Clinical application of accommodating intraocular lens

The present review describes recent advances in application of accommodating intraocular lenses （AIOLs）. Standard monofocal intraocular lenses （MIOLs） only correct distance vision, while AIOLs are designed to allow both good distance vision and near vision, which is achieved through the contraction and relaxation of ciliary muscles by providing transformation of the axial movement or curvature of the lens. Thus, AIOLs may be a better choice for those patients who demand a higher level of visual performance. Since techniques to analyze the performance of AIOLs have not been standardized, and there is a variety of both subjective and objective methods, it is hard to measure the performance of these intraocular lenses. By evaluating advantages and disadvantages of various AIOLs, and introducing techniques for measurement the performance postoperative, this paper can provide some relative information on choosing the type of AIOLs in the clinic.

Visual performance with accommodating and multifocal intraocular lenses

AIM： To compare the visual functional outcomes with accommodating and multifocal intraocular lenses（IOLs）.METHODS： Our retrospective comparative study included 51 patients（60 eyes） received implantation of an accommodating IOL（Tetraflex;16 patients,20 eyes）,a refractive multifocal IOL（Re Zoom;18 patients,20 eyes）,or a diffractive multifocal IOL（ZMA00;17 patients,20 eyes）.Subjective refraction,visual acuity,contrast sensitivity（CS）,intraocular aberration,and subjective photic phenomena were detected at 3mo after surgery.RESULTS： The spherical equivalent in the three groups was-0.38±0.54 D,0.14±0.56 D,and 0.35±0.41 D,respectively.No statistically significant differences were found in uncorrected and corrected distance visual acuity and uncorrected intermediate visual acuity among the groups（P=0.39）.The Re Zoom group had significantly better distance-corrected intermediate visual acuity than the ZMA00 group（P=0.003）.The ZMA00 group had significantly better near visual acuity than the other groups（P〈0.05）.Better contrast sensitivity values were observed in the Tetraflex group under most of the spatial frequencies conditions（P=0.025）.The total aberration was lowest in the ZMA00 group（P=0.000）,and the spherical aberration was highest in the Tetraflex group（P=0.000）.The three groups had similar frequency of ghosting and glare,and the Tetraflex group had a low rate of halos（P=0.01）.CONCLUSION： Both accommodating and multifocal IOLs can successfully restore distance and uncorrected intermediate visual acuities.Tetraflex accommodating IOLs perform better in CS and with less halos of photic phenomena.Re Zoom refractive multifocal IOLs havebetter performance in distance-corrected intermediate visual acuity than ZMA00 diffractive multifocal IOLs,and the latter achieved better near visual acuity and efficiently decreased the optical aberration.

Accommodating Growth

MARIA Jacobs and her husband left their home in South Africa and moved to Guangzhou, the capital city of south China＇s Guangdong Province. two years ago She enjoys her life in the city, mainly because she lives in the Ascott high-end serviced apartment complex located in the city＇s downtown area. which is not only close to all kinds of entertainment, but also offers convenient access to major business and shopping districts nearby.

Image registration of the human accommodating eye demonstrates equivalent increases in lens equatorial radius and central thickness

AIM: To compare the results of in vivo human high resolution image registration studies of the eye during accommodation to the predictions of mathematical and finite element models of accommodation. METHODS: Data from published high quality image registration studies of pilocarpine induced accommodative changes of equatorial lens radius(ELR) and central lens thickness(CLT) were statistically analyzed. RESULTS: The mean changes in ELR and CLT were 6.76 μm/diopter and 6.51 μm/diopter, respectively. The linear regressions, reflecting the association between ELR and accommodative amplitude(AAELR) was: slope=6.58 μm/diopter, r^2=0.98, P<0.0001 and between CLT and AACLT was: slope=6.75 μm/diopter, r^2=0.83, P<0.001. On the basis of these relationships, the CLT slope and the AAELR were used to predict the measured change in ELR(ELRpredicted). There was no statistical difference between ELRpredicted and the measured ELR as demonstrated by a Student's paired t-test: P=0.96 and linear regression analysis: slope=0.97, r^2=0.98, P<0.00001.CONCLUSION: Image registration with invariant positional references demonstrates that ELR and CLT equivalently minimally increase ~7.0 μm/diopter during accommodation. The small equivalent increases in ELRand CLT are associated with a large accommodative amplitude. These findings are consistent with the predictions of mathematical and finite element models that specified the stiffness of the lens nucleus is the same or greater than the lens cortex and that accommodation involves a small force(<5 g).

Formation mechanism of fault accommodation zones under combined stress in graben basin:Implications from geomechanical modeling

A fault accommodation zone is a type of structure that is defined as regulating displacement and strain between faults structure.Increasing numbers of fault accommodation zones are being identified in graben basins,indicating the potential exploration target and petroleum accumulation areas.This study aims to analyze the formation mechanism and development of fault accommodation zones under combined stress by a numerical simulation method considering geomechanical modeling.Using three-dimensional(3-D)seismic interpretation and fractal dimension method,exampled with the Dongxin fault zone,the fault activity and fault combination pattern were conducted to quantitatively characterize the activity difference in fault accommodation zones.Combined with mechanical experiment test,a geomehcanical model was established for fault accommodation zones in a graben basin.Integrating the paleostress numerical simulations and structural physical simulation experiment,the developmental characteristics and genetic mechanism of fault accommodation zones were summarized.Influenced by multi movements and combined stresses,three significant tectonic evolution stages of the Dongxing Fault Zone(DXFZ)were distinguished:During the E_(s)^(3)sedimentary period,the large difference in the stress,strain,and rupture distribution in various faults were significant,and this stage was the key generation period for the prototype of the DXFZ,including the FAZ between large-scale faults.During the E_(s)^(2)sedimentary period,the EW-trending symmetric with opposite dipping normal faults and the NE-SW trending faults with large scale were furtherly developed.The junction area of two secondary normal faults were prone to be ruptured,performing significant period for inheriting and developing characteristics of fault accommodation zones.During the Es1 sedimentary period,the high-order faults in the DXFZ exhibited the obvious fault depressions and strike-slip activity,and the fault accommodation zones were furtherly inherited and developed.This stage was the molded and formative period of the FAZ,the low-order faults,and the depression in the DXFZ.

SAGeLogE: A Decision Support System for Students’ Accommodation Management

SAGeLogE is the acronym of “Système d’Aide à la Gestion de Logements étudiants” which means student accommodation management support system. It’s a multi-criteria decision support system designed to manage accommodation allocation for university students. Within SAGeLogE we developed the “Minimum of Ranks” (MIRA) aggregation method. MIRA method involves the application of multi-criteria decision-making methods (MCDM) to initially obtain different ranking. Thus, we chose the Weighted Sum Method (WSM), Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) and Combined Compromise Solution (CoCoSo) methods to be implemented in SAGeLogE. To prioritize the weights of criteria, the Anality Hierarchy Process (AHP) method was used. The interest of using the MIRA method was to obtain a compromised ranking coming from these three multi-criteria decision-making methods (WSM, TOPSIS, CoCoSo). So, we know that the accommodation to be allocated to students is always lower than the number of accommodation requests received by the organization. Thus, SAGeLogE proposed a technique that makes it easier to select students ranked by the multi-criteria decision-making and MIRA methods according to a method of calculation of quota of available accommodations within university residences. Finally, university accommodation managers had a wide choice of student ranking according to the methods implemented in SAGeLogE. The SAGeLogE experiment was carried out on the site of Toamasina University in Madagascar for an academic year with 2026 student accommodation applications received. The experimentation showed the ability of SAGeLogE to achieve the result.

Coordinated planning for flexible interconnection and energy storage system in low-voltage distribution networks to improve the accommodation capacity of photovoltaic

The increasing proportion of distributed photovoltaics(DPVs)and electric vehicle charging stations in low-voltage distribution networks(LVDNs)has resulted in challenges such as distribution transformer overloads and voltage violations.To address these problems,we propose a coordinated planning method for flexible interconnections and energy storage systems(ESSs)to improve the accommodation capacity of DPVs.First,the power-transfer characteristics of flexible interconnection and ESSs are analyzed.The equipment costs of the voltage source converters(VSCs)and ESSs are also analyzed comprehensively,considering the differences in installation and maintenance costs for different installation locations.Second,a bilevel programming model is established to minimize the annual comprehensive cost and yearly total PV curtailment capacity.Within this framework,the upper-level model optimizes the installation locations and capacities of the VSCs and ESSs,whereas the lower-level model optimizes the operating power of the VSCs and ESSs.The proposed model is solved using a non-dominated sorting genetic algorithm with an elite strategy(NSGA-II).The effectiveness of the proposed planning method is validated through an actual LVDN scenario,which demonstrates its advantages in enhancing PV accommodation capacity.In addition,the economic benefits of various planning schemes with different flexible interconnection topologies and different PV grid-connected forms are quantitatively analyzed,demonstrating the adaptability of the proposed coordinated planning method.

Scheimpflug Imaging of the Anterior Eye Segment during Standardized Accommodation Stimulation in Patients with Emmetropia, Myopia and Hypermetropia

Understanding of the biomechanics of the accommodative apparatus in the eyes with different refraction is important for solving the problems of theoretical and practical ophthalmology. Purpose: To determine the changes of anterior eye segment dimensions during accommodation response in normal eyes and in patients with myopia, hypermetropia. Methods and Material: 116 eyes (56 patients aged from 18 to 30 years, refraction from -2.0 to + 2.0 D) were examined. All the patients underwent a full ophthalmological examination. The ocular anterior segment was imaged using a rotational Scheimpflug camera Pentacam HR (Oculus, Wetzlar, Germany) under non- and 3.0 D of accommodative demands. The statistical data were represented as the mean value ± standard deviation (M ± SD). The Shapiro-Wilk test was used to assess the normality distribution. Wilcoxon test was used for comparison. Results: Results showed an increase in the optical density of the crystalline lens, a pupil diameter decrease and changing of the iris profile during accommodation in all patients. An increase in the total corneal aberrations and decrease in the corneal spherical aberration were revealed only in emmetropic eyes. Conclusions: The accommodative response is a multicomponent process. Scheimpflug visualization revealed the differences in the accommodative response in normal and ametropic eyes.

Modeling and Analyzing Dynamic Response for An Offshore Bottom-Fixed Wind Turbine with Individual Pitch Control

The asymmetric or periodically varying blade loads resulted by wind shear become more significant as the blade length is increased to capture more wind power.Additionally,compared with the onshore wind turbines,their offshore counterparts are subjected to additional wave loadings in addition to wind loadings within their lifetime.Therefore,vibration control and fatigue load mitigation are crucial for safe operation of large-scale offshore wind turbines.In view of this,a multi-body model of an offshore bottom-fixed wind turbine including a detailed drivetrain is established in this paper.Then,an individual pitch controller(IPC)is designed using disturbance accommodating control.State feedback is used to add damping in flexible modes of concern,and a state estimator is designed to predict unmeasured signals.Continued,a coupled aero-hydro-servo-elastic model is constructed.Based on this coupled model,the load reduction effect of IPC and the dynamic responses of the drivetrain are investigated.The results showed that the designed IPC can effectively reduce the structural loads of the wind turbine while stabilizing the turbine power out-put.Moreover,it is found that the drivetrain dynamic responses are improved under IPC.

The Application of Communication Accommodation Theory to Identity Construction:A Case Study of My Fair Lady

My Fair Lady is a movie about how a lower class flower girl turns to an upper class lady by simply changing her language at the help of a linguist.It demonstrates the importance of communication accommodation,especially convergent accommodation,in using language as code and behavior to construct identity in the target community.

Gastrointestinal dysfunction in liver cirrhosis

Patients with liver cirrhosis exhibit several features of gut dysfunction which may contribute to the development of cirrhosis complications as well as have an impact on nutritional status and health-related quality of life.Gastrointestinal symptoms are common in cirrhosis and their pathophysiology probably involves factors related to liver disease severity,psychological distress,and gut dysfunction(e.g.,increased gastric sensitivity to distension and delayed gut transit).They may lead to reduced food intake and,thus,may contribute to the nutritional status deterioration in cirrhotic patients.Although tense ascites appears to have a negative impact on meal-induced accommodation of the stomach,published data on gastric accommodation in cirrhotics without significant ascites are not unanimous.Gastric emptying and small bowel transit have generally been shown to be prolonged.This may be related to disturbances in postprandial glucose,insulin,and ghrelin levels,which,in turn,appear to be associated to insulin resistance,a common finding in cirrhosis.Furthermore,small bowel manometry disturbances and delayed gut transit may be associated with the development of small bowel bacterial overgrowth.Finally,several studies have reported intestinal barrier dysfunction in patients with cirrhosis(especially those with portal hypertension),which is related to bacterial translocation and permeation of intestinal bacterial products,e.g.,endo-toxin and bacterial DNA,thus potentially being involved in the pathogenesis of complications of liver cirrhosis.

Sonographic evaluation of proximal gastric accommodation in patients with functional dyspepsia

AIM: To assess the value of ultrasonography (US) in evaluation of proximal gastric accommodation disorder in patients with functional dyspepsia (FD). METHODS: Between April 2011 and March 2012, 45 patients with FD and 27 healthy volunteers were enrolled in this study. Two-dimensional ultrasound (2DUS) and 3-dimensional ultrasound (3DUS) were performed sequentially to measure proximal gastric area (PGA), maximal proximal gastric diameter (MPGD), and proximal gastric volume (PGV). These values were measured separately in the two groups every other 5 min for a duration of 25 min after the beginning of ingestion of a test meal. Air pocket grading was done separately for images of 2DUS and blocks of 3DUS obtained at five scanning time points. RESULTS: Both PGA and PGV of patients were significantly smaller than healthy controls (P = 0.000 and 0.002, respectively). Comparing the two parameters between the groups at each time point, the differences were also statistically significant (P = 0.000-0.013), except at 10 min for the PGV (P = 0.077). However, no overall difference was found between the groups in the MPGD measurements (P = 0.114), though it was statistically significant at a 20-minute examination point (P = 0.026). A total of 360 sets or blocks of images were obtained for both 2DUS and 3DUS. For the images analyzed by 2DUS, none were excluded because of gastric gas, and 50 (13.9%) and 310 (86.1%) sets were determined as air pockets grades 1 and 2, respectively. For the images analyzed by 3DUS, 23 (6.4%) blocks were excluded from the measurement due to presence of a large fundus air pocket (grade 3); fifty (13.9%) and 287 (79.7%) blocks were also graded as 1 and 2, respectively. CONCLUSION: Measurement of both PGA and PGV by 2DUS and 3DUS could be useful for assessment of the proximal gastric accommodation.

Accommodation function comparison following use of contact lens for orthokeratology and spectacle use in myopic children: a prospective controlled trial

AIM： To study effects of orthokeratology（Ortho-k） on accommodation function in myopic children. METHODS： A prospective, non-randomized, case-control study was performed from September to October 2016. Eighty-three children with myopia were divided into two groups. One group was treated with the rigid contact lens for overnight Ortho-k, and the other was treated with single-vision spectacle lens（SVL）. Accommodation function were assessed by accommodative amplitude（AA）, accommodative sensitivity（AS）, accommodative lag（Lag）, negative relative accommodation（NRA）, and positive relative accommodation（PRA） before and 1, 3, 6 and 12 mo after treated. RESULTS： Totally 72 myopic children were finished the follow-up： 37 in Ortho-k group and 35 in SVL group. Wearing time had a significant effect on AA, AS, Lag, and NRA of myopic children in two groups（all P〈0.05）. Meanwhile, there was an interaction effect between wearing time and wearing types（FAA=5.3, FAS=45.5, FLag=7.0, FNRA=3.7, all P〈0.05）. However, the between-group difference of AA（F=0.1）, AS（F=3.2）, Lag（F=1.1）, NRA（F=0.3）, and PRA（F=0.1） showed no significance. AA, AS, NRA, Lag and PRA were improved significantly in Ortho-k group within 1 to 6 mo after wearing. CONCLUSION： Wearing Ortho-k can improve the accommodation function of myopic children, which might be one of the mechanisms for myopia control.

Personalized medicine in functional gastrointestinal disorders:Understanding pathogenesis to increase diagnostic and treatment efficacy

There is overwhelming evidence that functional gastrointestinal disorders(FGIDs) are associated with specific mechanisms that constitute important targets for personalized treatment. There are specific mechanisms in patients presenting with functional upper gastrointestinal symptoms(UGI Sx). Among patients with UGI Sx, approximately equal proportions(25%) of patients have delayed gastric emptying(GE), reduced gastric accommodation(GA), both impaired GE and GA,or neither, presumably due to increased gastric or duodenal sensitivity.Treatments targeted to the underlying pathophysiology utilize prokinetics,gastric relaxants, or central neuromodulators. Similarly, specific mechanisms in patients presenting with functional lower gastrointestinal symptoms, especially with diarrhea or constipation, are recognized, including at least 30% of patients with functional constipation pelvic floor dyssynergia and 5% has colonic inertia(with neural or interstitial cells of Cajal loss in myenteric plexus); 25% of patients with diarrhea-predominant irritable bowel syndrome(IBSD) has evidence of bile acid diarrhea; and, depending on ethnicity, a varying proportion of patients has disaccharidase deficiency, and less often sucrose-isomaltase deficiency. Among patients with predominant pain or bloating, the role of fermentable oligosaccharides, disaccharides, monosaccharides and polyols should be considered. Personalization is applied through pharmacogenomics related to drug pharmacokinetics, specifically the role of CYP2 D6, 2 C19 and 3 A4 in the use of drugs for treatment of patients with FGIDs. Single mutations or multiple genetic variants are relatively rare, with limited impact to date on the understanding or treatment of FGIDs. The role of mucosal gene expression in FGIDs, particularly in IBS-D, is the subject of ongoing research. In summary, the time for personalization of FGIDs, based on deep phenotyping, is here;pharmacogenomics is relevant in the use of central neuromodulators. There is still unclear impact of the role of genetics in the management of FGIDs.

Assessment of proximal gastric accommodation in patients with functional dyspepsia

Impaired gastric accommodation is one of the most important etiologic factors in the pathophysiology of functional dyspepsia.Ultrasound is a potential alternative method to study changes in gastric volume as a reflection of gastric accommodation.Ultrasound is suitable for patients because it is a non-invasive,easily repeated and non-radioactive procedure,and a previous study has demonstrated the feasibility of 3-dimensional ultrasound in examining functional dyspepsia.The brief article by Fan et al demonstrated that both the proximal gastric area and volume,measured by 2-and 3-dimensional ultrasound respectively,were significantly smaller in patients with functional dyspepsia than in healthy controls.These results are very interesting,but we raise the relevant point that it should have been mandatory to study both changes in gastric volume and their relationship with upper gastrointestinal symptoms in functional dyspepsia.In fact,the relationship between cardinal symptoms and several pathophysiologic mechanisms in functional dyspepsia remains a matter of debate.Moreover,further evaluation of distal gastric volume that has been previously implicated in the origin of functional dyspeptic symptoms is advisable.Therefore,impaired gastric accommodation does not serve as a clear marker of the cardinal symptoms experienced by patients with functional dyspepsia in daily life.

A comparison of surgical efficacy between a 1.8-mm microincision and 3.2-mm and 5.5-mm incisions for phacoemulsification

Phacoemulsification is a commonly used surgical method in cataract surgery. This paper observes and compares the surgical efficacy of three incisions of different length for phacoemulsification to identify the optimal method for cataract surgery. Ninety patients were enrolled in the present study and divided into three groups. The 1.8-mm group received Bausch ＆ Lomb MI60 foldable intraocular lens （IOL） implantation （n=30）, 3.2-mm group received Bausch ＆ Lomb Akreos AO foldable lens implantation （n=30）, and 5.5-mm group received Alcon TYPE 05 rigid IOL implantation （n=30）. Visual acuity, Oculyzer-based anterior segment analysis, and corneal endothelial cell count before surgery, and 3, 7, 30, and 90d after surgery were recorded and compared. Pseudophakic accommodation three days, one week, one month, and three months after surgery was determined. Intraoperative ultrasound time and ultrasonic energy were recorded. It was finally concluded that for phacoemulsification with the same phaco tip, a 1.8-mm microincision can lead to quicker recovery of visual acuity, more stable astigmatism, and higher pseudophakic accommodation than conventional incision.

Optimization operation model of electricity market considering renewable energy accommodation and flexibility requirement

The renewable portfolio standard has been promoted in parallel with the reform of the electricity market,and the flexibility requirement of the power system has rapidly increased.To promote renewable energy consumption and improve power system flexibility,a bi-level optimal operation model of the electricity market is proposed.A probabilistic model of the flexibility requirement is established,considering the correlation between wind power,photovoltaic power,and load.A bi-level optimization model is established for the multi-markets;the upper and lower models represent the intra-provincial market and inter-provincial market models,respectively.To efficiently solve the model,it is transformed into a mixed-integer linear programming model using the Karush–Kuhn–Tucker condition and Lagrangian duality theory.The economy and flexibility of the model are verified using a provincial power grid as an example.

Genetic models of structural traps related to normal faults in the Putaohua Oilfield,Songliao Basin

The Putaohua Oilfield is a fault-prolific area and the faults have close relation with structural traps. The genetic models of the structural traps in the Putaohua Oilfield can be divided into two types： individual fault model and multi-fault interaction model. This is based on the description of displacement distribution of typical individual normal faults, the geometry of the footwall and hanging wall, and the analysis of the interaction between faults and the corresponding change in geometry when the faults grow. The individual fault model is that the displacement reaches a maximum at or near the center of fault and decreases toward the fault tips, so a half-graben is formed on the hanging wall of the fault and a half- anticline is formed on the footwall because of the isostatic process. The multi-fault interaction model is that during the growth of faults, they overlap and interact with each other, and accommodation zones are formed in the overlapping segments. The accommodation zones are favorable targets for hydrocarbon exploration, and the trap characteristics are dependent The multi-fault interaction model can be subdivided on the extent of overlap and occurrence of faults. into three types： synthetic accommodation zone, convergent accommodation zone and divergent accommodation zone. Hydrocarbon migration and accumulation models of each type have been developed. The hydrocarbon migration and accumulation models of the traps with different genetic models have their own characteristics in the different stages of fault growth.

Tissue plasminogen activator-assisted vitrectomy in the early treatment of acute massive suprachoroidal hemorrhage complicating cataract surgery

Dear Editor,I am Dr.Zhao PQ,from the Department of Ophthalmology,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,China.