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To compare rates of surgical and clinical success in patients with Ahmed FP7 (FP7), Baerveldt 250 (B250), or Baerveldt 350 (B350) glaucoma drainage devices (GDDs).Retrospective cohort study.A total of 157 eyes of 129 adult patients with FP7, B250, B350 GDDs, and 190 eyes of 99 medically-controlled glaucoma patients were enrolled at a tertiary care institution from Aug 2017 through July 2019. They were followed through April 2020. Main outcome measures included surgical and clinical failure. Surgical failure was defined as intraocular pressure (IOP) outside 5-21 mmHg, IOP reduced20% below baseline, additional glaucoma surgery, GDD removal, or no light perception. Eyes that did not meet their goal IOP ranges or required secondary glaucoma interventions were deemed clinical failures.A total of 43 (12.4%) FP7, 36 (10.4%) B250, 78 (22.5%) B350 and 190 (54.8%) medically-treated control eyes were enrolled. By the post-operative year 3 visit, 10 (23.2%) FP7, 11 (30.6%) B250 and 32 (41.0%) B350 eyes had met a surgical failure criterion (P=0.127). There were no significant differences in the numbers of eyes meeting their IOP target ranges (P=0.510), and rates of secondary glaucoma surgeries (P=0.270). Overall clinical success was attained among 83.3% FP7, 81.8% B250 and 68.0% B350 eyes (P=0.447).The GDD groups were similar in their rates of success, based on both the surgical and clinical success definitions.

Background A patent foramen ovale (PFO) is a persistent embryonic defect in the interatrial septum. Platypnoea-orthodeoxia syndrome is characterized by positional hypoxaemia that is most commonly due to right-to-left shunting through a PFO. Dynamic right-to-left shunting through a PFO can also exacerbate positional hypoxaemia without platypnea-orthodeoxia syndrome. Case summary A 78-year-old woman with hyperthyroidism and paroxysmal atrial fibrillation (AF) presented with positional hypoxaemia exacerbated by supine positioning. Diagnostic testing revealed intermittent right-to-left shunting through a PFO triggered by worsening atrial functional tricuspid regurgitation and elevated right atrial pressures. Diuresis, rate control, and thyroidectomy initially led to resolution of positional hypoxaemia, but recurrent AF episodes triggered right-to-left shunting with recurrent desaturation. Left atrial and cavo-tricuspid isthmus ablation led to restoration of normal sinus rhythm and resolution of positional hypoxaemia without PFO closure. Discussion The clinical presentation of intermittent intracardiac right-to-left shunting can mimic decompensated heart failure with pulmonary oedema. Persistent hypoxaemia out of proportion to the degree of pulmonary oedema and minimally responsive to supplemental O2 should raise suspicion for right-to-left shunt aetiology. Positional arterial blood gases can facilitate the diagnostic evaluation of refractory hypoxaemia in cases of suspected shunting. Diagnostic imaging for PFO detection includes both transthoracic and transesophageal echocardiography with Valsalva manoeuver and agitated saline injection. Closure of a PFO for management of arterial deoxygenation syndromes should not be performed before treating other causes of arterial deoxygenation and optimizing factors that may exacerbate shunting across the PFO.

Background Since its approval for use in recurrent glioblastoma (GBM), the survival benefit of bevacizumab (Bev) remains to be demonstrated. To address this issue, we retrospectively examined survival from first recurrence in patients treated with Bev, lomustine (CCNU), or Bev/CCNU. Methods We identified 168 primary GBM patients diagnosed at UCLA and Kaiser Permanente LA who received upfront radio-chemotherapy, followed by Bev and/or CCNU at first recurrence. Three patient groups, contemporaneously diagnosed from 2009 through 2015, were identified: (1) patients treated with Bev alone (n = 49), (2) CCNU alone (CCNU 09-15) (n = 36), and (3) Bev/CCNU (n = 53). Another CCNU control group (n = 30) diagnosed from 2001 through 2004 (CCNU 01-04) was also derived. We measured tumor size at first recurrence treatment initiation, using bidimensional (2D) and volumetric (3D) techniques, and analyzed overall survival (OS) from first recurrence. Results Among the entire cohort, larger tumor size at first recurrence was associated with poorer survival. The CCNU 01-04 group had similar tumor size as the Bev arms and low Bev crossover (7%). Treatment with Bev was associated with improved survival in patients with large tumor 2D measurements: Median OS for Bev and Bev/CCNU groups were 6.71 mo (n = 27) and 6.97 mo (n = 36) vs 4.03 mo (n = 10) in CCNU 01-04. Analysis by 3D measurement yielded similar results. Interestingly, the CCNU 09-15 group showed the highest survival, likely due to smaller tumor size and crossover to Bev (69%). Conclusion Survival advantage from Bev treatment was observed only among patients with large tumor burden as determined by either 2D or 3D measurement.

We have successfully demonstrated (1) a 3D fabrication and packaging scheme that can readily convert hydraulic actuators into autonomous osmotic actuators, and (2) a new type of osmotic actuators that can generate desired locomotion and force outputs for orthodontic application. Soft bellow structures are employed to realize and amplify the actuation, including elongation, contraction, bending, and twisting. When placed in oral cavity, the actuators are osmotically pressurized to move and guide the teeth into proper alignment in a steady and preprogrammed manner. Besides pumping, it is demonstrated for the first time that osmotic actuation can be tailored to realize sophisticated functions.

Aim: Long-term survivors (LTS)after glioma recurrence while on bevacizumab (Bev)therapy are rarely reported in the current literature. The purpose of this case series is to confirm the existence of and describe a large cohort of recurrent glioma LTS treated with Bev (Bev-LTS). Patients & methods: We identified Bev-LTS as patients with post-Bev initiation survival times of ≥3 years among 1397 Bev treated recurrent glioma patients. Results: Among 962 grade-IV,221 grade III, and214 grade II Bev-treated glioma patients, we identified 28 (2.9%),14 (6.3%) and8(3.7%)Bev-LTS patients, respectively. 45Bev-LTS patients recurred on Bev, with 36 of those patients continuing therapy.Conclusion: Our study shows that a small portion of grade-IV, -III,and -II glioma patients can have long-term survival on Bev therapy even after Bev recurrence.

Soft actuators with embedded power sources are critical for applications where space is limited but safety and functionality are demanded. We have successfully demonstrated (1) a 3D design/fabrication/packaging scheme that can readily upgrade conventional hydraulic actuators into autonomous osmotic actuators, and (2) integrated soft actuators that can yield desired locomotion and force outputs for orthodontic application. Flexible composite structures with semipermeable interfaces are employed to realize the desired actuation, including elongation, contraction, bending, and twisting. More specifically, thin-walled polymer bellows are utilized to control and amplify the actuation caused by osmosis. In the prototype demonstration, 25 mm long soft bellow structures with outer diameters up to 4 mm and wall thicknesses down to 250 μm were designed, 3D printed, shrink wrapped with semipermeable membranes, assembled, and characterized. When placed in aqueous media, the actuators were osmotically pressurized to function in steady and preprogrammed manners. The constant water flow rate across the semipermeable interface (with an effective working area of 30 mm2) into each presented osmotic actuator was measured to be 156 μl h−1, while the inner pressure can reach 200 kPa in few hours. It was demonstrated that both the inner/outer pressure difference and locomotion/force outputs are proportional to the actuation time. When applied on teeth, the osmotic actuators are expected to steadily overcome the rising resistance from surrounding tissues, and therefore achieve constant-rate and long-lasting movement of teeth. In addition to pumping, it is demonstrated for the first time that osmotic actuation can be tailored to accomplish sophisticated locomotion functions.

This paper designs and implements a charger with high output current for EV batteries, the structure of the charger is formed of a four-phase interleaved buck converter with synchronous rectification and associated with the digital controller, in which the current sharing control is realized. The interleaved control scheme can reduce the output ripple and decrease the power component stress in battery charger application. In addition, synchronous rectification is utilized to improve power efficiency of the interleaved buck converter. This paper uses TMS32F28035 by TI as the digital controller to control the implemented four-phase buck converter to perform interleaved control, charging function and current sharing control. The specification of the used Yttrium Lithium battery is 20V/40Ah for experiments. The validity of the charger formed of the designed interleaved buck converter is conducted with the experiment results for constant current 40A output and the verification of current sharing control.

2052 Background: Bev was FDA approved for recurrent GBM in 2009. However, the survival benefit from Bev in GBM remains to be demonstrated. Methods: We retrospectively identified 168 primary GBM patients diagnosed between 2001-2015 at UCLA and Kaiser Permanente LA, who received upfront radio-chemotherapy, followed with Bev and/or Lomustine (CCNU) at 1st recurrence. We measured tumor size at 1st recurrent treatment initiation, using bi-dimensional (2D) and volumetric (3D) techniques. We analyzed overall survival (OS) from 1st recurrence by Kaplan-Meier analysis. Results: Three groups of patients diagnosed from 2009-2015 were identified: patients treated with Bev alone (n = 49), CCNU alone (n = 36), and concurrent Bev/CCNU (n = 53). Patients were statistically different in performance status at 1st recurrence and tumor size; the CCNU alone group had smaller tumor sizes at diagnosis compared to the Bev groups. The CCNU group showed substantially greater survival (median OS (mOS) = 14.1 mo) compared to the Bev and Bev/CCNU groups (mOS = 6.9 and 7.1 mo, respectively), which may be explained by the imbalance in tumor sizes among the groups, and high rate of crossover (69%) to Bev in subsequent recurrences. To minimize selection bias, we identified another control group (n = 30) diagnosed from 2001-2004 who received CCNU only (CCNU 01-04). These patients had tumor size and KPS more comparable to both Bev groups, and a low rate of crossover (7%). OS for CCNU 01-04 (mOS = 5.7 mo) was similar to the Bev groups. Across all patients, we observed poor OS associated with larger 2D size vs. those with small tumors (mOS = 6.7 vs. 8.8 mo; p = 0.003). In separate stratification of each treatment group by tumor size, this association was retained in the CCNU 01-04 group (mOS = 4.0 vs. 8.4 mo, p < 0.001), but not in either Bev (mOS = 6.7 vs. 7.3 mo) or BEV/CCNU (mOS = 7.0 vs. 8.8 mo). Analysis of effect of tumor size by 3D measurement yielded similar results. Conclusions: Bev appears to reduce the negative impact of large tumor size on GBM patient survival from 1st recurrence. 2D and 3D measurements were correlated, suggesting the adequacy of use of conventional tumor bi-dimensional measurement to predict benefit of Bev in patients based on tumor size.