1-Jahres-Ergebnisse nach kombinierter Kataraktoperation und Excimer-Laser-Trabekulotomie bei erhöhtem Intraokulardruck

Zusammenfassung: Hintergrund: Glaukom ist eine der häufigsten Ursachen für Blindheit. Normalerweise ist ein erhöhter Abflusswiderstand die Ursache, während die Kammerwasserproduktion normal bleibt. Medikamentöse Drucksenkung ist in der Regel die First-line-Behandlung. Der operative Goldstandard ist die Trabekulektomie (TE). Die TE hat jedoch zahlreiche postoperative Komplikationen. Deswegen bevorzugen wir für ausgesuchte Glaukompatienten die kombinierte Kataraktoperation mit der Excimer-Laser-Trabekulotomie (Phako-ELT). Indikationen sind eine Katarakt und gleichzeitig ein moderat erhöhter Intraokulardruck (IOD) ohne medikamentöse Therapie oder eine moderate Katarakt mit erhöhtem IOD trotz medikamentöser Therapie. Patienten und Methoden: Im Rahmen der ELT werden 10Poren über einen Winkel von 90° im Trabekelmaschenwerk erzeugt. Es wurden 28Augen von 28Patienten (10Männer, 18Frauen) 12Monate± 2Wochen nach kombinierter Phako-ELT nachuntersucht. Vier Patienten wurden wegen einer drucksenkenden Reoperation während des Nachbeobachtungszeitraums ausgeschlossen. Intraokulardruck, bestkorrigierter Visus und Anzahl der Glaukommedikamente ("anti-glaucoma drugs", AGD) wurden erhoben und eine Spaltlampenuntersuchung durchgeführt. Ergebnisse: Das Durchschnittsalter lag bei 74,33±11,81Jahren. Diagnosen waren primäres Offenwinkelglaukom bei 9Augen, Pseudoexfoliationsglaukom bei 15Augen, okuläre Hypertension und posttraumatisches Sekundärglaukom bei 3 bzw. 1Auge. Im Durchschnitt konnte durch Phako-ELT der IOD um 8,79±5,28mmHg (−34,70%, p<0,001) gesenkt werden. Die Anzahl der AGD konnte gleichzeitig um 0,79±1,50 (−62,70%, p=0,017) reduziert werden. Schlussfolgerungen: Eine ELT ist technisch einfach am Ende einer Kataraktoperation durchzuführen. Die Operationszeit wird lediglich um 2-3min verlängert. Wir fanden eine durchschnittliche IOD-Reduktion von 8,79mmHg (−34,70%) und gleichzeitig eine durchschnittliche Reduktion von AGD um 0,79. Es ist bekannt, dass der Effekt der IOD-Reduktion konstant mit der Zeit ist im Gegensatz zur Argon- oder selektiven Laser-Trabekuloplastik. Eine evtl. spätere fistulierende Operation ist nicht beeinträchtigt, da die Bindehaut nicht berührt wird und es folglich keine Vernarbung gibt. Für ausgewählte Glaukompatienten ist diese Operation eine Möglichkeit, die Trabekulektomie zu vermeide

Branched-chain amino acid levels are inversely associated with incident and prevalent chronic kidney disease in people with type 2 diabetes

AimTo investigate the association of plasma metabolites with incident and prevalent chronic kidney disease (CKD) in people with type 2 diabetes and establish whether this association is causal.Materials and MethodsThe Hoorn Diabetes Care System cohort is a large prospective cohort consisting of individuals with type 2 diabetes from the northwest part of the Netherlands. In this cohort we assessed the association of baseline plasma levels of 172 metabolites with incident (Ntotal = 462/Ncase = 81) and prevalent (Ntotal = 1247/Ncase = 120) CKD using logistic regression. Additionally, replication in the UK Biobank, body mass index (BMI) mediation and causality of the association with Mendelian randomization was performed.ResultsElevated levels of total and individual branched-chain amino acids (BCAAs)-valine, leucine and isoleucine-were associated with an increased risk of incident CKD, but with reduced odds of prevalent CKD, where BMI was identified as an effect modifier. The observed inverse effects were replicated in the UK Biobank. Mendelian randomization analysis did not provide evidence for a causal relationship between BCAAs and prevalent CKD.ConclusionsOur study shows the intricate relationship between plasma BCAA levels and CKD in individuals with type 2 diabetes. While an association exists, its manifestation varies based on disease status and BMI, with no definitive evidence supporting a causal link between BCAAs and prevalent CKD.Nephrolog

Discovery of predictors of sudden cardiac arrest in diabetes: rationale and outline of the RESCUED (REcognition of Sudden Cardiac arrest vUlnErability in Diabetes) project

Introduction Early recognition of individuals with increased risk of sudden cardiac arrest (SCA) remains challenging. SCA research so far has used data from cardiologist care, but missed most SCA victims, since they were only in general practitioner (GP) care prior to SCA. Studying individuals with type 2 diabetes (T2D) in GP care may help solve this problem, as they have increased risk for SCA, and rich clinical datasets, since they regularly visit their GP for check-up measurements. This information can be further enriched with extensive genetic and metabolic information. Aim To describe the study protocol of the REcognition of Sudden Cardiac arrest vUlnErability in Diabetes (RESCUED) project, which aims at identifying clinical, genetic and metabolic factors contributing to SCA risk in individuals with T2D, and to develop a prognostic model for the risk of SCA. Methods The RESCUED project combines data from dedicated SCA and T2D cohorts, and GP data, from the same region in the Netherlands. Clinical data, genetic data (common and rare variant analysis) and metabolic data (metabolomics) will be analysed (using classical analysis techniques and machine learning methods) and combined into a prognostic model for risk of SCA. Conclusion The RESCUED project is designed to increase our ability at early recognition of elevated SCA risk through an innovative strategy of focusing on GP data and a multidimensional methodology including clinical, genetic and metabolic analyses.Molecular Epidemiolog

Open data from the third observing run of LIGO, Virgo, KAGRA, and GEO

The global network of gravitational-wave observatories now includes five detectors, namely LIGO Hanford, LIGO Livingston, Virgo, KAGRA, and GEO 600. These detectors collected data during their third observing run, O3, composed of three phases: O3a starting in 2019 April and lasting six months, O3b starting in 2019 November and lasting five months, and O3GK starting in 2020 April and lasting two weeks. In this paper we describe these data and various other science products that can be freely accessed through the Gravitational Wave Open Science Center at https://gwosc.org. The main data set, consisting of the gravitational-wave strain time series that contains the astrophysical signals, is released together with supporting data useful for their analysis and documentation, tutorials, as well as analysis software packages

Search for eccentric black hole coalescences during the third observing run of LIGO and Virgo

Despite the growing number of binary black hole coalescences confidently observed through gravitational waves so far, the astrophysical origin of these binaries remains uncertain. Orbital eccentricity is one of the clearest tracers of binary formation channels. Identifying binary eccentricity, however, remains challenging due to the limited availability of gravitational waveforms that include the effects of eccentricity. Here, we present observational results for a waveform-independent search sensitive to eccentric black hole coalescences, covering the third observing run (O3) of the LIGO and Virgo detectors. We identified no new high-significance candidates beyond those that have already been identified with searches focusing on quasi-circular binaries. We determine the sensitivity of our search to high-mass (total source-frame mass M > 70 M⊙) binaries covering eccentricities up to 0.3 at 15 Hz emitted gravitational-wave frequency, and use this to compare model predictions to search results. Assuming all detections are indeed quasi-circular, for our fiducial population model, we place a conservative upper limit for the merger rate density of high-mass binaries with eccentricities 0 < e ≤ 0.3 at 16.9 Gpc−3 yr−1 at the 90% confidence level

Modulation of CD11C+ splenic dendritic cell functions in murine visceral leishmaniasis: correlation with parasite replication in the spleen

BALB/c mice resolve Leishmania donovani infection in the liver over an 8–12-week period. However, after an initial phase of 2–4 weeks where increases in parasite load are not readily detectable, parasite numbers in the spleen begin to increase reaching maximum levels at 16 weeks post-infection. Thereafter, parasite replication in the spleen is controlled and BALB/c mice maintain this residual parasite load in the spleen for many months, without further increase. We evaluated functions of CD11C+ splenic dendritic cells throughout the course of L. donovani infection in the spleen of BALB/c mice. Unlike the dendritic cell (DC)-specific antigen DEC-205, CD11C was not up-regulated on macrophages during visceral leishmaniasis. No appreciable impairment of splenic DC functions was observed when this antigen-presenting cell subset was purified from 30-day post-infected mice. Significant impairment in inducing allogeneic mixed lymphocyte reaction (MLR) and presenting L. donovani antigens or keyhole limpet haemocyanin (KLH) to specific T cells was observed with CD11C+ splenic DC purified from 60-day post-infected mice. Functional impairment of splenic DC at 60 days post-infection correlated with their reduced surface expression of major histocompatibility complex (MHC) class II molecules, impairment of interleukin-12 (IL-12) production and to their ability to suppress interferon-γ (IFN-γ) production by Leishmania antigen-primed T cells. Of interest, the impairment of splenic DC in presenting Leishmania antigens or KLH to specific T cells was corrected at 120 days post-infection, and correlated with their up-regulation of MHC class II expression, IL-12 production, induction of IFN-γ by Leishmania antigen-primed T cells and the onset of control over splenic parasite replication in vivo. These results indicate that functional integrity of DC may be important in controlling L. donovani infection

Potential and existing mechanisms of enteric methane production in ruminants

Enteric methane (CH4) emissions in ruminants have attracted considerable attention due to their impact on greenhouse gases and the contribution of agricultural practices to global warming. Over the last two decades, a number of approaches have been adopted to mitigate CH4 emissions. However, the mechanisms of methanogenesis have still not been fully defined. According to the genome sequences of M. ruminantium in the rumen and of M. AbM4 in the abomasum, the pathways of carbon dioxide (CO2) reduction and formate oxidation to CH4 have now been authenticated in ruminants. Furthermore, in the light of species or genera description of methanogens, the precursors of methanogenesis discovered in the rumen and research advances in related subjects, pathways of acetate dissimilation via Methanosarcina and Methanosaeta as well as metabolism of methanol to CH4 might be present in the rumen, although neither process has yet been experimentally demonstrated in the rumen. Herein the research advances in methanogenesic mechanisms including existing and potential mechanisms are reviewed in detail. In addition, further research efforts to understand the methanogenesis mechanism should focus on isolation and identification of more specific methanogens, and their genome sequences. Such increased knowledge will provide benefits in terms of improved dietary energy utilization and a reduced contribution of enteric CH4 emissions to total global greenhouse gas emissions from the ruminant production system