[Review by the French Glaucoma Society on the roles of new surgical techniques in glaucoma]. / Mise au point de la Société française du glaucome sur la place des nouvelles techniques chirurgicales dans le glaucome.

The surgical management of glaucoma has been enriched in recent years by the arrival of new surgical techniques as a group known as MIGS (minimally invasive glaucoma surgery). The objective of these new techniques is to reduce intraocular pressure (IOP) while limiting the risk of complications of conventional filtering surgery and allowing faster visual recovery. MIGS can be classified into three main categories depending on the route used to promote the outflow of aqueous humor: the trabecular route, the suprachoroidal route and the subconjunctival route. MIGS using the subconjunctival route are also called minimally invasive bleb surgery (MIBS). These new techniques do not replace conventional filtering surgery, which remains the gold standard technique, but now offer new alternatives for the surgical management of glaucoma patients in combination with cataract surgery or as stand-alone procedures.

InGaAs quantum dots grown by molecular beam epitaxy for light emission on Si substrates.

The aim of this study is to achieve homogeneous, high density and dislocation free InGaAs quantum dots grown by molecular beam epitaxy for light emission on silicon substrates. This work is part of a project which aims at overcoming the severe limitation suffered by silicon regarding its optoelectronic applications, especially efficient light emission device. For this study, one of the key points is to overcome the expected type II InGaAs/Si interface by inserting the InGaAs quantum dots inside a thin silicon quantum well in SiO2 fabricated on a SOI substrate. Confinement effects of the Si/SiO2 quantum well are expected to heighten the indirect silicon bandgap and then give rise to a type I interface with the InGaAs quantum dots. Band structure and optical properties are modeled within the tight binding approximation: direct energy bandgap is demonstrated in SiO2/Si/InAs/Si/SiO2 heterostructures for very thin Si layers and absorption coefficient is calculated. Thinned SOI substrates are successfully prepared using successive etching process resulting in a 2 nm-thick Si layer on top of silica. Another key point to get light emission from InGaAs quantum dots is to avoid any dislocations or defects in the quantum dots. We investigate the quantum dot size distribution, density and structural quality at different V/III beam equivalent pressure ratios, different growth temperatures and as a function of the amount of deposited material. This study was performed for InGaAs quantum dots grown on Si(001) substrates. The capping of InGaAs quantum dots by a silicon epilayer is performed in order to get efficient photoluminescence emission from quantum dots. Scanning transmission electronic microscopy images are used to study the structural quality of the quantum dots. Dislocation free In50Ga50As QDs are successfully obtained on a (001) silicon substrate. The analysis of QDs capped with silicon by Rutherford Backscattering Spectrometry in a channeling geometry is also presented.

[Ocular intolerance to antiglaucoma medications is underestimated]. / Tolerance locale des medications antiglaucomateuses un probleme sous-estime.

Since about 20 years, the large panel of the antiglaucoma eyedrops has drastically changed the management of glaucoma. Indications for filtering surgery had decreased in frequency. A great number of patients are controlled only by medications. However ocular intolerance and side effects have been reported until in 50% of the cases with 10% of severe manifestations of intolerance. Ocular side effects to topical medications may very often alter compliance. Ocular intolerance had been shown to be secondary to immunological mechanisms and direct or indirect toxicity. The immunological or allergic mechanisms are induced by a type I or IV hypersensibility and only represent 3% to 10% of all the side effects induced by topical medications. Toxic effect can be a direct through different mechanisms: pure toxic effect, acid pH, osmolarity of the solution, photosensibilisation. This will induce inflammatory reaction that will produce fibrosis in the long term. This toxic effect can be worsened by eye dryness or rosacea. Toxicity can also be indirect through an alteration of the conjunctival microbial flora and/or the lacrymal secretion. Concomitant obstruction of the lacrymal ducts may also contribute to this effect. These mechanisms could have been elucidated thank to histological studies from conjunctival mark, and more recently with confocal HRT, which gives an analysis of the ocular surface in vivo. Appropriate and early detection of intolerance to antiglaucoma medications is mandatory to adjust management strategies accordingly. These are based on the suppression or the reduction of conservative agents whenever possible, the use of fixed combinations, the reduction of the number of the instillations and the associated treatment of the ocular surface.

A fast technique to measure the dewpoint pressure of a retrograde condensate gas using a microfluidic volume.

A new method to determine the dewpoint pressure of a retrograde condensate from a fast, non-equilibrium measurement performed in a microfluidic optical cell is presented. The inflection point of the optical transmission recorded during depressurization agrees well with the dewpoint pressure of the sample, determined by conventional laboratory techniques. With this new technique, a measurement can be performed in less than 5 min and requires far less than a milliliter of the sample. Benchmarking of this technique is presented using four retrograde condensate samples, which were created in the laboratory using multi-component compositions that are based on oilfield samples. Each sample was characterized at three different temperatures, and their maximum relative liquid volumes (maximum liquid volume/total system volume at the dewpoint pressure) ranged from 1.3% to 13.5% for these temperatures. The dewpoint pressure measured by this technique differs by no more than 100 psi from that measured in a conventional laboratory for samples of a richness of 4% or higher, while leaner samples display a difference of ∼200 psi.

A delayed Boerhaave's syndrome diagnosis treated by thoracoscopy in prone position.

Boerhaave's syndrome or postemetic rupture of the esophagus, carries a high morbidity and mortality. The authors report a delayed Boerhaave's syndrome diagnosis (3 days), successfully treated by right thoracoscopic debridement in prone position. Thanks to gravity the cardiopulmonary bloc drops back and the access to the esophagus is direct allowing for accurate placement of the chest tubes near the perforation. The procedure is completed by laparoscopic placement of a feeding jejunostomy with the patient supine.

Optimization and scale-up of a fluid bed tangential spray rotogranulation process.

The production of pellets in the pharmaceutical industry generally involves multi-step processing: (1) mixing, (2) wet granulation, (3) spheronization and (4) drying. While extrusion-spheronization processes have been popular because of their simplicity, fluid-bed rotogranulation (FBRG) is now being considered as an alternative, since it offers the advantages of combining the different steps into one processing unit, thus reducing processing time and material handling. This work aimed at the development of a FBRG process for the production of pellets in a 4.5-l Glatt GCPG1 tangential spray rotoprocessor and its optimization using factorial design. The factors considered were: (1) rotor disc velocity, (2) gap air pressure, (3) air flow rate, (4) binder spray rate and (5) atomization pressure. The pellets were characterized for their physical properties by measuring size distribution, roundness and flow properties. The results indicated that: pellet mean particle size is negatively affected by air flow rate and rotor plate speed, while binder spray rate has a positive effect on size; pellet flow properties are enhanced by operating with increased air flow rate and worsened with increased binder spray rate. Multiple regression analysis enabled the identification of an optimal operating window for production of acceptable pellets. Scale-up of these operating conditions was tested in a 30-l Glatt GPCG15 FBRG.

Use of auditory steady-state responses in children and comparison with other electrophysiological and behavioral tests.

OBJECTIVE: In patients who cannot or will not cooperate in behavioral hearing assessment, electrophysiological examinations are used, but are time-consuming because the subject has to remain immobile. The aim of this study was to assess whether auditory steady-state responses (ASSR) are sufficiently reliable, compared to auditory brainstem responses (ABR) and free-field audiometry, for assessment to begin with ASSR instead of ABR. MATERIAL AND METHODS: A retrospective study was performed between January 2012 and April 2013, including children less than 6 years of age who could not be tested via headphones. ASSR and ABR were measured during natural sleep or under phenobarbital-alimemazine sedation. Subjective pure-tone audiometry was performed, using the visual reinforcement audiometry method, in 69 children who were able and willing to cooperate. RESULTS: A total of 175 children were included. ASSR and ABR thresholds showed good positive correlation (338 ears; Pearson's correlation coefficient, 0.87). Behavioral thresholds correlated significantly with ASSR thresholds (Student t-test for matched series; P<0.05). ASSR thresholds were usually better than behavioral thresholds, with a difference of 8-15dB HL. CONCLUSION: ASSR is reliable in children under 6 years of age, and should be performed before ABR when hearing threshold rather than latency is to be determined.

Transmural myocardial infarction with coexisting critical aortic stenosis as an etiology for early myocardial rupture.

Myocardial rupture is the most important cause of post-infarct sudden death after myocardial infarction other than shock and dysrhythmias. Usually unrecognized, pseudoaneurysm formation is a delayed consequence of myocardial rupture in a small portion of patients who will remain at high risk for late rupture and death. Clinical studies have defined a profile of the patient who is at increased risk for post-infarct myocardial rupture. We believe that an additional factor, ventricular outflow tract obstruction, may add to the risk of having a post infarct rupture. A high degree of suspicion by the clinician accompanied by the timely performance of diagnostic tests may help to decrease the mortality from this catastrophic event.

Pre-clamp cardioprotection by protein kinase C (PKC) inhibitor improves left ventricular function following canine normothermic arrest.

Since protein kinase C (PKC) has been proven to be a mediator of neutrophil activation and of intracellular calcium homeostasis, its inhibition could protect the myocardium from the deleterious effects of ischemic/reperfusion inury (IRI). The principal objective of this study was to evaluate the efficacy of the PK inhibitor SPC-100270 (2S,3S)-2-amino, 3-octadecanediol in a canine model of IRI. A double-blind study was conducted in which 19 coonhound dogs received either SPC-100270 or a vehicle before going on cardiopulmonary bypass (CPB). After 60 minutes of global normothermic (37 degree C) cardiac arrest (cross-clamp time 65-81 minutes for SPC-100270 and 65-72 minutes for control) and discontinuation of CBP, an epicardial short axis view echocardiogram was performed and reviewed by a double-blinded observer to determine the ejection fraction (EF). EF value exceeded 20% in 5 out of 9 SPC-100270 animals (27%-44%) and in 0 of 10 controls (0%-16%). These data show that SPC-10027 significantly (p=0.01 by Fisher's Exact Test) increased the probability that the animals would exhibit an EF greater than 20%.

Regulation of optic nerve head blood flow in normal tension glaucoma patients.

PURPOSE: To investigate the regulation of the optic nerve blood flow (Fonh) in response to an increase of the perfusion pressure (PPm) in normal tension glaucoma (NTG) patients and in age-matched normal volunteers. METHODS: Measurements were performed in 16 eyes of NTG patients and in 10 eyes of age-matched controls. Laser Doppler flowmetry (LDF) was applied to calculate the relative flux of red blood cells at the temporal rim of the optic nerve head (ONH) in response to increases in PPm. PPm was raised through an increase in systemic blood pressure induced by isometric exercise. Before being tested, all patients had 3 weeks of washout of any local medication. RESULTS: In the NTG group, mean ophthalmic arterial blood pressure increased during isometric exercise from 73 to 89 mmHg (22%), resulting in a 29% increase of the PPm. This increase did not induce any significant change in mean Fonh. For the control group, the 28% increase of PPm also did not significantly affect Fonh. There was a trend for a greater increase in vascular resistance during isometric exercise in the NTG than in the normal control group (47% versus 25%). CONCLUSIONS: The LDF parameters, measured in the ONH, did not indicate an abnormal Fonh regulation in response to an increase of the PPm in either normal subjects or NTG patients. The maintenance of constant blood flow is achieved by an increase in local vascular resistance. Our data show a greater percent increase in vascular resistance in the NTG patients compared to the normal subjects for a similar percent increase in PPm in both groups during squatting. This suggests some alteration of the vessel tone regulatory mechanisms in NTG patients.

[Arterial hypotension in glaucoma of normal or moderately high pressure]. / Hypotension artérielle dans le glaucome à pression normale ou modérément élevée.

BACKGROUND: Arterial hypotension, by decreasing blood flow in the optic nerve head, may be a risk factor for glaucomatous damage. The purpose of this study was to compare blood pressure in different types of glaucoma patients, using ambulatory recording. METHODS: An ambulatory blood pressure recording was performed in 55 glaucoma patients over a 24-hour period. Two groups of patients could have been differentiated according to pretreatment intra-ocular pressure level: a group of 38 patients (GPNM) with normal or moderately elevated intra-ocular pressure, and a group of 17 patients (GPH) with high intra-ocular pressure. RESULTS: A statistically significant different lower blood pressure was found in group GPNM for: diastolic mean blood pressure (76.4 versus 81.4 mmmHg p = 0.05), diastolic nocturnal (71.8 versus 78.1 mmHg p = 0.025), and for some hourly intervals: from 2:00 to 3:00 (p = 0.008), 8:00 to 9:00 (p = 0.01) and 15:00 to 18:00 (p = 0.03). The mean lowest readings were lower (p < 0.05) in group GPNM (95.8/54.4 versus 102/59.9 mmHg). The percentage of low readings (9.9% versus 5.1% p = 0.01) and systolic drops (0.226 versus 0.192 p = 0.018) were also higher in this group. CONCLUSION: Hypoperfusion of optic nerve head may be a significant factor in glaucomatous damage by compromising blood supply. It is important to identify arterial hypotension when examining of normal or moderately elevated pressure glaucoma patients, and ambulatory monitoring of blood pressure is currently the best test. These episodes should be taken into consideration, especially when initiating systemic antihypertensive therapy, in order to maintain, as well as possible, perfusion of the optic nerve head.

[Role of arterial blood pressure in the development of glaucomatous lesions]. / Rôle de la tension artérielle dans l'évolutivité des lésions glaucomateuses.

PURPOSE: In a significant number of glaucoma patients, progression of visual field loss occurs despite adequate intraocular pressure (IOP) control. Other factors, mainly vascular, seem to play a role in the pathogenesis of these glaucomas. The purpose of this study was to investigate the role of blood pressure (BP) as one of the vascular risk factors for progression of glaucomatous damage. METHODS: Eighty-three glaucoma patients were categorizated as to whether their visual field defect were stable or progressive in the face of clinically stable IOP; all patients were followed for at least two years. The mean systolic and diastolic BP were determined, using a 24-hour ambulatory recording device, during diurnal (6 am-10 pm) and nocturnal (10 pm-6 am) periods. For each patient, the nocturnal systolic and diastolic dips, and the BP variability (i.e. standart deviation, and percentage decrease from maximal to minimal readings) were determined. RESULTS: Forty-three patients had stable visual fields (25 females, 58.9 years old +/- 6.88; 18 males, 58.6 years old +/- 11), while 40 patients showed progressive visual field loss (23 females, 67.4 years old +/- 9.98; 17 males, 64.5 years old +/- 9.44). In the progressive group, women were older (p = 0.017), systolic (p = 0.0375) and diastolic (p = 0.0083) dips were greater, as also BP variability: systolic standard deviation was greater (p = 0.027) as percentage decrease from maximal systolic readings (p = 0.034). There were no difference for systolic, diastolic, diurnal or nocturnal mean BP in these two groups. CONCLUSIONS: The finding in this study suggests that age, decreased nocturnal BP and high BP variability may be additional risk factors for progression of glaucomatous field loss.

[Is trabeculectomy without danger in case of threatened fixation?]. / La trabéculectomie est-elle sans danger en cas de menace sur le point de fixation?

PURPOSE: This study examined the impact of trabeculectomy on the central visual field in patients in which field loss threatens fixation. METHODS: Fifty eyes in 45 patients demonstrating a visual field loss threat to fixation underwent trabeculectomy. All patients underwent visual field assessment before and within two months of surgery, using both the 24-2 quantitative program on the Humphrey Field Analyser, and the macular program which measures the threshold sensitivity three times per 16 points distributed in the central 5 degrees centrally at 2 degrees intervals. For inclusion in the study, each eye had to show involvement of at least two contiguous points in the central macular program, with a decrease in sensitivity to 15 dB or less, in a quadrant corresponding to a well-defined visual field defect shown on program 24-2. RESULTS: The average post-operative follow-up was 7.1 months (+/- 5.52). Overall intraocular pressure reduction was 40%. Visual acuity decreased on an average of half line. None of the eyes showed loss of fixation. The average number of points with decreased sensitivity in the central 5 degrees (15 dB sensitivity or less) was 6.06 points (+/- 3.36) pre-operatively and 5.78 points (+/- 3.85) post-operatively (p = NS). Mean Defect (MD) was noted to decrease by 1 dB (p = 0.0295) whereas Corrected Pattern Standard Deviation (CPSD) and Foveal Sensitivity (FS) was essentially stable. CONCLUSION: Based on the study, it appears that trabeculectomy can be safely offered to patients for surgical reduction of intraocular pressure even in those cases where central fixation is threatened by loss of vision within the five degrees of fixation.

[Color Doppler ultrasonography of short para-optic ciliary arteries in vascular glaucoma]. / Echo-Doppler couleur des artères ciliaires courtes para-optiques dans le glaucome vasculaire.

PURPOSE: To study color Doppler imaging in orbital vessels, especially para-optic short ciliary arteries, in patients with vascular glaucoma. PATIENTS AND METHODS: Twenty vascular normal or moderate elevated pressure glaucoma patients (6 with bilateral glaucoma, 9 with unilateral glaucoma et 5 with asymmetric glaucoma) underwent a color Doppler imaging (Accusson 128XP) in orbital arteries: common carotid, ophthalmic artery, central retinal artery, short para-optic ciliary arteries. Systolic and diastolic blood flow velocities were measured, and resistance index of Pourcelot and ratios between different parameters were calculated. RESULTS: In patients with unilateral glaucoma, ratios of systolic velocities between para-optic ciliary artery and common carotid, and ratio of Pourcelot index between para-optic ciliary artery and ophthalmic artery were increased in glaucomatous eyes. And Pourcelot index were statistically significant increased in all glaucomatous patients of the study compared with normal subjects. DISCUSSION AND CONCLUSION: Comparison of Pourcelot index and ratios between parameters makes color Doppler imaging more reliable, especially when analyse short para-optic ciliary arteries, which vascularize optic nerve. In these arteries Pourcelot index was increased in vascular glaucoma patients. Vascular risk factor should be taken into consideration in this form of glaucoma.

[HRT and glaucoma surgery follow-up]. / HRT et suivi des glaucomateux opérés.

Heidelberg Retina Tomography (HRT) analysis of the optic nerve might be temporarily modified after glaucoma surgery. However, optimal follow-up of glaucoma patients requires comparing reliable optic nerve images. The aim of this study was to define the consequences of glaucoma surgery on HRT measurements. Results showed temporary modifications until at least the third month, suggesting that it is better to wait 6 months after surgery to obtain reliable measurements.

[Contribution of individual characteristics to learning by children with first exposure to a prevention of abuse program]. / La contribution des caractéristiques individuelles aux apprentissages des enfants du primaire participant à un atelier de prévention des abus.

This study explores the contribution of personal characteristics in the knowledge and skills gains of children taking part in the child abuse prevention program ESPACE. The program is an adaptation of the widely implemented American Child Assault Prevention Program (CAP). A group of 107 fourth-grade children completed a knowledge questionnaire and a video vignette measure designed to evaluate preventive skills in abusive and potentially abusive situations. Children were also invited to complete questionnaires evaluating individual characteristics such as self-esteem, locus of control and self-efficacy. The results highlight the importance of certain individual variables such as the child's gender, self-efficacy and perception of athletic competence in the acquisition of sexual abuse preventive skills.

[Visual field progression in glaucoma: cluster analysis]. / Progression du champ visuel dans le glaucome: intérêt de l'analyse de l'évolution des clusters.

BACKGROUND: Visual field progression analysis is one of the key points in glaucoma monitoring, but distinction between true progression and random fluctuation is sometimes difficult. There are several different algorithms but no real consensus for detecting visual field progression. The trend analysis of global indices (MD, sLV) may miss localized deficits or be affected by media opacities. Conversely, point-by-point analysis makes progression difficult to differentiate from physiological variability, particularly when the sensitivity of a point is already low. The goal of our study was to analyse visual field progression with the EyeSuite™ Octopus Perimetry Clusters algorithm in patients with no significant changes in global indices or worsening of the analysis of pointwise linear regression. PATIENT AND METHOD: We analyzed the visual fields of 162 eyes (100 patients - 58 women, 42 men, average age 66.8 ± 10.91) with ocular hypertension or glaucoma. For inclusion, at least six reliable visual fields per eye were required, and the trend analysis (EyeSuite™ Perimetry) of visual field global indices (MD and SLV), could show no significant progression. The analysis of changes in cluster mode was then performed. In a second step, eyes with statistically significant worsening of at least one of their clusters were analyzed point-by-point with the Octopus Field Analysis (OFA). RESULTS: Fifty four eyes (33.33%) had a significant worsening in some clusters, while their global indices remained stable over time. In this group of patients, more advanced glaucoma was present than in stable group (MD 6.41 dB vs. 2.87); 64.82% (35/54) of those eyes in which the clusters progressed, however, had no statistically significant change in the trend analysis by pointwise linear regression. CONCLUSION: Most software algorithms for analyzing visual field progression are essentially trend analyses of global indices, or point-by-point linear regression. This study shows the potential role of analysis by clusters trend. However, for best results, it is preferable to compare the analyses of several tests in combination with morphologic exam.

[Ocular blood flow in glaucoma]. / Le flux sanguin oculaire dans le glaucome.

In clinical practice, the vascular factor seems to be essential in glaucoma. Nevertheless, the various studies investigating the relations between the changes in ocular blood flow and risk of glaucoma often have diverse and contradictory conclusions. The variety of the methods in studies on ocular blood flow, the absence of a reference examination, and the absence of large clinical studies probably explain the problems bringing to light an indisputable relation. However, it remains essential, in any glaucoma, to look for and treat the vascular risk factor and most particularly to decrease intraocular pressure, the treatment that currently remains the most reliable to improve ocular blood flow.

Cladocera of the Lençóis Maranhenses (NE - Brazil): faunal composition and a reappraisal of Sars' Method.

We studied the Cladocera of a group of ephemeral interdunal pools in the Lençóis Maranhenses, Maranhão State (NE - Brazil) and recorded 34 species. The fauna was overwhelmingly neotropical, with no evidence of invasive species. Species composition differed in Lagoa da Colher, an acid system. We provide notes on behaviour, morphology and taxonomy of some lesser-known anomopods, with emphasis on the Chydoridae. We figure male Oxyurella longicaudis, Chydorus eurynotus, Disparalona leptorhyncha, Alonella dadayi and A. clathratula. We provide notes on the "Sars' Method", hatching of freshwater crustaceans from dry mud, a simple technique that complements the information of hit-and-run surveys. About half of the total species number (44%) was revived through this method; 18% of species were additional to field-collected samples. The Sars' method also yielded abundant specimens of rare species, useful for identification and studies on behaviour.