A Case of Lepromatous Leprosy (Lucio's Phenomenon) Presenting as Periorbital Edema.

Despite low prevalence of leprosy worldwide, new cases continue to present and require swift evaluation and diagnosis to prevent complications. Here, we describe a case of lepromatous leprosy with Lucio's phenomenon initially presenting with facial and periorbital edema. A 38-year-old Brazilian woman presented to the emergency department with facial swelling and erythema, initially treated as cellulitis. Due to rapid worsening despite broad-spectrum antibiotics, she underwent soft tissue exploration and biopsy due to concern for necrotizing fasciitis. During her course, she also developed retiform purpura of bilateral upper and lower extremities. Periorbital and lower extremity pathological specimens ultimately revealed acid-fast bacilli consistent with Mycobacterium leprae , and the patient improved with multidrug therapy. This case illustrates the diagnostic difficulty of lepromatous leprosy with Lucio's phenomenon, which can initially present with periorbital edema.

The association of moderate-to-vigorous and light-intensity physical activity on static balance in middle-aged and older-aged adults.

BACKGROUND: Falls are the leading cause of injury among adults ≥ 65 years of age. Participation in physical activity (PA) is associated with improved balance, though it is impact in the middle-age population is not well understood. AIM: The purpose of the current study was to examine the influence of PA intensity on static balance in middle-aged and older aged individuals. METHODS: Included were middle-aged adults (40-64 years) and older adults (≥ 65 years) from the 2003-2004 years of the National Health and Nutrition Evaluation Survey. Light physical activity (LPA) and moderate-vigorous physical activity (MVPA) were collected via accelerometer and static balance via the Romberg Test of Standing Balance. RESULTS: No significant odds ratio relationship was found between MVPA or LPA and having good static balance in the middle-aged population; 1.04 (95% CI 0.95, 1.13) p = 0.427 and 1.05 (95% CI 0.97, 1.14) p = 0.182, respectively. Whereas, in older adults, every 60-min increase in LPA was significantly associated with 28% higher odds of good balance (95% CI 1.15, 1.41; p < 0.001), and every 10-min increase in MVPA with 25% higher odds of good balance (95% CI 1.08, 1.45; p = 0.006). DISCUSSION: LPA and MVPA were not associated with good static balance in middle-aged adults, but in older adults LPA was significantly associated with good static balance. CONCLUSION: A significant relationship is found between age and fall risk, which is a major concern in the aging population.

Morphological changes to Schlemm's canal and the distal aqueous outflow pathway in monkey eyes with laser-induced ocular hypertension.

Though roughly 30-50% of aqueous outflow resistance resides distal to Schlemm's canal (SC), the morphology of the conventional outflow pathway distal to SC has not been thoroughly evaluated. This study examined the morphological changes along proximal and distal aspects of the conventional aqueous outflow pathway and their association with decreased outflow facility in an experimental model of glaucoma in cynomolgus macaques. Nd:YAG laser burns were made to 270-340 degrees of the trabecular meshwork (TM) of one eye (n = 6) or both eyes (n = 2) of each monkey to induce ocular hypertension. Distinct regions of the TM were left unlasered. Contralateral eyes (n = 5) were not lasered and were utilized as controls. Monkeys were sacrificed ≥58 months after their last laser treatment. All eyes were enucleated and perfused at 15 mmHg for 30 min to measure outflow facility. Two pairs of eyes were also perfused with fluorescein to examine segmental outflow. All eyes underwent perfusion-fixation for 1 h. Anterior segments were cut into radial wedges and processed for light and electron microscopy. Width, height, and cross-sectional area (CSA) of SC were compared between high- and low-flow regions of control eyes, and between non-lasered regions of laser-treated eyes and control eyes. Number and CSA of intrascleral veins (ISVs) were compared between non-lasered and lasered regions of laser-treated eyes and control eyes, and between high- and low-flow regions of control eyes. Scleral collagen fibril diameter was compared between control eyes and lasered and non-lasered regions of laser-treated eyes. Median outflow facility was significantly decreased in laser-treated eyes compared to control eyes (P = 0.02). Median CSA and height of SC were smaller in high-flow regions than low-flow regions of control eyes (P < 0.05). Median width of SC was not significantly different between high- and low-flow regions of control eyes (P > 0.05). Median CSA, width, and height of SC were not different between non-lasered regions and control eyes (P > 0.05). SC was partially or completely obliterated in lasered regions. Median number of ISVs was significantly decreased in lasered regions compared to non-lasered regions (P < 0.01) and control eyes (P < 0.01). Median CSA of ISVs did not differ between these groups (P > 0.05). Median number and CSA of ISVs were not significantly different between high- and low-flow regions of control eyes (P > 0.05). Lasered regions displayed looser scleral stroma and smaller median diameter of collagen fibrils adjacent to the TM compared to non-lasered regions (P < 0.05) and control eyes (P < 0.05). Dense TM, partial to complete obliteration of SC, and a decreased number of patent ISVs may account in part for the decreased outflow facility in monkey eyes with laser-induced ocular hypertension. The significance of changes in scleral structure in laser-treated eyes warrants further investigation.

Relationships between Intraocular Pressure, Effective Filtration Area, and Morphological Changes in the Trabecular Meshwork of Steroid-Induced Ocular Hypertensive Mouse Eyes.

We investigated whether an inverse relationship exists between intraocular pressure (IOP) and effective filtration area (EFA) in the trabecular meshwork (TM) in a steroid-induced ocular hypertensive (SIOH) mouse model and the morphological changes associated with the reduction of EFA. C57BL/6 mice (n = 15 per group) received either 0.1% dexamethasone (DEX) or saline eye drops twice daily for five weeks. IOP was measured weekly. Fluorescent tracers were injected into the anterior chamber to label EFA at the endpoint. Injected eyes were fixed and processed for confocal microscopy. EFA in the TM was analyzed. Light and electron microscopy were performed in high- and low-tracer regions of six eyes per group. The mean IOP was ~4 mm Hg higher in DEX-treated than saline-treated control eyes (p < 0.001) at the endpoint. EFA was reduced in DEX-treated eyes compared to controls (p < 0.01) and negatively correlated with IOP (R2 = 0.38, p = 0.002). Reduced thickness of juxtacanalicular tissue (JCT) and increased abnormal extracellular matrix in the JCT were found to be associated with reduced EFA. Our data confirm the inverse relationship between EFA and IOP, suggesting that morphological changes in the JCT contribute to the reduction of EFA, thus elevating IOP in SIOH mouse eyes.

Morphological factors associated with giant vacuoles with I-pores in Schlemm's canal endothelial cells of human eyes: A serial block-face scanning electron microscopy study.

Increased intraocular pressure (IOP) is the main risk factor for primary open-angle glaucoma and results from impaired drainage of aqueous humor (AH) through the trabecular outflow pathway. AH must pass the inner wall (IW) endothelium of Schlemm's canal (SC), which is a monolayer held together by tight junctions, to exit the eye. One route across the IW is through giant vacuoles (GVs) with their basal openings and intracellular pores (I-pores). AH drainage through the trabecular outflow pathway is segmental. Whether more GVs with both basal openings and I-pores are present in the active flow areas and factors that may influence formation of GVs with I-pores have not been fully elucidated due to limitations in imaging methods. In this study, we applied a relatively new technique, serial block-face scanning electron microscopy (SBF-SEM), to investigate morphological factors associated with GVs with I-pores in different flow areas. Two normal human donor eyes were perfused at 15 mmHg with fluorescent tracers to label the outflow pattern followed by perfusion-fixation. Six radial wedges of trabecular meshwork including SC (2 each from high-, low-, and non-flow areas) were imaged using SBF-SEM (total: 9802 images). Total GVs, I-pores, basal openings, and four types of GVs were identified. Percentages of GVs with I-pores and basal openings and number of I-pores/GV were determined. Overall, 14.4% (477/3302) of GVs had I-pores. Overall percentage of GVs with both I-pores and basal openings was higher in high- (15.7%), than low- (12.6%) or non-flow (7.3%) areas. Of GVs with I-pores, 83.2% had a single I-pore; 16.8% had multiple I-pores (range: 2-6). Additionally, 180 GVs (90 with I-pores and 90 without I-pores) were randomly selected, manually segmented, and three-dimensionally (3D) reconstructed to determine size, shape, and thickness of the cellular lining. Size of GVs (including median volume, surface area, and maximal cross-sectional area) with I-pores (n = 90) was significantly larger than GVs without I-pores (n = 90) using 3D-reconstructed GVs (P ≤ 0.01). Most I-pores (73.3%; 66/90) were located on or close to GV's maximal cross-sectional area with significant thinning of the cellular lining. Our results suggest that larger size and thinner cellular lining of GVs may contribute to formation of GVs with I-pores. More GVs with I-pores and basal openings were observed in high-flow areas, suggesting these GVs do provide a channel through which AH passes into SC and that increasing this type of GV may be a potential strategy to increase aqueous outflow for glaucoma treatment.

Influence of Body Mass on Fitness Performance in Naval Special Warfare Operators.

ABSTRACT: Wood, DE and Swain, DP. Influence of body mass on fitness performance in Naval Special Warfare operators. J Strength Cond Res 35(11): 3120-3127, 2021-U.S. Naval Special Operations Forces have performed some of the U.S. Military's most rigorous missions. The Human Performance Program (HPP) developed a physical performance testing battery to assess and monitor physical fitness. Testing bias relative to body mass has been noted in the past literature, including military physical fitness tests. This retrospective study looked to determine whether there is body mass bias in the HPP fitness assessment and whether an optimum body mass for each fitness test could be determined. Data from 333 subjects (age: 28.4 ± 5.0 years; height: 178.4 ± 6.2 cm; mass: 86.0 ± 9.2 kg) were analyzed to compare body mass with performance on the 8 tests: standing long jump, Pro-Agility test, weighted pull-up, body weight bench press, 1 repetition maximum (1RM) deadlift, 274-m shuttle run, 4.83-km run, and 800-m swim. Linear regression analysis was used to analyze the relationship of body mass to performance; a second-degree polynomial was used to determine best-fit curves for each of the physical fitness tests; analysis of variance was used to examine differences in performance between body mass groups. Significantly better performance for lighter subjects was found in the Pro-Agility test, weighted pull-up, body weight bench press, 274-m shuttle run, and 4.83-km run. Heavier subjects performed better in the 1RM deadlift. Second-degree polynomial regression revealed optimum body mass for the Pro-Agility test, 274-m shuttle run, and 4.83-km run to be 7-16 kg heavier than the lowest body mass. These findings could help professionals better assess and train operators of varying body size.

The Physical Parameters of Tactical Climbing and Performance Characteristics of Naval Special Warfare Operators.

ABSTRACT: Wood, DE and Swain, DP. The physical parameters of tactical climbing and performance characteristics of naval special warfare operators. J Strength Cond Res 35(4): 949-954, 2021-Vertical elevation may be critical for advantage to Special Operation Forces and require strength, power, endurance, and technique. This study sought to (a) study differences in physical capacities of Naval Special Warfare lead climbers from nonlead climbers, (b) compare anthropometrics of lead climbers from nonlead climbers, and (c) catalogue the types and weights of the various climbing systems to assess total system weight to the lead climber's body mass. Climbing surveys were collected and retrospective physical capacity data from 15 SEa, Air and Land lead climbers (age: 31.2 ± 5.1 years; height: 181.4 ± 6.4 cm; mass: 89.4 ± 10.0 kg; body fat: 14.1 ± 3.7%) were compared against previously reported data of 305 nonlead climbers (age: 28.8 ± 5.2 years; height: 177.6 ± 12.0 cm; mass: 85.8 ± 9.7 kg; body fat: 17.3 ± 4.7%). Lead climbers had significantly less body fat percentage (p = 0.017). Lead climbers also performed significantly better on the pro-agility test (p = 0.017) and deadlift (p = 0.002). The total mass reported for the climbing equipment for each tactical scenario was up to 4.9 kg for urban climbing, up to 13.7 kg for alpine climbing, and up to 8.0 kg for maritime climbing. With a typical combat load of 21.4 kg, adding an alpine climbing load exceeds one-third of the lead climbers' own body mass. Strength and conditioning programming for this population should take into consideration the total system weight for testing and training purposes and should also consider climbing-specific strength testing and training to optimize climbing capability.

Macular vessel density versus ganglion cell complex thickness for detection of early primary open-angle glaucoma.

BACKGROUND: To evaluate the macular vessel density (VD) and ganglion cell complex (GCC) thickness in pre-perimetric (PPG) and early perimetric primary open-angle glaucoma (PG) eyes, and to compare the diagnostic ability of the two measurements to discriminate PPG and early PG eyes from healthy eyes. METHODS: Seventy-nine eyes in 72 subjects (31 normal, 26 PPG, and 22 early PG eyes) were included in the consecutive case series. Macular VD and GCC thickness were acquired simultaneously using the 6 × 6 mm2 high-density AngioRetina scanning mode. Diagnostic abilities were assessed using the area under the receiver operating characteristic curve (AUROC). RESULTS: Compared to healthy eyes, whole image VD (wiVD) and GCC thickness were significantly lower in PPG and early PG eyes (all P < 0.025). The percent reduction of wiVD was lower than that of GCC thickness in early PG eyes (P < 0.05), while they were similar in PPG eyes (P > 0.05). Regionally, greater VD attenuation and GCC thinning were identified in the perifovea than in the parafovea in both groups (all P < 0.05). Moreover, the percent reduction of VD was less than that of GCC thickness in the perifoveal region in PPG eyes (P < 0.05). The AUROCs for wiVD and GCC thickness were 0.824 and 0.881, respectively, in PPG eyes (P > 0.05), and 0.918 and 0.977, respectively, in early PG eyes (P > 0.05). CONCLUSIONS: Macular VD and GCC thickness significantly decreased in PPG and early PG eyes. The perifoveal region appeared to be more vulnerable to macular VD attenuation and GCC thinning in early glaucoma. Our results showed that macular VD measurements may be helpful for detecting and understanding early glaucomatous damage.

Ammonia Inhalation Does Not Increase Deadlift 1-Repetition Maximum in College-Aged Male and Female Weight Lifters.

Vigil, JN, Sabatini, PL, Hill, LC, Swain, DP, and Branch, JD. Ammonia inhalation does not increase deadlift 1-repetition maximum in college-aged male and female weight lifters. J Strength Cond Res 32(12): 3392-3397, 2018-Ammonia inhalant use by powerlifters and weight lifters is a prevalent practice with little research support for improved performance. The purpose of this study was to investigate the effects of ammonia as a stimulant on athletic performance during a deadlift 1-repetition maximum (1RM) absolute strength test. Subjects (men: n = 10, mean ± SD age = 21 ± 1 year, mass = 72.5 ± 6.8 kg; and women: n = 10, age = 22 ± 5 years, mass = 66.2 ± 8.1 kg) were required to have at least 2 years of resistance training experience while lacking a history of asthma, lightheadedness, fainting, anaphylaxis, sickle cell traits, and other respiratory disorders. After a baseline 1RM test, subjects were paired by 1RM performance and gender, then randomly assigned in a counterbalanced treatment order to control (water) or ammonia trials after a minimum 72-hour recovery period for another 1RM test involving attempts at 100.0, 102.5, 105.0, and 107.5% of the established 1RM value. Testing was then repeated after the minimum rest period for the remaining trial. Results revealed the expected gender main effect for absolute deadlift 1RM (93.0 ± 29.5 [women]; 152.0 ± 29.5 kg [men]; p < 0.001), but no trial main effect (p = 0.874) or gender by trial interaction effect (baseline = 93.0 ± 15.3, 151.8 ± 42.3 kg; water = 92.0 ± 12.5, 150.9 ± 37.8 kg; ammonia = 92.5 ± 16.4, 153.4 ± 37.9 kg) for women and men, respectively (p = 0.559). Within the limitations of this study, there is no support for the practice of ammonia inhalation to improve deadlift 1RM in training or competition.

Impact Forces of Walking and Running at the Same Intensity.

Moderate-intensity walking (horizontal, WH), vigorous-intensity walking (incline, WI), and vigorous-intensity running (horizontal, R) were compared. The hypothesis is that running creates greater loading forces than walking even at the same aerobic intensity. Young adults (10 M and 10 F; age, 22.8 ± 0.5 years) performed 3 exercise trials in a counter-balanced order: walking 5.5 kph at 0% grade (WH); walking 5.5 kph at 11% (WI); and running at 8.0 kph at 0% (R). Oxygen consumption (V[Combining Dot Above]O2), step frequency, peak vertical ground reaction force (VGRF), and vertical force loading rate were recorded during the last 5 minutes of each trial. Results are mean ± SE. Net V[Combining Dot Above]O2 during WH (10.5 ± 0.3 ml·min·kg) was significantly less than WI (26.3 ± 0.3) and R (25.1 ± 0.7 ml·min·kg). Step frequency was significantly greater during R (163 ± 1.5 steps per minute) than both walking conditions (WH, 128 ± 1.0 steps per minute; WI, 126 ± 1.2 steps per minute). Peak VGRF was significantly greater during running (844 ± 47 N) than both walking conditions (WH, 581 ± 27 N; WI, 565 ± 28 N). Force loading rate was significantly greater with R (8,214 ± 26 N·s) than WH (6,497 ± 15 N·s ) and WI (5,699 ± 16 N·s ), with WH > WI. Vigorous-intensity walking produced no greater loading forces than moderate-intensity walking. However, running at a vigorous intensity produced substantially greater loading forces than walking of the same intensity. These findings suggest that vigorous aerobic exercise may be performed without elevated orthopedic stress, depending on the mode prescribed.

Effect of added mass on treadmill performance and pulmonary function.

Military personnel engage in strenuous physical activity and load carriage. This study evaluated the role of body mass and of added mass on aerobic performance (uphill treadmill exercise) and pulmonary function. Performance on a traditional unloaded run test (4.8 km) was compared with performance on loaded tasks. Subjects performed an outdoor 4.8-km run and 4 maximal treadmill tests wearing loads of 0, 10, 20, and 30 kg. Subjects' pulmonary function (forced expired volume in 1 second [FEV1], forced vital capacity [FVC], and maximal voluntary ventilation [MVV]) was tested with each load, and peak values of heart rate, oxygen consumption ((Equation is included in full-text article.)), ventilation (VE), and respiratory exchange ratio (RER) were measured during each treadmill test. Performance on the 4.8-km run was correlated with treadmill performance, measured as time to exhaustion (TTE), with the strength of the correlation decreasing with load (r = 0.87 for 0 kg to 0.76 for 30 kg). Body mass was not correlated with TTE, other than among men with the 30-kg load (r = 0.48). During treadmill exercise, all peak responses other than RER decreased with load. Pulmonary function measures (FEV1, FVC, and MVV) decreased with load. Body mass was poorly correlated with treadmill performance, but added mass decreased performance. The decreased performance may be in part because of decreased pulmonary function. Unloaded 4.8-km run performance was correlated to unloaded uphill treadmill performance, but less so as load increased. Therefore, traditional run tests may not be an effective means of evaluating aerobic performance for military field operations.

Autonomic response to tactical pistol performance measured by heart rate variability.

This study evaluated changes in autonomic tone during a tactical pistol competition. At rest and during a match, heart rate variability (HRV) was examined in 28 healthy subjects. Heart rate variability time-domain variables (including interbeat interval [IBI]) and frequency-domain variables (low frequency [LF], high frequency [HF], total power [TP]) measured during shooting were subtracted from those measured during rest to produce Δs. The shooting task involved several, rapid tactical maneuvers. Raw time to completion and inaccurate shots (points down [PDs]) were recorded and combined to form a match score where lower values indicated superior shooting performance. Mean (±SD) raw time was 135.9 ± 34.1 seconds, PDs were 78 ± 34, and match score was 175.3 ± 39.8. Shooting decreased IBI (i.e., increased heart rate) and LF. ΔLF, ΔHF, and ΔTP were independent of ΔIBI. Raw time was significantly (p ≤ 0.05) correlated to shooting IBI (r = 0.404) and ΔIBI (r = -0.426). Points down were significantly correlated to ΔTP (r = 0.416) and ΔLF (r = 0.376). Match score was significantly correlated to ΔIBI (r = -0.458), ΔHF (r = 0.467), ΔLF (r = 0.377), and ΔTP (r = 0.451). In conclusion, individuals with a greater decrease in IBI (and thus heart rate) performed better by accomplishing the match faster. Individuals with less change in stress-related HRV measures (LF, HF, and TP) performed better through improved accuracy. Thus, HRV-derived sympathetic response is significantly related to shooting performance and should be used to assess marksmanship effectiveness under duress.

Effect of intensity of aerobic training on insulin sensitivity/resistance in recreationally active adults.

Previous research demonstrates that moderate-intensity aerobic exercise improves insulin effectiveness. Whether higher exercise intensities improve insulin action more so is unclear. The purpose of this study was to evaluate the effect of various levels of aerobic intensity on insulin action in young adult men and women. Forty-five healthy subjects (22.2 ± 3.9 years; 169 ± 9 cm; 74.5 ± 17.8 kg) were matched for age, gender, and VO2max and randomly assigned to moderate-intensity (50% heart rate reserve [HRR]), vigorous-intensity (75% HRR), maximal-intensity intervals (95/50% HRR) or a non-exercising control group. Subjects completed a 6-week training protocol on a stationary bicycle ergometer. Weekly duration and frequency of training varied to ensure equivalent energy expenditure across groups. The homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) were used to assess insulin effectiveness. Significant increases occurred after training in VO2max in the vigorous-intensity(15.4%) and maximal-intensity(14.2%) groups (p < 0.01) but not the moderate-intensity or control group. There were no significant changes in insulin effectiveness in any exercise group. Training intensity did not significantly affect insulin effectiveness in a young adult population as assessed by HOMA or QUICKI; it did, however, significantly affect VO2max.

Descemet's membrane injury due to bullet shockwave trauma.

Purpose: To report a case of corneal edema associated with Descemet membrane (DM) damage likely due to shockwave trauma from a bullet passing by the eye. Observations: A 27-year-old man presented to the emergency department with pain, redness, and severely decreased vision in the left eye immediately following a gun assault. Examination of the eye revealed a temporal conjunctival laceration, corneal edema, hyphema, and vitreous hemorrhage. Bullets were found in the patient's left chest and axilla, and a laceration was present on the bridge of his nose, but no foreign bodies were found in or around the eyes. The intraocular hemorrhage and corneal edema gradually resolved, and it became apparent that there were DM irregularities that possibly represented micro-ruptures. After 7 months, uncorrected visual acuity improved to 20/25, and the cornea was free of edema but had persistent small focal areas of DM thickening and scarring. Conclusions and Importance: This case illustrates that DM and possibly endothelial cell damage can occur due to shockwave injury from high-speed projectiles. In our case of presumed small central DM micro-ruptures, the corneal edema resolved, and the vision significantly improved with topical therapy and observation, suggesting an overall good prognosis from such injuries.

Five-year outcomes of selective laser trabeculoplasty: A retrospective study.

Introduction: Studies have shown the efficacy of selective laser trabeculoplasty (SLT) to lower intraocular pressure (IOP) as adjuvant therapy during short-term follow-up. However, few studies have assessed the long-term efficacy of SLT on preventing worsening Humphrey visual field (HVF) parameters and thinning of the retinal nerve fiber layer (RNFL) with continued medical therapy. Methods: A retrospective chart review was conducted of 51 eyes of 39 patients with glaucoma treated with SLT at Boston Medical Center between 2012 and 2016 with 3- and 5-year follow-up. Outcome measures included IOP, visual acuity, number of glaucoma medications, number of months to subsequent surgical intervention. HVF outcome measures included mean deviation (MD) and pattern standard deviation (PSD). Optical coherence tomography (OCT) outcome measures included RNFL mean thickness, and superior and inferior thicknesses. Results: Twenty-five eyes received subsequent surgical intervention (mean time to intervention = 33.6 ± 20.0 months). In the eyes that did not receive another intervention, mean IOP was significantly decreased by 3.2 and 3.5 mmHg at 3- and 5-year after SLT, respectively. Mean number of glaucoma medications was significantly increased at 5-year (2.7 ± 1.6; P = 0.04), compared to pre-SLT (2.0 ± 1.1). Mean HVF MD was significantly higher at 5-year (-7.64 ± 6.57 dB) compared to pre-SLT (-5.61 ± 3.90 dB). Mean PSD significantly increased at 3-year (5.30 ± 2.91 dB) and 5-year (6.84 ± 2.62 dB), compared to pre-SLT (4.63 ± 2.70 dB; P = 0.04 and ≤0.01, respectively). On OCT, inferior quadrant RNFL thickness decreased significantly at 5-year (88.5 ± 19.3 µm), compared to pre-SLT (94.0 ± 23.2 µm). Discussion: Although 51% of eyes had IOP controlled at 5-year post-SLT, mean number of glaucoma medications was significantly higher. Also, there was progression of MD and PSD on HVF and inferior quadrant thinning on OCT at 5-year. We found a significant association between age at SLT and risk of subsequent surgical intervention over 5-year follow-up. Our study adds to our understanding of long-term outcomes of adjuvant SLT for glaucoma patients receiving medical therapy.

Schlemm's Canal Endothelium Cellular Connectivity in Giant Vacuole and Pore Formation in Different Flow-type Areas: A Serial Block-Face Scanning Electron Microscopy Study.

Glaucoma is associated with increased resistance in the conventional aqueous humor (AH) outflow pathway of the eye. The majority of resistance is thought to reside in the juxtacanalicular connective tissue (JCT) region of the trabecular meshwork and is modulated by the inner wall (IW) endothelial cells of Schlemm's canal (SC). The IW cells form connections with the underlying JCT cells/matrix, and these connections are thought to modulate outflow resistance. Two ways by which AH crosses the IW endothelium are through: 1) the formation of outpouchings in IW cells called giant vacuoles (GVs) and their intracellular pores (I-pores), and 2) intercellular pores between two adjacent IW cells (B-pores). AH outflow is segmental with areas of high-, low-, and non-flow around the circumference of the eye. To investigate whether changes in cellular connectivity play a role in segmental outflow regulation, we used global imaging, serial block-face scanning electron microscopy (SBF-SEM), and 3D reconstruction to examine individual IW cells from different flow areas of ex vivo perfused normal human donor eyes. Specifically, we investigated the differences in cellular dimensions, connections with JCT cells/matrix, GVs, and pores in SC IW cells between high-, low-, and non-flow areas. Our data showed that: 1) IW cell-JCT cell/matrix connectivity was significantly decreased in the cells in high-flow areas compared to those in low- and non-flow areas; 2) GVs in the cells of high-flow areas had significantly fewer connections beneath them compared to GVs in the cells of low- and non-flow areas; 3) Type IV GVs (with I-pores and basal openings) had significantly fewer connections beneath them compared to Type I GVs (no I-pore or basal opening). Our results suggest that a decreased number of cellular connections between the IW and JCT in high-flow areas is associated with increased numbers of GVs with I-pores and larger Type IV GVs observed in previous studies. Therefore, modulating the number of cellular connections may affect the amount of high-flow area around the eye and thereby modulate AH outflow.

Endothelial Glycocalyx Morphology in Different Flow Regions of the Aqueous Outflow Pathway of Normal and Laser-Induced Glaucoma Monkey Eyes.

Glycocalyx morphology was examined in the trabecular outflow pathway of monkey eyes with and without experimental glaucoma. Laser burns were administered along ~270 degrees of the trabecular meshwork (TM) of one eye (n = 6) or both eyes (n = 2) of each monkey until intraocular pressure remained elevated. Portions of the TM were not laser-treated. Unlasered eyes (n = 6) served as controls. Enucleated eyes were perfused at 15 mmHg to measure the outflow facility, perfused with fluorescein to evaluate the outflow pattern, perfusion-fixed for glycocalyx labeling, and processed for electron microscopy. Coverage and thickness of the glycocalyx were measured in the TM, Schlemm's canal (SC), collector channels (CCs), intrascleral veins (ISVs), and episcleral veins (ESVs) in non-lasered regions and high- and low-flow regions of controls. Compared to controls, laser-treated eyes had decreased outflow facility (p = 0.02). Glycocalyx thickness increased from the TM to ESVs in non-lasered regions and controls (p < 0.05). Glycocalyx coverage was generally greater distally in non-lasered regions (p < 0.05). In lasered regions, TM, SC, and CCs were partly to completely obliterated, and ISVs and ESVs displayed minimal glycocalyx. Whether the glycocalyx is decreased in the trabecular outflow pathway of human glaucomatous eyes warrants investigation.

Effect of training with and without a load on military fitness tests and marksmanship.

The purpose of this study was to determine whether military-style training performed while carrying a weighted vest and backpack (Load condition) resulted in superior training adaptations (specifically, changes in military fitness and marksmanship) than did more conventional training (No-Load condition). A total of 33 college-aged men and women (16 Load, 17 No-Load) completed all testing and 9 weeks of training (1 h·d, 4 d·wk). No-Load training consisted of military calisthenics, sprints, agility drills, and running. Load training was similar except that running was replaced with stair climbing, and Load increased across the 9 weeks to 20 kg for women and 30 kg for men. Pretraining and posttraining, all subjects performed an uphill treadmill test with full load to determine peak oxygen consumption (VO(2)peak), the marine physical fitness test (PFT) and combat fitness test (CFT) without load, other fitness tests, and an indoor marksmanship test using a laser-fitted carbine. The marksmanship test was performed with full load and done before and immediately after a 200-m shuttle run performed in 60 seconds. Both groups significantly improved their VO(2)peak, PFT, and CFT scores by similar amounts. Pretraining, shooting score decreased significantly after the 200-m run and then rapidly recovered, with no difference between groups. A similar, but nonsignificant, pattern in shooting scores was seen in both groups posttraining. In conclusion, loaded training did not produce measurable advantages compared with unloaded training in this population. A strenuous anaerobic challenge caused a temporary reduction in marksmanship.

Outcomes of home parenteral nutrition in 34 patients with intestinal failure from recurrent or progressive peritoneal malignancy of gastro-intestinal tract origin.

OBJECTIVES: To investigate the outcomes of 34 patients with intestinal failure secondary to advanced peritoneal malignancy on home parenteral nutrition (HPN). METHODS: A retrospective analysis of all known patients receiving HPN at any time between January 2012 and the 31st March 2020 registered in a high volume peritoneal malignancy surgical centre database. RESULTS: The median duration of HPN for all patients was 309.5 days (range 31-2198). Overall 11/34 went on to have multivisceral transplants. Of these 5/11 resumed normal oral intake off HPN, 3 died and 3 required ongoing HPN. Average time on HPN for patients with pseudomyxoma peritonei of appendix origin was 338 days (71-2198) compared with 90 days (31-260) in the group with more aggressive tumours. CONCLUSIONS: HPN is feasible and effective in selected patients with pseudomyxoma peritonei as either a bridge to transplant or definitive treatment. As expected, patients with more aggressive tumours fare worse.

Developing a Simulated Online Model That Integrates GNSS, Accelerometer and Weather Data to Detect Parturition Events in Grazing Sheep: A Machine Learning Approach.

In the current study, a simulated online parturition detection model is developed and reported. Using a machine learning (ML)-based approach, the model incorporates data from Global Navigation Satellite System (GNSS) tracking collars, accelerometer ear tags and local weather data, with the aim of detecting parturition events in pasture-based sheep. The specific objectives were two-fold: (i) determine which sensor systems and features provide the most useful information for lambing detection; (ii) evaluate how these data might be integrated using ML classification to alert to a parturition event as it occurs. Two independent field trials were conducted during the 2017 and 2018 lambing seasons in New Zealand, with the data from each used for ML training and independent validation, respectively. Based on objective (i), four features were identified as exerting the greatest importance for lambing detection: mean distance to peers (MDP), MDP compared to the flock mean (MDP.Mean), closest peer (CP) and posture change (PC). Using these four features, the final ML was able to detect 27% and 55% of lambing events within ±3 h of birth with no prior false positives. If the model sensitivity was manipulated such that earlier false positives were permissible, this detection increased to 91% and 82% depending on the requirement for a single alert, or two consecutive alerts occurring. To identify the potential causes of model failure, the data of three animals were investigated further. Lambing detection appeared to rely on increased social isolation behaviour in addition to increased PC behaviour. The results of the study support the use of integrated sensor data for ML-based detection of parturition events in grazing sheep. This is the first known application of ML classification for the detection of lambing in pasture-based sheep. Application of this knowledge could have significant impacts on the ability to remotely monitor animals in commercial situations, with a logical extension of the information for remote monitoring of animal welfare.