Combining flanged intrascleral IOL fixation with Glaucoma Surgery: Initial experience

Purpose To report the initial clinical outcomes of combining glaucoma surgery with flanged intrascleral intraocular lens (F-SFIOL) fixation as a single stage procedure. Methods Retrospective, non-comparative case-series of eyes which underwent combined surgery for glaucoma with F-SFIOL and had at least 6-months of follow-up. A fellowship-trained senior glaucoma surgeon managed all the cases. Results Twelve-eyes of 10 glaucoma patients (8 males, 2 females) underwent F-SFIOL; only 8 of these eyes were combined with a glaucoma procedure. Mean age of patients was 55.1 ± 16.1 years (95%CI [44.4,73.2], median 61 years) and were followed-up for a mean of 21.0 ± 9.5 months, 95% CI [13.1,28.9], median 18 months. F-SFIOL was combined with trabeculectomy ± Mitomycin C in 4 eyes, Ahmed Glaucoma Valve in 3 eyes and needling of a pre-existing bleb in 1. Each eye had controlled intraocular pressure (IOP) at last follow-up (pre-procedure 29.1 ± 13.4 mmHg, 95% CI [17.9, 40.3], median 27 mmHg to 14.5 ± 3.2 mmHg, 95% CI [11.8, 17.1], median 13 mmHg, p = 0.006) and decreased need for number of anti-glaucoma medication (AGM) (pre-procedure 3.7 ± 1.1, 95% CI [2.8,4.6], median 4 to 0.7 ± 0.7, 95% CI [0.1,1.3] median 1, p < 0.001). In all the eyes, best corrected visual acuity (BCVA) was either stable or improved; only 1 eye had astigmatism worse than that pre-existing. In 1 eye IOL was explanted, with an additional procedure to control IOP. No serious long-term complications occurred in any subject. Conclusion The initial experience of single-stage F-SFIOL along with glaucoma surgery, both being performed by the same anterior-segment surgeon, is promising, thereby avoiding the cost, specialised skill, and potential complications of a posterior approach. Glaucoma surgery combined with and adapted to suture-less, flap-less, glue-less intra-scleral IOL fixation is hitherto unreported.

Temporary worsening of mitral regurgitation due to conduction disturbance after transcatheter aortic valve implantation

Background Mitral regurgitation after transcatheter aortic valve implantation (TAVI) can be caused by various etiologies. Case presentation An 81-year-old woman with mild mitral regurgitation and complete right bundle branch block was scheduled to undergo TAVI under general anesthesia. After the deployment of the prosthetic valve, electrocardiography depicted a wide QRS wave and bradycardia, suggestive of complete atrioventricular block. Although there was no lesion indicative of tissue injury to the valve itself, worsening of mitral regurgitation was identified on transesophageal echocardiography. The hemodynamic condition was stable, and no additional procedure was performed. Electrocardiography depicted a return to a narrow QRS wave 3 days after surgery, and the mitral regurgitation appeared comparable to the preoperative grade. We assumed that the worsening of mitral regurgitation was caused by dyssynchrony in the left ventricle due to the conduction disorder. Conclusions Mitral regurgitation after TAVI needs observation, including the determination of the etiology and treatment principle.

Influence of Pharyngeal Anaesthesia on Post-Bronchoscopic Coughing: A Prospective, Single Blinded, Multicentre Trial

Background: Local anaesthesia of the pharynx (LAP) was introduced in the era of rigid bronchoscopy (which was initially a conscious procedure under local anaesthetic), and continued into the era of flexible bronchoscopy (FB) in order to facilitate introduction of the FB. LAP reduces cough and gagging reflex, but its post-procedural effect is unclear. This prospective multicentre trial evaluated the effect of LAP on coughing intensity/time and patient comfort after FB, and the feasibility of FB under propofol sedation alone, without LAP. Material and methods: FB was performed in 74 consecutive patients under sedation with propofol, either alone (35 patients, 47.3%) or with additional LAP (39 patients, 52.7%). A primary endpoint of post-procedural coughing duration in the first 10 min after awakening was evaluated. A secondary endpoint was the cough frequency, quality and development of coughing in the same period during the 10 min post-procedure. Finally, the ease of undertaking the FB and the patient’s tolerance and safety were evaluated from the point of view of the investigator, the assistant technician and the patient. Results: We observed a trend to a shorter cumulative coughing time of 48.6 s in the group without LAP compared to 82.8 s in the group receiving LAP within the first 10 min after the procedure, although this difference was not significant (p = 0.24). There was no significant difference in the cough frequency, quality, peri-procedural complication rate, nor patient tolerance or safety. FB, including any additional procedure, could be performed equally well with or without LAP in both groups. Conclusions: Our study suggests that undertaking FB under deep sedation without LAP does to affect post-procedural cough duration and frequency. However, further prospective randomised controlled trials are needed to further support this finding.

Transurethral Incision of the Bladder Neck with Additional Procedure Resumes Spontaneous Voiding in Female Voiding Dysfunction – A Long-term Follow-up

Introductions: To evaluate the long-term effectiveness of transurethral incision of the bladder neck (TUI-BN) with or without additional procedure for female voiding dysfunction.Methods: Women with voiding difficulty and underwent TUI-BN in recent 12 years were included. All patients underwent videourodynamics study (VUDS) at baseline and after TUI-BN. Successful outcome was defined as having a voiding efficiency (VE) by ≥50% after treatment. Patients with insufficient improvement were opt for repeated TUI-BN, urethral onabotulinumtoxinA injection or transurethral external sphincter incision (TUI-ES). The current voiding status, surgical complications were evaluated.Results: A total of 102 women with VUDS evidence of a narrow bladder neck during voiding were enrolled. The long-term success rate of the first TUI-BN was 29.4% (30/102) and increased to 66.7% (34/51) after combining TUI-BN and additional procedure. The overall long-term success rates were 74.6% in detrusor underactivity (DU), 52.0% in detrusor overactivity and low contractility, 50.0% in bladder neck obstruction (p=0.022). Spontaneous voiding was achieved in 66 (64.7%) patients, de novo urinary incontinence in 21 (20.6%), and vesicovaginal fistula in 4 (3.9%), all were repaired.Conclusions: TUI-BN alone or in combination with additional procedure was safe, effective and durable. Patients with DU benefit most in resuming spontaneous voiding.

Aspiration or arthrotomy for paediatric septic arthritis of the shoulder and elbow: a systematic review

Upper extremity arthritis in children can be treated with joint aspiration, arthroscopy or arthrotomy, followed by antibiotics. The literature seems inconclusive with respect to the optimal drainage technique. Therefore, the objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the upper extremity in children. Two independent investigators systematically searched the electronic MEDLINE, EMBASE and Cochrane databases for original articles that reported outcomes of aspiration, arthroscopy or arthrotomy for septic arthritis of the paediatric shoulder or elbow. Outcome parameters were clinical improvement, need for repetitive surgery or drainage, and complications. Out of 2428 articles, seven studies with a total of 171 patients treated by aspiration or arthrotomy were included in the systematic review. Five studies reported on shoulder septic arthritis, one study on elbow septic arthritis, and one study on both joints. All studies were retrospective, except for one randomized prospective study. No difference was found between type of treatment and radiological or clinical outcomes. Aspiration of the shoulder or elbow joint required an additional procedure in 44% of patients, while arthrotomy required 12% additional procedures. Conclusion: Both aspiration and arthrotomy can achieve good clinical results in children with septic arthritis of the shoulder or elbow joint. However, the scientific quality of the included studies is low. It seems that the first procedure can be aspiration and washout and start of intravenous antibiotics, knowing that aspiration may have a higher risk of additional drainage procedures. Cite this article: EFORT Open Rev 2021;6:651-657. DOI: 10.1302/2058-5241.6.200122

Karst Recharge Areas Identified by Combined Application of Isotopes and Hydrogeological Budget

The identification of recharge areas in karst aquifers allows us to perform sustainable management of these groundwater resources. Stable isotopes (δ18O and δ2H) have been largely used to provide information about recharge elevation in many mountainous regions. In this paper, an improved version of a recent “isotope-driven model”, for the identification of recharge areas, was applied to Capodacqua di Spigno Spring (south of the Latium region). The model upgrade consists of a preliminary check procedure to estimate the degree of influence of the rainfall’s isotopic variability on the spring water. This additional procedure gives us an indication of the reliability of the model and its applicability conditions. Moreover, the dataset of the spring was updated to analyze the degree of reliability of the isotope-driven model. The purpose of this study was to combine the previously mentioned isotope-driven model with hydrogeological tools. A quantitative study of the basin, based on the estimation of the average monthly infiltration volume, was performed by using the inverse hydrogeological water budget. In this way, the qualitative model for the recharge areas’ estimation was validated by a quantitative hydrogeological tool. Both models show that, for karst mountain basins, the recharge areas decrease as the average recharge elevations increase, including areas at high altitudes.

Impact of digitalization on development of the VAT taxation system

he article establishes that the development of e-commerce generates serious tax threats. The problem of VAT collection is exacerbated, as non-residents who carry out transactions on supplies of electronic services often fall outside the system of consumption taxation. VAT fraud also distorts competition and increases inequality in the distribution of tax burden. The OECD recommends for the countries to apply at the taxation of e-commerce the approach providing collection of VAT by the principle of country of destination including a reverse charge mechanism, which assigns obligations for payment the VAT of foreign supplier to the customer in the country of consumption. It has been found that the EU is reforming the VAT system on the following principles: tackling fraud; “One Stop Shop”, greater consistency, less red tape. The efforts of the European Commission are primarily aimed at modernizing the collection of VAT in the area of cross-border e-commerce in the B2C format, including more scope for the MOSS regime. It is concluded that in Ukraine, in order to start levying VAT from operations on supplies of electronic services to final consumers by a non-resident, it is necessary to solve the following problems: determination of potential benefits and costs from the introduction of such taxation; definition of the term “electronic services” for VAT purposes; registration of a non-resident as a VAT payer; identification of the recipient of services - the resident of Ukraine to determine the place of supply in B2C format; determination of the procedure for VAT payment; providing a non-resident - VAT payer with the opportunity to pay tax in foreign banks and submit tax reports in the electronic form; introduction of an additional procedure for verifying non-residents reporting.

Rapid Detection of blaKPC-9 Allele from Clinical Isolates

The emergence of Klebsiella pneumoniae carbapenemase (KPC) nosocomial outbreaks related to specific blaKPC gene variants dictates the need for applicable diagnostic methods for allele discrimination. We report here a simple method of blaKPC-9 allele recognition based on a combination of endonuclease digestion analysis and PCR amplification using unique primers. K. pneumoniae isolates carrying the blaKPC gene were tested. Digestion with RsaI restriction endonuclease was found to efficiently differentiate the blaKPC-2 from the blaKPC-9 variants into two distinct groups of digestion patterns named KPC-2-like and KPC-9-like, respectively. An additional procedure, the amplification refractory mutation system (ARMS) method, was applied to identify the variant within the same group. The principles of this procedure could be developed to identify several blaKPC gene variants, as well as monitoring the spread and evolution of specific KPC variants within local geographical regions.

Forming the Telecommunication Networks’ Cross-Sections to Analyze the Latter Stability with Different Connectivity Measures

The problem of stability analysis and its components of reliability and survivability is quite popular both in the field of telecommunications and in other industries involved in the development and operation of complex networks. The most suitable network model for this type of problem is a model that uses the postulates of graph theory. At the same time, the assumption of the random nature of failures of individual links of the telecommunications network allows it to be considered in the form of a generalized Erdos–Renyi model. It is well known that the probability of failure of elements can be interpreted in the form of a readiness coefficient and an operational readiness coefficient, as well as in the form of other indicators that characterize the performance of elements of a telecommunications network. Most approaches consider only the case of bipolar connectivity, when it is necessary to ensure the interaction of two end destinations. In modern telecommunications networks, services such as virtual private networks come to the fore, for which multipoint connections are organized that do not fit into the concept of bipolar connectivity. In this regard, we propose to extend this approach to the analysis of multi-pole and all-pole connections. The approach for two-pole connectivity is based on a method that uses the connectivity matrix as a basis, and, in fact, assumes a sequential search of all combinations of vertex sections, starting from the source and drain. This method leads to the inclusion of non-minimal cross-sections in the general composition, which required the introduction of an additional procedure for checking the added cross-section for non-excess. The approach for all-pole connectivity is based on a method that uses the connectivity matrix as a basis, and, in fact, assumes a sequential search of all combinations of vertex sections, not including one of the vertices considered terminal. A simpler solution was to control the added section for uniqueness. The approach for multipolar connectivity is similar to that used in the formation of the set of minimal all-pole sections and differs only in the procedure for selecting the combinations used to form the cross-section matrix, of which only those containing pole vertices are preserved. As a test communication network, the Rostelecom backbone network is used, deployed to form flows in the direction of "Europe-Asia". It is shown that multipolar sections are the most general concept with respect to two-pole and all-pole sections. despite the possibility of such a generalization, in practical applications it is advisable to consider particular cases due to their lower computational complexity.

Descending aortic transection for recurrence of a pseudoaneurysm previously treated with a stent graft after extra-anatomical bypass for aortic coarctation: a case report

Background In adult patients with primary or recurrent coarctation of the aorta (CoA), extra-anatomic bypass grafting (EABG) has been widely used as a surgical treatment option. However, there have been few reports on pseudoaneurysms (PAs) of the distal anastomotic sites after extra-anatomic bypass for CoA. Case presentation A 51-year-old man with hemoptysis was transferred to our hospital. Twenty years ago, he had undergone EABG from the ascending to the descending aorta (ascending-to-descending EABG) for CoA with right aortic arch. Eight years ago, he underwent thoracic endovascular aortic repair (TEVAR) for the ruptured PA on the distal anastomotic site of the EABG. Contrast-enhanced computed tomography scans revealed recurrent ruptured PA on the distal anastomotic site of the EABG. Therefore, we decided to replace the descending aorta, followed by end-to-side anastomosis of the EABG to the replaced descending aorta. However, due to massive adhesion of the lung to the EABG and PA, we performed transection of the descending aorta to decompress the PA. The postoperative course was uneventful, and the patient is doing well 5 months after surgery. Conclusions Aortic transection between the CoA and the distal anastomosis site may be a useful additional procedure in patients previously treated with TEVAR for PAs in the distal anastomosis site after EABG.