Asunto(s)
Nitroimidazoles , Oxazoles , Humanos , Oxazoles/administración & dosificación , Oxazoles/efectos adversos , Oxazoles/uso terapéutico , Nitroimidazoles/administración & dosificación , Nitroimidazoles/efectos adversos , Nitroimidazoles/uso terapéutico , Masculino , Femenino , Resultado del Tratamiento , Persona de Mediana EdadRESUMEN
BACKGROUND: Evidence on the impact of tuberculosis (TB) treatment on lung function is scarce. The aim of this study was to evaluate post-treatment sequelae in drug-susceptible and drug-resistant-TB (DR-TB) cases in Mexico and Italy.METHODS: At the end of TB treatment the patients underwent complete clinical assessment, functional evaluation of respiratory mechanics, gas exchange and a 6-minute walking test. Treatment regimens (and definitions) recommended by the World Health Organization were used throughout.RESULTS: Of 61 patients, 65.6% had functional impairment, with obstruction in 24/61 patients (39.4%), and 78% with no bronchodilator response. These effects were more prevalent among DR-TB cases (forced expiratory volume in 1 s/forced vital capacity [FEV1/FVC] < lower limit of normality, 14/24 vs. 10/34; P = 0.075). DR-TB patients showed moderately severe (FEV1 < 60%) and severe obstruction (FEV1 < 50%) (P = 0.008). Pre- and post-bronchodilator FEV1 and FEV1/FVC (% of predicted) were significantly lower among DR-TB cases. Plethysmography abnormalities (restriction, hyperinflation and/or air trapping) were more frequent among DR-TB cases (P = 0.001), along with abnormal carbon monoxide diffusing capacity (DLCO) (P = 0.003).CONCLUSION: The majority of TB patients suffer the consequences of post-treatment sequelae (of differing levels), which compromise quality of life, exercise tolerance and long-term prognosis. It is therefore important that lung function is comprehensively evaluated post-treatment to identify patient needs for future medication and pulmonary rehabilitation.
Asunto(s)
Preparaciones Farmacéuticas , Enfermedad Pulmonar Obstructiva Crónica , Tuberculosis Resistente a Múltiples Medicamentos , Volumen Espiratorio Forzado , Humanos , Italia , Pulmón , México , Calidad de Vida , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Capacidad VitalRESUMEN
Adjunctive therapeutic agents may be used to improve the response to nonsurgical periodontal therapy. Local delivery of statins (simvastatin, artovastatin and rosuvastatin) is a promising adjunct to scaling and root planing (SRP). Thus, the aim of this review is to evaluate if adjunctive local delivery of statins is more effective than SRP alone. Randomized clinical trials that presented a test group evaluating local delivery of statins as adjuncts in healthy, diabetic and smoking patients were included. Medline and the Cochrane library database were searched up to November 2016. Random effects meta-analyses were conducted for pocket depth change and clinical attachment gain. One hundred and twenty-five studies potentially related to the aim of this review were screened, but only 10 were included. The majority of the trials reported additional clinical benefits in the groups that were treated with adjunctive local delivery of statins. Pooled calculations showed that local delivery of statins resulted in additional reduction of pocket depth and clinical attachment gain in healthy people, smokers and diabetic patients. Local statins may offer additional clinical benefits to SRP, even in smokers and diabetics.
Asunto(s)
Periodontitis Crónica/terapia , Raspado Dental , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Aplanamiento de la Raíz , Terapia Combinada , HumanosRESUMEN
The resilience of forage under rotational grazing to climate change disturbances, in particular the effects of dry spells is a basic attribute to achieve the sustainability of the dairy cattle production system. This work presents a method based on the system dynamics to estimate the indices of resilience: hardness, robustness, recovery rapidity, and elasticity. A meta-model for the management of the plant-animal ecosystem was adapted to simulate the effects of the disturbances caused by the dry spells in the dry matter stock in the paddocks. The in silico experiments results showed differences between the resilience of the two forage cultivars for the same magnitude of disturbance and differences due to the time of occurrence of water deficit in the forage growth phase or in the paddock use phase by the animals. The recovery rapidity index showed a conceptual adherence to the conditions of rotational grazing, due to the time required to define the entry and exit of the animals in the paddock. It was concluded that the operationalization and evaluation of the resilience generated information about the dry matter stock dynamics that are useful for rotational grazing planning.
A resiliência de forrageiras sob pastoreio rotativo aos distúrbios de mudanças climáticas, em particular aos efeitos do déficit hídrico em veranicos, é um atributo básico para alcançar a sustentabilidade do sistema de produção de leite. Este trabalho apresenta um método baseado na dinâmica de sistemas para estimar os índices de resiliência: dureza, robustez, rapidez de recuperação e elasticidade. Um metamodelo para o manejo do ecossistema planta-animal foi adaptado para simular os efeitos dos distúrbios causados por veranicos no estoque de matéria seca dos piquetes. Os resultados dos experimentos in silicomostram diferenças entre as resiliências de dois cultivares de forrageiras para uma mesma magnitude de distúrbio e diferenças devido a época de ocorrência do déficit hídrico ser na fase de crescimento da forrageira ou na fase de uso dos piquetes pelos animais. O índice de rapidez de recuperação mostrou aderência conceitual para as condições de pastoreio rotativo, devido à premência de tempo na definição da entrada e saída dos animais nos piquetes. Concluiu-se que a operacionalização e avaliação da resiliência geram informações sobre a dinâmica do estoque de matéria seca ofertada para os animais e que estas informações são úteis para o planejamento do pastoreio rotativo.
Asunto(s)
Femenino , Animales , Bovinos , Estiaje , Fenómenos Fisiológicos de las Plantas , Cambio Climático , Restauración y Remediación Ambiental , Ejercicio de Simulación , Leche , Modelos AnatómicosRESUMEN
The resilience of forage under rotational grazing to climate change disturbances, in particular the effects of dry spells is a basic attribute to achieve the sustainability of the dairy cattle production system. This work presents a method based on the system dynamics to estimate the indices of resilience: hardness, robustness, recovery rapidity, and elasticity. A meta-model for the management of the plant-animal ecosystem was adapted to simulate the effects of the disturbances caused by the dry spells in the dry matter stock in the paddocks. The in silico experiments results showed differences between the resilience of the two forage cultivars for the same magnitude of disturbance and differences due to the time of occurrence of water deficit in the forage growth phase or in the paddock use phase by the animals. The recovery rapidity index showed a conceptual adherence to the conditions of rotational grazing, due to the time required to define the entry and exit of the animals in the paddock. It was concluded that the operationalization and evaluation of the resilience generated information about the dry matter stock dynamics that are useful for rotational grazing planning.(AU)
A resiliência de forrageiras sob pastoreio rotativo aos distúrbios de mudanças climáticas, em particular aos efeitos do déficit hídrico em veranicos, é um atributo básico para alcançar a sustentabilidade do sistema de produção de leite. Este trabalho apresenta um método baseado na dinâmica de sistemas para estimar os índices de resiliência: dureza, robustez, rapidez de recuperação e elasticidade. Um metamodelo para o manejo do ecossistema planta-animal foi adaptado para simular os efeitos dos distúrbios causados por veranicos no estoque de matéria seca dos piquetes. Os resultados dos experimentos in silicomostram diferenças entre as resiliências de dois cultivares de forrageiras para uma mesma magnitude de distúrbio e diferenças devido a época de ocorrência do déficit hídrico ser na fase de crescimento da forrageira ou na fase de uso dos piquetes pelos animais. O índice de rapidez de recuperação mostrou aderência conceitual para as condições de pastoreio rotativo, devido à premência de tempo na definição da entrada e saída dos animais nos piquetes. Concluiu-se que a operacionalização e avaliação da resiliência geram informações sobre a dinâmica do estoque de matéria seca ofertada para os animais e que estas informações são úteis para o planejamento do pastoreio rotativo.(AU)
Asunto(s)
Animales , Femenino , Bovinos , Fenómenos Fisiológicos de las Plantas , Restauración y Remediación Ambiental , Cambio Climático , Estiaje , Modelos Anatómicos , Ejercicio de Simulación , LecheRESUMEN
Diabetes mellitus (DM) is a well-known risk factor for tuberculosis (TB). However, it is not known to what extent DM affects the outcome in patients with multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) treated with second-line anti-TB drugs. The objective of this study was to compare the microbiological evolution (sputum smear and culture conversion) and final outcomes of MDR/XDR-TB patients with and without DM, managed at the national TB reference centre in Mexico City. RESULTS: Ninety patients were enrolled between 2010 and 2015: 73 with MDR-TB (81.1%), 11 with pre-XDR-TB (e.g. MDR-TB with additional resistance to one injectable drug or a fluoroquinolone, 12.2%) and 6 (6.7%) with XDR-TB. Out of these, 49 (54.4%) had DM and 42 (86%) were undergoing insulin treatment. No statistically significant differences were found in treatment outcomes comparing DM vs. non-DM MDR-TB cases: 18/32 (56.3%) of DM cases and 19/24 (79.2%) non DM patients achieved treatment success (p=0.07). The time to sputum smear and culture conversion was longer (although not statistically) in patients without DM, as follows: the mean (±SD) time to sputum smear conversion was 53.9 (±31.4) days in DM patients and 65.2 (±34.8) days in non-DM ones (p=0.15), while the time to culture conversion was 66.2 (±27.6) days for DM and 81.4 (±37.7) days for non-DM MDR-TB cases (p=0.06). CONCLUSIONS: The study results support the Mexican National TB programme to strengthen its collaboration with the DM programme, as an entry point for TB (and latent TB infection) screening and management.
Asunto(s)
Antituberculosos/farmacología , Antituberculosos/uso terapéutico , Complicaciones de la Diabetes/microbiología , Mycobacterium tuberculosis/efectos de los fármacos , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Complicaciones de la Diabetes/tratamiento farmacológico , Tuberculosis Extensivamente Resistente a Drogas/complicaciones , Tuberculosis Extensivamente Resistente a Drogas/tratamiento farmacológico , Tuberculosis Extensivamente Resistente a Drogas/microbiología , Humanos , México , Mycobacterium tuberculosis/aislamiento & purificación , Esputo/microbiología , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/complicacionesRESUMEN
Evidence on effectiveness, safety, and tolerability of imipenem/clavulanate (IC) and linezolid containing regimens to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) is scarce. The aim of this observational study is to evaluate the therapeutic contribution of IC and linezolid to manage MDR/XDR-TB cases at the reference centre of São Paulo state, Brazil. Twelve patients (9 males, 1 HIV positive in antiretroviral treatment, 4 MDR, 8 XDR) were treated with IC, 11 of them within linezolid-containing regimens. They all were previously treated with treatment failure, for a median (IQR, interquartile range) of 4.5 (2-6.5) times, having a severe resistance pattern (median number of resistances: 7 (5-8)) and being sputum smear and culture positive. IC and linezolid were prescribed at the dose of 1000mg/day and 600mg/day, respectively. The overall exposure was (median (IQR)) 419 (375.5-658) days for IC and 678 (392-720) days for linezolid. All of them converted their sputum (time to sputum conversion; 60 (37.5-90) days) and culture (75 (60-135) days), and 7 were cured while 5 are still on treatment with a gradually improving clinical picture. While no adverse events were reported for IC, 2 minor side effects, only, were attributed to linezolid (17%); in both cases the drug was re-started without further problems. Our study suggests that IC and linezolid-containing regimens can be used safely and with satisfactory outcomes in reference centres to treat MDR/XDR-TB patients.
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Antibacterianos/administración & dosificación , Ácido Clavulánico/administración & dosificación , Tuberculosis Extensivamente Resistente a Drogas/tratamiento farmacológico , Imipenem/administración & dosificación , Linezolid/administración & dosificación , Inhibidores de beta-Lactamasas/administración & dosificación , Adolescente , Adulto , Antibacterianos/efectos adversos , Brasil , Ácido Clavulánico/efectos adversos , Quimioterapia Combinada , Femenino , Humanos , Imipenem/efectos adversos , Linezolid/efectos adversos , Masculino , Persona de Mediana Edad , Derivación y Consulta , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven , Inhibidores de beta-Lactamasas/efectos adversosRESUMEN
This report describes the miRQuest - a novel middleware available in a Web server that allows the end user to do the miRNA research in a user-friendly way. It is known that there are many prediction tools for microRNA (miRNA) identification that use different programming languages and methods to realize this task. It is difficult to understand each tool and apply it to diverse datasets and organisms available for miRNA analysis. miRQuest can easily be used by biologists and researchers with limited experience with bioinformatics. We built it using the middleware architecture on a Web platform for miRNA research that performs two main functions: i) integration of different miRNA prediction tools for miRNA identification in a user-friendly environment; and ii) comparison of these prediction tools. In both cases, the user provides sequences (in FASTA format) as an input set for the analysis and comparisons. All the tools were selected on the basis of a survey of the literature on the available tools for miRNA prediction. As results, three different cases of use of the tools are also described, where one is the miRNA identification analysis in 30 different species. Finally, miRQuest seems to be a novel and useful tool; and it is freely available for both benchmarking and miRNA identification at http://mirquest.integrativebioinformatics.me/.
Asunto(s)
Biología Computacional/métodos , Internet , MicroARNs/genética , Programas InformáticosRESUMEN
O manejo positivo em novilhas primíparas antes do parto, realizado através de estímulos táteis, pode ser benéfico para o comportamento na rotina de ordenha. O objetivo do trabalho foi avaliar a utilização do estímulo tátil em novilhas leiteiras e seus efeitos no comportamento e produção de leite após o parto. Foram utilizadas 10 novilhas primíparas da raça Holandesa. Metade do grupo recebeu treinamento com estímulo tátil em todas as partes do corpo, enquanto a outra metade não recebeu estimulação (grupo controle). O período de treinamento foi dividido em três fases: inicial, do primeiro ao sexto dia; intermediário, do sétimo ao 12º dia, e final, do 13º ao 23º dia de treinamento. Durante o treinamento foram avaliados, por cinco minutos, movimentação e deslocamento por escores. Também foram registradas medidas fisiológicas [frequência respiratória (FR) e temperatura do olho mínima (TOmín) através da câmera termográfica]. Após o parto, as novilhas foram levadas para a primeira ordenha, quando foram iniciadas as avaliações durante os 10 primeiros dias de ordenha (20 ordenhas consecutivas). As avaliações comportamentais dos animais foram realizadas atribuindo-se escore de reatividade 1 (comportamentos desejáveis) e 2 (comportamentos indesejáveis): entrada na baia, assepsia dos tetos, ordenha de jato de leite para teste de mastite, momento de colocação das teteiras e processo de retirada do leite, além da quantidade de leite produzida. As médias da TOmín e da FR decresceram no decorrer do período de treinamento. Foi observada diferença significativa para o escore de deslocamento (P=0,019), com redução do deslocamento do período inicial para o final (60,0% para 25,7%). Na colocação das teteiras, as novilhas estimuladas apresentaram menor reatividade (P=0,002), com menor frequência de comportamento indesejável (12,0%), do que as novilhas não estimuladas (30,2%). A curva de produção de leite média para os primeiros 60 dias de lactação do grupo das novilhas...
The positive management of primiparous heifers before calving through tactile stimulation may have beneficial effects on behavior during routine milking. The objective of this study was to evaluate the use of tactile stimulation in dairy heifers and its effects on behavior and milk production after calving. Ten primiparous Holstein heifers were used. Half the group received training with tactile stimulation of all body regions, while the other group did not receive stimulation (control group). The training period was divided into three phases: early, days 1 to 6 of training; intermediate: days 7 to 12, and final, days 13 to 23. During training, movement and displacement scores were obtained over a period of 5 minutes. Physiological parameters were also recorded [respiratory rate (FR) and minimum eye temperature (ETmin) measured with a thermal imaging camera]. After calving, the heifers were submitted to first milking when the evaluations were started for the first 10 days of milking (20 consecutive milkings). The behavior of the animals was evaluated by attributing a reactivity score of 1 (desirable behaviors) or 2 (undesirable behaviors): entry into the pen, teat disinfection, milking one or two jets of milk for mastitis testing, attachment of teat cups, and removal of milk, as well as the amount of milk produced. Mean ETmin and FR decreased over the training period. A significant difference was observed for displacement score (P=0.019), with a reduction in displacement from the early to the final period (from 60.0% to 25.7%). During the attachment of teat cups, stimulated heifers were less reactive (P=0.002), characterized by a lower frequency of undesirable behaviors (12.0%), than unstimulated heifers (30.2%). The average milk yield during the first 60 days of lactation was higher for the group of stimulated heifers (Ln y=2.200.0102t+0.331lnt, R2=0.76) compared to unstimulated heifers (Ln y=1.540.0191x+0.578lnx, R2=0.79), with this...
Asunto(s)
Femenino , Animales , Conducta Animal , Lactancia , Leche , Periodo Posparto , Estimulación FísicaRESUMEN
O manejo positivo em novilhas primíparas antes do parto, realizado através de estímulos táteis, pode ser benéfico para o comportamento na rotina de ordenha. O objetivo do trabalho foi avaliar a utilização do estímulo tátil em novilhas leiteiras e seus efeitos no comportamento e produção de leite após o parto. Foram utilizadas 10 novilhas primíparas da raça Holandesa. Metade do grupo recebeu treinamento com estímulo tátil em todas as partes do corpo, enquanto a outra metade não recebeu estimulação (grupo controle). O período de treinamento foi dividido em três fases: inicial, do primeiro ao sexto dia; intermediário, do sétimo ao 12º dia, e final, do 13º ao 23º dia de treinamento. Durante o treinamento foram avaliados, por cinco minutos, movimentação e deslocamento por escores. Também foram registradas medidas fisiológicas [frequência respiratória (FR) e temperatura do olho mínima (TOmín) através da câmera termográfica]. Após o parto, as novilhas foram levadas para a primeira ordenha, quando foram iniciadas as avaliações durante os 10 primeiros dias de ordenha (20 ordenhas consecutivas). As avaliações comportamentais dos animais foram realizadas atribuindo-se escore de reatividade 1 (comportamentos desejáveis) e 2 (comportamentos indesejáveis): entrada na baia, assepsia dos tetos, ordenha de jato de leite para teste de mastite, momento de colocação das teteiras e processo de retirada do leite, além da quantidade de leite produzida. As médias da TOmín e da FR decresceram no decorrer do período de treinamento. Foi observada diferença significativa para o escore de deslocamento (P=0,019), com redução do deslocamento do período inicial para o final (60,0% para 25,7%). Na colocação das teteiras, as novilhas estimuladas apresentaram menor reatividade (P=0,002), com menor frequência de comportamento indesejável (12,0%), do que as novilhas não estimuladas (30,2%). A curva de produção de leite média para os primeiros 60 dias de lactação do grupo das novilhas...(AU)
The positive management of primiparous heifers before calving through tactile stimulation may have beneficial effects on behavior during routine milking. The objective of this study was to evaluate the use of tactile stimulation in dairy heifers and its effects on behavior and milk production after calving. Ten primiparous Holstein heifers were used. Half the group received training with tactile stimulation of all body regions, while the other group did not receive stimulation (control group). The training period was divided into three phases: early, days 1 to 6 of training; intermediate: days 7 to 12, and final, days 13 to 23. During training, movement and displacement scores were obtained over a period of 5 minutes. Physiological parameters were also recorded [respiratory rate (FR) and minimum eye temperature (ETmin) measured with a thermal imaging camera]. After calving, the heifers were submitted to first milking when the evaluations were started for the first 10 days of milking (20 consecutive milkings). The behavior of the animals was evaluated by attributing a reactivity score of 1 (desirable behaviors) or 2 (undesirable behaviors): entry into the pen, teat disinfection, milking one or two jets of milk for mastitis testing, attachment of teat cups, and removal of milk, as well as the amount of milk produced. Mean ETmin and FR decreased over the training period. A significant difference was observed for displacement score (P=0.019), with a reduction in displacement from the early to the final period (from 60.0% to 25.7%). During the attachment of teat cups, stimulated heifers were less reactive (P=0.002), characterized by a lower frequency of undesirable behaviors (12.0%), than unstimulated heifers (30.2%). The average milk yield during the first 60 days of lactation was higher for the group of stimulated heifers (Ln y=2.200.0102t+0.331lnt, R2=0.76) compared to unstimulated heifers (Ln y=1.540.0191x+0.578lnx, R2=0.79), with this...(AU)
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Animales , Femenino , Leche , Lactancia , Periodo Posparto , Conducta Animal , Estimulación FísicaRESUMEN
The reactive oxygen species (ROS) produced by neutrophils are involved in the pathogenesis of several diseases, for which the intake of antioxidants could benefit patients either as a prophylactic or therapeutic treatment. Propolis is among the known antioxidants, and its chemical composition may vary under the influence of seasonality, which may interfere in its biological properties. This work evaluates the role of seasonality on the production of some important compounds of propolis samples produced monthly from November 2001 through October 2002 as well as the effect of these samples on the oxidative metabolism of stimulated neutrophils, by using both luminol and lucigenin to produce chemiluminescence (CLlum and CLluc, respectively). The cytotoxicity of the most active extracts to neutrophils was also investigated. The inhibitory effect of the propolis samples varied significantly during the studied period for both assays (3.4 ± 1.1 to 16.0 ± 1.1 µg/mL for CLlum and 6.2 ± 2.0 to 30.0 ± 5.0 µg/mL for CLluc), which was also observed in the quantitative profile of the main analyzed compounds (aromadendrin-4'-methyl ether, artepillin C, and baccharin). This effect started to become more prominent during the fall and, among all the studied extracts, the one obtained in May displayed the highest inhibitory effect on CL production (3.4 ± 1.1 µg/mL for CLlum and 6.2 ± 2.0 µg/mL for CLluc). The HPLC qualitative profiles of the extracts of propolis samples were quite similar, but there was a huge variation in terms of quantitative profile. It seems that aromadendrin-4'-methyl ether and baccharin play an essential role in the antioxidant activity, while artepillin C is not very important for this effect. The extracts presenting the highest antioxidant activity were produced in May, June, and August, and they did not display cytotoxicity at 25 µg/mL; quercetin, used as control, was not toxic to neutrophils at 8.5 µg/mL.
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Neutrófilos/metabolismo , Própolis/farmacología , Animales , Baccharis/química , Baccharis/metabolismo , Abejas , Brasil , Células Cultivadas , Relación Dosis-Respuesta a Droga , Femenino , Própolis/química , Conejos , Estaciones del Año , ZimosanRESUMEN
The unexpected fact that a spherical dielectric particle with refractive index higher than the surrounding medium will not always be attracted towards high intensity regions of the trapping beam is fully demonstrated here using a simple ray optics approach. This unusual situation may happen due to the inversion of gradient forces, as shown here. Therefore, conventional schemes, such the one based on the use of two counter-propagating beams to cancel the scattering forces, will fail to trap the particle. However, effective trapping still can be obtained by adopting suitable incident laser beams.
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Modelos Químicos , Nanopartículas/química , Nanopartículas/efectos de la radiación , Pinzas Ópticas , Simulación por Computador , Refractometría , Estrés MecánicoRESUMEN
PURPOSE: To determine the minimum effective dosage, most effective route of administration and long-term effects of mitomycin C for prevention of recurrence after pterygium surgery. METHODS: In a prospective, masked study, 227 patients undergoing surgery for primary pterygia were assigned randomly to five groups: group 1 received a single intraoperative application of 0.2 mg/ml mitomycin C for 3 minutes; group 2 received a single intraoperative application of 0.4 mg/ml mitomycin C for 3 minutes; group 3 received mitomycin C eye drops 0.2 mg/ml three times daily for 7 days; group 4 received mitomycin C eye drops 0.4 mg/ml three times daily for 14 days; group 5 acted as a control (surgery alone). RESULTS: After a mean follow-up time of 28 months, recurrence rates of 6.66%, 4.08%, 4.26%, 4.44%, and 29.27%, respectively, were observed. Statistical analysis showed significant differences between groups receiving mitomycin C and the control (P < or = 0.001). There was no statistical difference among treated groups (P > or = 0.0681). No complications of therapy were observed. CONCLUSION: These results support the efficacy and relative safety of a single, low-concentration, intraoperative application of mitomycin C in pterygium surgery together with the use of a conjunctival flap, avoiding excessive cauterization of the sclera and leaving bare sclera.