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

Reception Tests of the Cryogenic Distribution line for the Large Hadron Collider

The paper describes the thermo-mechanical validation of the first sector of cryogenic distribution line (QRL) [1]. The design of the line is recalled and the test methodology presented together with the main results of the reception test at cryogenic temperature

First Experience with the LHC Cryogenic Instrumentation

The LHC under commissioning at CERN will be the world's largest superconducting accelerator and therefore makes extensive use of cryogenic instruments. These instruments are installed in the tunnel and therefore have to withstand the LHC environment that imposes radiation-tolerant design and construction. Most of the instruments require individual calibration; some of them exhibit several variants as concerns measuring span; all relevant data are therefore stored in an Oracle® database. Those data are used for the various quality assurance procedures defined for installation and commissioning, as well as for generating tables used by the control system to configure automatically the input/output channels. This paper describes the commissioning of the sensors and the corresponding electronics, the first measurement results during the cool-down of one machine sector; it discusses the different encountered problems and their corresponding solutions

Functional outcomes of multi-condition collaborative care and successful ageing: results of randomised trial

Objective To evaluate the effectiveness of integrated care for chronic physical diseases and depression in reducing disability and improving quality of life

Conservation genetics of the pond bat (Myotis dasycneme) with special focus on the populations in northwestern Germany and in Jutland, Denmark

Conservation genetics is important in the management of endangered species, helping to understand their connectivity and long‐term viability, thus identifying populations of importance for conservation. The pond bat (Myotis dasycneme) is a rare species classified as “Near Threatened” with a wide but patchy Palearctic distribution. A total of 277 samples representing populations in Denmark, Germany, Latvia, Hungary, and Russia were used in the genetic analyses; 224 samples representing Denmark, Germany, and Russia were analyzed at 10 microsatellite loci; 241 samples representing all areas were analyzed using mitochondrial D‐loop and cytochrome B sequences. A Bayesian clustering approach revealed two poorly resolved clusters, one representing the Danish and German groups and the other the Russian group. However, significantly different pairwise FST and DEST estimates were observed between the Danish and German groups and between the Danish and Russian groups suggesting a recent population structure. These conflicting results might be attributed to the effect of migration or low resolution due to the number of microsatellite markers used. After concatenating the two mitochondrial sequences, analysis detected significant genetic differentiation between all populations, probably due to genetic drift combined with a founder event. The phylogenetic tree suggested a closer relationship between the Russian and Northern European populations compared to the Hungarian population, implying that the latter belongs to an older ancestral population. This was supported by the observed haplotype network and higher nucleotide diversity in this population. The genetic structuring observed in the Danish/German pond bat stresses the need for a cross‐border management between the two countries. Further, the pronounced mtDNA structuring, together with the indicated migration between nearby populations suggest philopatric female behavior but male migration, emphasizes the importance of protecting suitable habitat mosaics to maintain a continuum of patches with dense pond bat populations across the species' distribution range

Wake up, wake up! It's me! It's my life! patient narratives on person-centeredness in the integrated care context: a qualitative study

Person-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care. Person-centeredness is also considered a core element of integrated care. Yet typologies of integrated care mainly describe how patients fit within integrated services, rather than how services fit into the patient's world. Patient-centeredness has been commonly defined through physician's behaviors aimed at delivering patient-centered care. Yet, it is unclear how 'person-centeredness' is realized in integrated care through the patient voice. We aimed to explore patient narratives of person-centeredness in the integrated care context

Outpatient costs in pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting

<p>Abstract</p> <p>Background</p> <p>To assess differences in outpatient costs among pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting.</p> <p>Methods</p> <p>A retrospective case control study over 3 years (2002-2004). Data on 7128 depressed patients and 23772 non-depressed matched controls were available from the electronic medical record system of 20 general practices organized in one large primary care organization in the Netherlands. A total of 393 depressed patients with diabetes and 494 non-depressed patients with diabetes were identified in these records. The data that were extracted from the medical record system concerned only outpatient costs, which included GP care, referrals, and medication.</p> <p>Results</p> <p>Mean total outpatient costs per year in depressed diabetes patients were €1039 (SD 743) in the period 2002-2004, which was more than two times as high as in non-depressed diabetes patients (€492, SD 434). After correction for age, sex, type of insurance, diabetes treatment, and comorbidity, the difference in total annual costs between depressed and non-depressed diabetes patients changed from €408 (uncorrected) to €463 (corrected) in multilevel analyses. Correction for comorbidity had the largest impact on the difference in costs between both groups.</p> <p>Conclusions</p> <p>Outpatient costs in depressed patients with diabetes are substantially higher than in non-depressed patients with diabetes even after adjusting for confounders. Future research should investigate whether effective treatment of depression among diabetes patients can reduce health care costs in the long term.</p