatomical outcomes of anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with exudative age-related macular degeneration (AMD) with or without obstructive sleep apnea (OSA); (2) In total, 65 patients with AMD with or without OSA who received three consecutive doses of intravitreal anti-VEGF injections were enrolled. The primary outcomes-best-corrected visual acuity (BCVA) and central macular thickness (CMT)-were assessed at 1 and 3 months. Moreover, morphological changes observed through optical coherence tomography were analyzed; (3) In total, 15 of the 65 patients had OSA and were included in the OSA group; the remaining 50 patients were included in the non-OSA (control) group. At 1 and 3 months after treatment, BCVA and CMT had improved but did not differ significantly between the groups. More patients in the OSA group demonstrated subretinal fluid (SRF) resorption at 3 months after treatment than in the non-OSA group (p = 0.009). Changes in other imaging biomarkers, such as intraretinal cysts, retinal pigment epithelium detachment, hyperreflective dots, and ellipsoid zone disruptions, did not differ significantly between the groups; (4) Our results suggest that the BCVA and CMT outcomes 3 months after anti-VEGF treatment are similar between patients with and without OSA. Moreover, patients with OSA may exhibit superior SRF resorption. A large-scale prospective study is mandatory to evaluate the association between SRF resorption and visual outcomes in AMD patients with OSA.

ANGIOGRAPHIC SUBTYPES OF POLYPOIDAL CHOROIDAL VASCULOPATHY IN TAIWAN: A Prospective Multicenter Study.

PURPOSE: To determine the incidence and clinical characteristics of angiographic subtypes of polypoidal choroidal vasculopathy (PCV). METHODS: It is a prospective, multicenter, cross-sectional study. Patients with newly diagnosed exudative macular degeneration are classified into PCV, age-related macular degeneration (AMD), and retinal angiomatous proliferation. Polypoidal choroidal vasculopathy is further classified into two subtypes depending on the presence (Type 1: polypoidal choroidal neovascularization) or absence (Type 2: typical PCV) of feeder vessels on indocyanine green angiography. RESULTS: We enrolled 169 patients: 76 (45%) with PCV, 75 (44.4%) with AMD, and 14 (8.3%) with retinal angiomatous proliferation. Of the patients with PCV, 20 (26%) were classified as Type 1 PCV and 56 (74%) were classified as Type 2 PCV. The Type 1 PCV had a similar mean age compared to the AMD group (73.1 ± 9.6 vs. 75.6 ± 8.8 years, P = 0.281) and the Type 2 PCV (68.8 ± 9.6 years) was younger than the AMD group (P < 0.001). Type 1 PCV presented with worse visual acuity compared with the AMD. Both PCV subtypes had a higher incidence of hemorrhagic complications (85% and 75% respectively). CONCLUSION: Type 2 PCV is more common than Type 1 PCV in Taiwan. Our results support the hypothesis that polypoidal choroidal neovascularization and typical PCV may be distinct entities.

Rapid resolution of retinoschisis with acetazolamide.

PURPOSE: To report the results of an acetazolamide (Diamox(®)) treatment regimen in a genetically confirmed case of X-linked juvenile retinoschisis (XLRS). METHODS: A patient with XLRS was prescribed acetazolamide (Diamox(®)) at a dose of 500 mg/day, then discontinued the treatment due to non-compliance for 4 days, and finally resumed the course of treatment. Best-corrected visual acuity, retinal structure, and function were monitored with autofluorescence, spectral domain-optical coherence tomography (SD-OCT), adaptive optics scanning laser ophthalmoscopy (AOSLO), and full-field electroretinogram (ERG). Full-field ERG was performed using DTL recording electrodes and Ganzfeld stimulation according to ISCEV standards. RESULTS: Serial monitoring of the cysts by SD-OCT revealed a strong association between the effects of acetazolamide administration and the size of the schisis. A reduction in foveal cyst size was significant in as rapid as 6 days after acetazolamide initiation. AOSLO data revealed that the resolution of cone cell images improves as the foveal schisis decreases in size. CONCLUSIONS: Efficacy of acetazolamide in patients with XLRS can be apparent in as rapid as a week of therapy. AOSLO can be a good method to evaluate the cone cells after acetazolamide treatment in the early stages of XLRS.

Electrochemical nitrate reduction over bimetallic Pd-Sn nanocatalysts with tunable selectivity toward benign nitrogen.

Nitrate is recognized as a highly impactful water contaminant among various pollutants in water. To address the ever-growing demand for water purification, this work investigates the bimetallic palladium (Pd) and tin (Sn) catalysts, which are electrochemically deposited on stainless steel mesh support (Pd-Sn/SS) for the selective conversion of harmful nitrate (NO3-) into benign nitrogen (N2) gas. Results indicate that the bimetallic composition in Pd-Sn/SS electrodes substantially influenced the reaction route for nitrate reduction as well as the performance of nitrate transformation and nitrogen selectivity. It is found that the electrode prepared from Pd:Sn = 1:1 (mole ratio) demonstrates an outstanding nitrate conversion of 95%, nitrogen selectivity of 88%, and nitrogen yield of 82%, which outperform many reported values in the literature. The electrochemically synthesized bimetallic electrode proposed herein enables a new insight for promoting the reactivity and selectivity of nitrate reduction in water.

Enhanced nitrate reduction over functionalized Pd/Cu electrode with tunable conversion to nitrogen and sodium hydroxide recovery.

Development of heteroatomic electrocatalysts with a particular geometric structure for wastewater denitrification remains a formidable challenge. Herein, we reported the fabrication of a series of PdCu electrodes with Pd electrodeposition times varying from 60 s to 360 s. Physiochemical and electrochemical techniques were used to analyze the structure, morphology and activity of as prepared catalytic electrodes. XRD data revealed the formation of a PdCu alloy, while a reduced particle sizes (ca. 5.3 nm) and a uniform distribution of Pd over Cu was demonstrated by TEM. The XPS measurement indicated the presence of redox (Pd0 and Cu+2) states hence demonstrating the formation of a PdCu alloy. A nitrate removal efficiency of ~98 %, N2 selectivity ~86 % with an alkali recovery of 335 mM was obtained over Pd/Cu 180 s at 0.68 mA cm-2. Enhanced nitrate reducibility and extended durability reveal the viability of a novel electrocatalytic and electrodialysis system for degrading NO3- in water, as well as a system for efficiently recovering liquid alkali.

Change of Optical Coherence Tomography Morphology and Associated Structural Outcome in Diabetic Macular Edema after Ranibizumab Treatment.

(1) Background: To investigate the correlation between therapeutic outcome and morphologic changes for diabetic macular edema (DME) after intravitreal injection of ranibizumab (IVIR). (2) Methods: This retrospective study included 228 eyes received IVIR for DME. Each participant was traced for two years after the initial IVIR, while the data of ophthalmic examination, optical coherence tomography (OCT) image, and systemic diseases were collected. The study population was categorized into different subgroups according to the existence of OCT morphologic change and the initial OCT morphologic pattern, including diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD), and vitreomacular interface abnormalities (VMIAs). The primary outcomes were the baseline best-corrected visual acuity (BCVA) and central macular thickness (CMT) during a two-year study period. The distribution of OCT morphologic change and its relation to primary outcome were analyzed. (3) Results: Comparing the 42 eyes (18.4%) with OCT morphological changes to another 186 eyes (81.6%) without such alteration, the former showed a poorer baseline BCVA (0.84 ± 0.39 vs. 0.71 ± 0.36, p = 0.035), worse final BCVA (0.99 ± 0.44 vs. 0.67 ± 0.30, p = 0.001), and thicker final CMT (354.21 ± 89.02 vs. 305.33 ± 83.05, p = 0.001). Moreover, the VMIA developed in 14.9% of all DME patients presenting the most common morphologic change among DRT, CME, and SRD. Besides, the presence of stroke was independently correlated to the morphologic change (adjusted odds ratio [aOR]: 6.381, 95% confidence interval (CI): 1.112-36.623, p = 0.038). (4) Conclusions: The change of OCT morphology in DME patients receiving IVIR was correlated to worse structural and visual outcome while the formation of VMIA most commonly occurred after initial treatment.

Optical Coherence Tomographic Patterns as Predictors of Structural Outcome After Intravitreal Ranibizumab in Diabetic Macula Edema.

BACKGROUND/OBJECTIVES: The purpose of this study was to present an association between the treatment response of diabetic macular edema (DME) to intravitreal ranibizumab (IVR) injections and different morphology patterns using spectral domain optical coherence tomography (SD-OCT). SUBJECTS/METHODS: This retrospective study included 216 eyes of 142 subjects who received IVR for DME and were observed for at least 2 years. Medical charts and SD-OCT images of consecutive patients were reviewed at baseline, 1, 3, 6, 12, and 24 months after first IVR treatment. The OCT patterns were characterized as diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD), and vitreomacular interface abnormalities (VMIAs). All patients were classified into four groups based on the OCT findings. RESULTS: For a total of 216 eyes, 36 eyes were classified into the DRT group, 76 in the CME group, 42 in the SRD group, and 62 in the VMIA group. There were significant central macula thickness (CMT) improvements in all groups at the 1st month and the 2nd year, except for the DRT group at the 2nd year. Patients with OCT findings of hyperreflective dots (HRDs), metabolic parameters of hyperlipidemia, and coronary artery disease (CAD) had significantly less improvements in CMT at 2-year follow-up (P=0.029, 0.007, <0.001, respectively). CONCLUSION: A trend toward decreased effectiveness after long-term IVR treatment was observed in the DRT group. Consistent IVR treatment could still achieve favorable improvement in the reduction of CMT in 2-year follow-up in the VMIA group. Different OCT patterns in DME may affect the therapeutic role of anti-VEGF agents and predict the structure outcome.

Postoperative Mycobacteroides abscessus subsp. abscessus endophthalmitis: Clinical analysis of 12 clustered adults and a proposed therapeutic algorithm.

PURPOSE: Postoperative endophthalmitis caused by nontuberculous mycobacterium is a rare but devastating complication after intraocular surgery. However, optimal treatment strategies remain undetermined in view of its rarity. METHODS: We investigated the cases of culture-proven postoperative Mycobacteroides abscessus subsp. abscessus endophthalmitis in southern Taiwan, focusing on clinical manifestations and microbiological study, and aimed to describe clinical staging and to propose a therapeutic modality for this disease. RESULTS: Twelve cases, including two published cases, were treated in two medical centers in southern Taiwan between Aug. 2011 and Dec. 2016, and all ever received cataract surgery at one clinic. Their disease courses could be categorized into four distinct stages, i.e., the initial, quiescent, recurrent, and end stage, and some cases experienced 1-4 cycles of quiescent-recurrent stages. Although all eyes ended up with phthisis or were eviscerated, the affected eyes receiving pars plana vitrectomy (PPV) tended to become quiescent and survived longer than those without PPV (adjusted hazard ratio: 13.9, p < 0.05). Eight isolates of eight patients were available for microbiological study. All isolates were susceptible to amikacin, and inducible clarithromycin resistance was observed in 100% of isolates. CONCLUSION: Despite the preservation of vision in postoperative M.abscessus endophthalmitis remained a challenge, a stage-based approach is proposed, which may facilitate decision-makings for the future study.

Sintering of MSWI fly ash by microwave energy.

This study presents the sintering of municipal solid waste incineration (MSWI) fly ash assisted by microwave energy. The composition of fly ash was investigated by chemical sequential extraction and modified microwave digestion method. Effects of process time, container materials, aging time and salt contents were also discussed. The major elements of fly ash are Ca, Cl, Na, Si, K, Al, Mg, and Zn, and the metal species, Zn, Cr, Pb, Ca, and Cu, are mainly in the oxide phase. Under microwave processing, the fly ash was sintered into a glass-ceramics and the leaching concentrations of heavy metals were restrained. The stabilization efficiency increased with an increase in processing time in most of the cases. Better stabilization efficiency of fly ash was discovered by using the SiO(2) or Al(2)O(3) container than by using the graphite plate/SiC plate. The presence of salt in the fly ash could enhance the sintering and stabilization of fly ash. During the aging time of 0-30 days, negligible Pb in the sintered fly ash was leached out, and the leaching concentration was lower than the criterion.

Resolution of Unilateral Dome-Shaped Macula With Serous Detachment After Treatment of Topical Carbonic Anhydrase Inhibitors.

Dome-shaped macula (DSM) is a morphological feature outlined through the use of optical coherence tomography and characterized by an inward or anterior deviation of the macula with respect to chorioretinal concavity. Currently, there is no validated therapy for serous retinal detachment secondary to DSM. The authors report a case of childhood unilateral DSM in a hyperopic eye with normal axial length that was complicated with subretinal fluid (SRF). Topical carbonic anhydrase inhibitors may be an acceptable and safer option for patients presented with nonresolving SRF associated with DSM. Further randomized controlled trials are necessary to confirm the efficacy of this therapeutic approach. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e218-e221.].

Adsorption characteristics of ammonium ion onto hydrous biochars in dilute aqueous solutions.

This research aims at studying the characteristics of ammonium adsorption onto hydrous bamboo biochar. Results showed that pH played the most important role in ammonium adsorption. High ionic strength enhanced the ammonium adsorption capacity of bamboo biochar. Ammonium adsorption was exothermic and spontaneous. FTIR results showed shift, disappearance, or appearance of specific functional groups on the bamboo biochar surface. Surface precipitation and complex formation contributed to the adsorption of ammonium onto hydrous bamboo biochar. Biochar can be an effective adsorbate for ammonium removal from water. Additionally, the formation of nitrogen containing precipitates on the biochar surface, potentially, leads to the in-situ synthesis of slow-release fertilizer.

The adsorption characteristics of fluoride on commercial activated carbon treated with quaternary ammonium salts (Quats).

Commercial activated carbon was treated with six quaternary ammonium salts (Quats), namely, hexyltrimethylammonium (HTMA), octyltrimethylammonium (OTMA), decyltrimethylammonium (DCTMA), dodecyltrimethylammonium (DDTMA), Tetradecyltrimethylammonium (TDTMA), and hexadecyltrimethylammoium (HDTMA) as to enhance the fluoride adsorption capacity. In batch mode experiments, fluoride adsorption onto the Quats-treated activated carbon decreased dramatically with increase in solution pH. Fluoride removal by the Quats-treated activated carbons was closely related to the Quats chain length at less-than critical micelle concentration (CMC). Multi-site adsorption isotherm described fluoride adsorption characteristics well. Results showed that activated carbon treated with DDTMA exhibited the best fluoride adsorption density among all Quats investigated. DDTMA-treated activated carbons exhibited two-fold increase in the fluoride adsorption capacity compared to the untreated activated carbon. Results of regeneration, by alkaline desorption and/or Quats re-loading, showed fluoride-laden activated carbons have high reusability. DDTMA increased the positive surface charge of the activated carbon that enhanced fluoride adsorption. DDTMA-treated activated carbon was promising for fluoride removal from water with much enhanced removal capacity.

Thermal detoxification of hazardous metal sludge by applied electromagnetic energy.

Industrial wastewater sludge was treated by microwave processes to enhance the stabilization of laden copper. The effects of additives, processing time, microwave adsorbents, moisture content, reaction atmosphere, and cooling gas were investigated. The stabilization results were significantly enhanced by metal powder additives, prolonged microwave processing time, proper moisture content, the addition of carbonaceous materials, and a reaction environment with inert gas. It was also found that the moisture content would increase the homogeneity of applied microwave energy, and thus achieve a better overall efficiency between stabilizing agents and copper. The added metal powders may reduce Cu(II) to Cu(0) in the sludge or TCLP. The resulting thermal energy of microwave radiation, and microarcing process and the oxidation heat of Al powder may also assist the transformation of Cu(II) into CuO and CuAl2O4 phases. Part of the sludge was vitrified within inert gas environment when the processing time was longer than 18 min and active carbon dosage was more than 3g. Reduction reactions also occurred in the hybrid microwave processes, leading to the reduction of sulfates and metal ions, and the formation of Cu2S and FeS. Moreover, the microwave radiation can also enhance the feasibility of co-treating of inorganic and organic solid waste.

The relationship between age, axial length and retinal nerve fiber layer thickness in the normal elderly population in Taiwan: The Chiayi eye study in Taiwan.

AIMS: To interpret how the thickness of the peripapillary retinal nerve fiber layer (RNFL) changes with increasing age, axial length, or anterior chamber depth as measured by spectral domain optical coherence tomography (OCT) in the normal elderly population in Taiwan. METHODS: A total of 82 volunteers (143 eyes) were enrolled. Generalized estimating equations were used to evaluate the correlation. RESULTS: The RNFL was significantly thinner in the superonasal (p = 0.004), inferotemporal (p = 0.046), and temporolower (p = 0.009) segments with age. The same trend was also observed in the superotemporal (p = 0.330) segment, although it was not statistically significant. The global RNFL thickness decreased by 4.97 µm per decade (ß = -0.497; p = 0.021), and thinning was significant in the superonasal (-9.90 µm per decade, p < 0.001) and temporolower (-6.78 µm per decade, p < 0.001) segments; the same trend showed borderline significance in the superotemporal (-6.96 µm per decade, p = 0.073) and inferotemporal (-7.23 µm per decade, p = 0.059) segments. In eyes with longer axial length, the RNFLs significantly decreased in the non-temporal segments. Global RNFL thickness decreased by 3.086 µm for each additional millimeter of axial length (ß = -3.086; p < 0.001). CONCLUSIONS: Changes in RNFL thickness were correlated with age in the superonasal, superotemporal, inferotemporal, and temporolower segments, and were correlated with axial length in the non-temporal segments. Anterior chamber depth was not correlated with RNFL thickness.

Microwave enhanced stabilization of heavy metal sludge.

A microwave process can be utilized to stabilize the copper ions in heavy metal sludge. The effects of microwave processing on stabilization of heavy metal sludge were studied as a function of additive, power, process time, reaction atmosphere, cooling gas, organic substance, and temperature. Copper leach resistance increased with addition of aluminum metal powder, with increased microwave power, increased processing time, and using a gaseous environment of nitrogen for processing and air for cooling [N2/air]. The organic in the sludge affected stabilization, whether or not the organic smoldered. During heating in conventional ovens, exothermic oxidation of the organic resulted in sludge temperatures of about 500 degrees C for oven control temperatures of 200-500 degrees C. After microwave heating dried the sludge, the sludge temperature rose to 500 degrees C. The reaction between copper ions and metal aluminum in the dried sludge should be regarded as a solid phase reaction. Adding aluminum metal powder and reaction temperature were the key parameters in stabilizing copper in the heavy metal sludge, whether heated by microwave radiation or conventional oven. The mass balance indicates insignificant volatization of the copper during heating.

The assistance of microwave process in sludge stabilization with sodium sulfide and sodium phosphate.

After industrial wastewater sludge passed through an acid-extraction process to reclaim most of the copper ions in it, the residue may still need to be treated by stabilization technologies. The common method for the stabilization of hazardous waste in Taiwan is by cement solidification. However, this method has the disadvantage of an increase in waste volume. In this study, it was tried to combine the advantages of sulfur anions and phosphate anions with the characteristics of microwave energy to offer a new method which can avoid the disadvantage of cement solidification. From the results, it was found that the assistance of heating in sludge stabilization with additives was effective. Huge amounts of additives were saved. Compared with the assistance of the traditional electrical-heating in sludge stabilization with additives, that of the microwave process saved much time and was more powerful. However, when the reaction time was longer, a re-leaching situation would occur. The hybrid microwave process, a procedure of leading an inert gas into the microwave process, could overcome the disadvantage of the microwave process with regard to the long reaction time. Finally, a modified hybrid microwave process which reduced the use of gas was performed and recommended.