Clinical Results of Ab Interno Canaloplasty in Patients with Open-Angle Glaucoma.

PURPOSE: To report treatment outcomes of ab interno canaloplasty using the Visco360 and Omni system devices as a standalone procedure or combined with cataract surgery in patients with open-angle glaucoma (OAG). DESIGN: Retrospective, single-center, consecutive case series. STUDY PATIENTS: Eighty-nine eyes of 64 patients aged 43 to 91 with open-angle glaucoma treated with ab interno canaloplasty between January 2018 and September 2019. Eyes with previous incisional glaucoma surgery and eyes with less than 90 degrees of viscodilation were excluded. INTERVENTION: Patients underwent ab interno canaloplasty as a stand-alone procedure or in conjunction with cataract surgery. Ab interno canaloplasty was performed with either the Visco360 or Omni System devices (Sight Sciences, Menlo Park, CA). Treatment consisted of viscodilation without trabeculotomy. MAIN OUTCOME MEASURES: Primary outcome measures were mean IOP and mean number of glaucoma medications. Additional analysis included the impact of degrees of treatment on treatment outcomes. RESULTS: Preoperative mean IOP was 24.5 ± 8.3; the number of preoperative glaucoma medications was 2.5 ± 1.3. At 18 months postoperative, the mean IOP was reduced 36% to 15.8 ± 2.5 (P<0.001) and glaucoma medications were reduced 32% to 1.7 ± 1.5 (P<0.05). Higher preoperative IOP was significantly correlated with increased IOP lowering. Reduction of mean IOP and medications were not significantly different between standalone ab interno canaloplasty vs cataract surgery/ab interno canaloplasty. Reduction of mean IOP and medications were not significantly different between patients with 180 degrees of treatment vs 360 degrees of treatment. CONCLUSION: Ab interno canaloplasty reduces IOP and glaucoma medication use in patients with OAG whether as a standalone surgery or in combination with cataract surgery.

Support for mentors in clinical education.

Mentorship of student nurses within the clinical environment is a well-established aspect of nurse training. With theory and practice being given equal weighting in the assessment of students' fitness to practise, effective mentorship in clinical settings is essential. While there have been calls for improvements to the clinical learning environment, the demands of daily practice mean it can be difficult to achieve effective mentorship. This article outlines one trust's initiative to improve mentorship support by introducing a clinical education mentorship support team.

Nonfouling capture-release substrates based on polymer brushes for separation of water-dispersed oil droplets.

We have demonstrated capture and release of underwater-oil droplets based on fouling-resistant surfaces coated with pH-responsive polymer brushes. In response to the change of environmental pH, oil droplets were captured on the polymer brush-modified surfaces in the high adhesion state. As the droplet volume increased upon coalescence with other oil droplets in the aqueous phase, the captured droplets eventually self-released from the surfaces under the influence of buoyancy and rose to the air-water interface. The fact that the polymer brush surfaces were partially oil-wettable (high oil-in-water contact angles) enabled the adhesion but not the spreading of oil droplets. This allowed buoyancy release of oil droplets and led to fouling-resistant surfaces that could be reused for capture-release of more oil droplets. The practicality and versatility of this oil droplet capture-release system was demonstrated using monodisperse and polydisperse hydrocarbon oil compositions in purified water, tap water, and brines in which the salt concentration was as high as that of seawater.

The early history of myasthenia gravis.

Myasthenia gravis was first recognised as a distinct clinical entity by Thomas Willis, a 17th century Oxford physician, whose 1672 account in Latin was largely unnoticed until 1903. The first modern description was made in 1877 by Samuel Wilks, a London physician. Towards the close of the 19th century, primary muscle diseases and diseases due to denervation of muscle were studied by English, French, and German physicians. The first full descriptions of myasthenia gravis were by Wilhelm Erb, of Heidelberg, and Samuel Goldflam of Warsaw. The account by Willis, and the 19th century literature of myasthenia gravis are reviewed, revealing the dominance of German physicians and neuropathologists in the early understanding of the disease. The development in pathology, aetiology, and therapy in the first half of the 20th century are described.

Giant micellar worms under shear: a rheological study using SANS.

Flow-SANS experiments were performed on viscoelastic aqueous solutions of erucyl bis(hydroxyethyl) methylammonium chloride in the presence of potassium chloride. This cationic surfactant has the ability to form very long and flexible wormlike micelles upon addition of salt. The effects of the key-parameters-shear rate, temperature, surfactant and salt concentration-on the ability of the micelles to align in the flow-field were investigated. The scattering data were analyzed in terms of an anisotropy factor (Af). It was found that the wormlike micelles aligned in the direction of the applied shear rate and that the anisotropy factor increased with shear rate. In addition, an increase in temperature caused a decrease of the anisotropy factor (Af) due to the formation of shorter worms. Furthermore, the branching of the micelles at high ionic strength caused the anisotropy factor to decrease in comparison with the values obtained from linear wormlike micelles, hence revealing that the formation of 3-way junctions restricts the alignment of the micelles in the shear-flow. Furthermore, the total surfactant concentration was found to affect the shear-induced patterns significantly, and different behaviors were observed depending on the ionic strength.

Mixed spherical and wormlike micelles: a contrast-matching study by small-angle neutron scattering.

Small-angle neutron scattering studies were used to investigate the effect of adding an alcohol ethoxylate nonionic surfactant (d-C12E20) to aqueous solutions of a cationic surfactant, erucyl bis(hydroxyethyl) methylammonium chloride (EHAC), with and without salt (KCl). The systematic use of contrast-matching, by alternately highlighting or hiding one of the surfactants, confirms that mixed micelles are formed. In salt-free solutions, mixed spherical micelles are formed and a core-shell model combined with a Hayter-Penfold potential was used to describe the data. The core radius is dominated by the EHAC tails and the outer radius determined by the ethoxylate headgroups of the nonionic surfactant. Addition of KCl promotes micellar growth; however, results of varying the solvent contrast revealed that when the nonionic surfactant is incorporated into the wormlike structure micellar breaking is promoted. Thus, mixed wormlike micelles with shorter contour lengths compared to the pure EHAC worms are formed.

Growth and scission energy of wormlike micelles formed by a cationic surfactant with long unsaturated tails.

The structural and dynamic properties of micellar solutions of erucyl bis(hydroxyethyl)methylammonium chloride blended with 2-propanol, in the presence of KCl, have been investigated by means of light scattering and rheological experiments. In the dilute regime, the micellar growth is larger than expected from mean-field or scaling models. The results obtained in the vicinity of the overlap concentration suggest the presence of large aggregates, with size >100 nm, possibly micellar rings or microgels. In the semidilute regime, the relationship between the zero shear viscosity and the surfactant concentration is described by a power law with an exponent in agreement with the mean-field model of linear micelles. The methods based on the analysis of the temperature dependence of the complex shear modulus to provide a measure of the scission energy are discussed.

Impacting the length of wormlike micelles using mixed surfactant systems.

The effect of adding an alcohol ethoxylate nonionic surfactant (C(18)E(18)) to aqueous solutions of a cationic surfactant, erucyl bis(hydroxyethyl) methylammonium chloride (EHAC,CH(3)(CH(2))(7)(CH)(2)(CH(2))(12)N(+)-(CH(2)CH(2)OH)(2)CH(3)Cl(-)), was studied using small-angle neutron scattering (SANS), steady-state rheology, and cryo-transmission electron microscopy (Cryo-TEM). This cationic surfactant has the ability to self-assemble into giant wormlike micelles in the presence of an electrolyte, such as KCl. In salt-free solutions, the mixture of the two surfactants gave rise to spherical micelles. The scattering curves obtained were fitted with a polydisperse core-shell model combined with a Hayter Penfold potential. The inner and outer radii were found to be dependent on the surfactant ratio. In the presence of KCl, mixed wormlike micelles were formed. However, further addition of C(18)E(18) promoted the breaking of the micellar worms with the appearance of a structure peak in the scattering curves. In addition, it was found that the low shear viscosity is decreased upon addition of the alcohol ethoxylate nonionic surfactant. These findings are in good qualitative agreement with the Cryo-TEM images. The results show that the addition of the nonionic surfactant to the system is a method of controlling the worm length.