Effect of ultrasonographic lung consolidation on health and growth in dairy calves: A longitudinal study

Bovine respiratory disease (BRD) is a common and complex disease process in calves. Subclinical disease exists and early detection can be challenging due to inconsistent or nonexistent clinical signs. Thoracic ultrasonography (TUS) is often used and has the potential to improve the identification of respiratory diseases. Combining systematic TUS with clinical examination allows distinguishing BRD, including upper respiratory tract disease (clinical signs of respiratory disease, but no significant lung consolidation), clinical pneumonia (clinical signs of respiratory disease along with lung consolidations), and subclinical pneumonia (no clinical signs, but lung consolidations). Data on subclinical pneumonia are scarce, particularly outside of the North American or European contexts similar to Iran in west Asia with a dry and semi-arid climate and intensive breeding systems similar to North America which breeding calves begin in individual boxes, then moving to group pens, and finally to free stall or open shed housing systems. The first objective of this longitudinal study was to use weekly ultrasonography to monitor calves from birth until weaning in an Iranian dairy herd. The second objective was to look for any association between individual lung consolidation episode or cumulative consolidation episodes on preweaning growth. Thoracic ultrasonography was performed on calves (n = 221) weekly from birth to weaning (8 wk), and scanning occasions for each calf were equally distributed with 1-wk intervals (using consolidation threshold ≥3 cm as a specific lung consolidation definition, and ≥1 cm as a more sensitive threshold). Calf body weights were recorded using a weight tape. Other information recorded were transfer of passive immunity (TPI) using serum Brix (%) ≥8.4% as adequate TPI within the first week after birth and the treatment history of the calves. The main strategy for modeling was to determine how long-term lung consolidation affects average daily gain (ADG) during the preweaning period. A linear model was used to determine the effect of the number of weeks with consolidation on ADG. Using consolidation threshold of ≥3 cm, the mean (±SD) of total ADG for calves with no consolidation episode, 1 consolidation episode, and 2 or more consolidation episodes were 0.45 (±0.10), 0.39 (±0.10), and 0.38 (±0.11) kg/d, respectively. In the final multivariable regression analysis model and based on consolidation threshold of ≥3 cm, calves with 1 and 2 or more consolidation episodes had significantly lower ADG ± standard error (SE) of 0.04 ± 0.02 kg/d, and 0.06 ± 0.02 kg/d, respectively compared with animals with no consolidation episode. A total of 20% of calves (46/229 calves that entered the study) were treated for respiratory disease based on clinical signs (based on farmer examination). The final model also included specific confounders related to ADG and their interactions with lung consolidation (TPI and BRD treatment). An overall of 86% of adequate TPI was obtained. Bovine respiratory disease treatment based on farmer diagnosis had a larger negative effect on preweaning ADG than ultrasonography-diagnosed consolidation episodes (lower ADG ± SE of 0.10 ± 0.03 kg/d). When using a more sensitive consolidation threshold (≥1 cm as consolidation), the number of weeks with consolidation was also negatively associated with the ADG in the multivariable linear regression model with significant difference of 0.05 ± 0.02 kg/d for nonconsolidated calves versus calves consolidated for 2 or more weeks and insignificant difference of 0.01 ± 0.02 kg/d for nonconsolidated calves versus calves with 1 consolidation episode.

Domestic Ocular Injuries: A Case Series

Purpose

To determine the nature and types of domestic eye injuries.

Methods

The authors prospectively analyzed data of 100 consecutive patients with domestic eye injury (104 eyes) referred to the emergency room of Farabi Hospital during October 2003. Standardized international classification of ocular trauma (Birmingham Eye Trauma Terminology) was used for eye injury classification.

Results

Domestic ocular trauma represented 4.85% of all ocular emergencies (2061 patients) referred to the emergency room during that period. Male to female ratio was 1.13 and mean age of patients was 26±18 years (range, 1–73). Cornea was involved in 50.0% and sclera, lens, and retina each was involved in 4.8%. There was severe visual loss (best-corrected distance visual acuity <20/200 due to trauma) in 4% of the patients. The most frequent domestic ocular injury was globe injury (93.7%) including mechanical (72.1% closed and 4.8% open), chemical (14.4%), and thermal (1.9%) injuries.

Conclusions

Closed mechanical injuries were the most common type of domestic ocular injury in our series. Considering the high rate of domestic eye trauma among ocular emergency cases, more preventive measures should be taken at home.

Bevacizumab-Augmented Retinal Laser Photocoagulation in Proliferative Diabetic Retinopathy: A Randomized Double-Masked Clinical Trial

Purpose

To evaluate the additional therapeutic effect of single intravitreal bevacizumab injection on standard laser treatment in the management of proliferative diabetic retinopathy.

Methods

A prospective, fellow-eye sham controlled clinical trial was conducted on 80 eyes of 40 high-risk characteristic proliferative diabetic retinopathy type II diabetics. All cases received standard laser treatment according to Early Treatment Diabetic Retinopathy Study protocol. Avastin-assigned eyes received 1.25 mg intravitreal bevacizumab (Genentech Inc., San Francisco, CA) on the first session of their laser treatments. Fluorescein angiography was performed at baseline and at weeks 6 and 16, and proliferative diabetic retinopathy regression was evaluated in a masked fashion.

Results

The median age was 52 years (range: 39–68) and 30% of the participants were male. All patients were followed for 16 weeks. A total of 87.5% of Avastin-injected eyes and 25% of sham group showed complete regression at week 6 of follow-up (pp<0.005). However, at week 16, PDR recurred in a sizable number of the Avastin-treated eyes, and the complete regression rate in the two groups became identical (25%; p=1.000); partial regression rates were 70% vs 65%. In the subgroup of Avastin-treated eyes, multivariate analysis identified hemoglobin A1c as the strongest predictor of proliferative diabetic retinopathy recurrence (p=0.033).

Conclusions

Intravitreal bevacizumab remarkably augmented the short-term response to scatter panretinal laser photocoagulation in high-risk characteristic proliferative diabetic retinopathy but the effect was short-lived, as many of the eyes showed rapid recurrence. Alternative dosing (multiple and/or periodic intravitreal Avastin injections) is recommended for further evaluation.

Ultrasonographic biometry of the normal eye of the Persian cat

OBJECTIVE

To describe the normal ultrasonographic biometry of the Persian cat's eyes using B-mode ultrasonography.

METHODS

In a cross-sectional study, 20 healthy Persian cats with no history of previous ophthalmic disease were examined. Ocular biometry of the left and right eyes was measured using B-mode ultrasonography. Comparison of the average measurements between left and right eyes and between vertical and horizontal planes was performed using paired-sample t test. Correlation of ocular parameters with sex, age, head circumference and eye colour was evaluated.

RESULTS

Mean ± standard deviation (SD) measurements of the ocular structures of anterior chamber, lens thickness, vitreous chamber and anterior to posterior dimension of the globe in 40 eyes were 4.1 ± 0.7, 7.7 ± 0.5, 8.2 ± 0.4 and 20.7 ± 1.0 mm, respectively. No significant difference was found between the ocular biometry of the left and right eyes or the horizontal and vertical planes. Of the ocular parameters, the following had a significant positive correlation with head circumference: axial globe length, anterior chamber and lens thickness. The vitreous body had a positive correlation with age.

CONCLUSIONS

Regarding the breed predisposition of Persian cats to ocular problems, the present study provides baseline information for further clinical investigations of ocular abnormalities using B-mode ultrasonography.

Prevalence and risk factors of retinal vein occlusion: the Gutenberg Health Study

OBJECTIVE

To determine the age- and sex-specific prevalence and determinants of retinal vein occlusions (RVOs) in a large population-based German cohort.

METHODS

The investigation included 15,010 participants (aged 35-74 years) from the Gutenberg Health Study. We determined the prevalence of RVO (central retinal vein occlusion [CRVO] and branch retinal vein occlusion [BRVO]) for the local population by assessing fundus photographs of 12 954 (86.3%; 49.8% women and 50.2% men) participants. Further, we analyzed the associations of RVO with cardiovascular, anthropometric, and ophthalmic parameters.

RESULTS

The weighted prevalences of RVO, CRVO, and BRVO were 0.40%, 0.08%, and 0.32%, respectively. Men were 1.7 times more frequently affected by RVO than were women. Prevalence of RVO was 0.2% in participants aged 35-44 and 45-54 years, respectively, 0.48% in those aged 55-64 years, and 0.92% in those aged 65-74 years. Of persons with RVO, 91.5% had one or more cardiovascular risk factor or disease vs. 75.9% of persons without RVO. BRVO was associated with arterial hypertension (odds ratio 2.69, 95% confidence interval 1.27-5.70) and atrial fibrillation (3.37, 1.24-9.12) and CRVO with higher age (7.02, 1.63-30.19) and a family history of stroke (4.64, 1.18-18.25). Median visual acuity (base 10 logarithm of minimum angle of resolution) was 0.2 in persons with RVO vs. 0.05 in those without.

CONCLUSION

The prevalence of RVO in this German population was 0.4%, and men were 1.7 times more frequently affected than women. CRVO was associated with higher age and a family history of stroke, and BRVO was associated with arterial hypertension and atrial fibrillation.

Thyroid-associated orbitopathy is linked to gastrointestinal autoimmunity

Common autoimmune disorders tend to co-exist in the same subjects and cluster in families. The objective of this study was to determine the prevalence of autoimmune co-morbidity in patients with autoimmune thyroid disease (AITD) with and without thyroid-associated orbitopathy (TAO). This was a cross-sectional study conducted at an academic tertiary referral centre. Of 1310 patients with AITD [n = 777 or 59% with Graves' disease (GD) and n = 533, 41% with Hashimoto's thyroiditis (HT)] followed at a specialized joint thyroid-eye out-patient clinic, 176 (13·4%) had an adult type of the autoimmune polyglandular syndrome, 129 (9·8%) type 1 diabetes, 111 (8·5%) coeliac disease, 60 (4·6%) type A autoimmune gastritis, 57 (4·4%) vitiligo and 25 (1·9%) Addison's disease. Coeliac disease and autoimmune gastritis were associated positively with GD [odds ratio (OR) = 2·18; P = 0·002 and OR = 6·52; P < 0·001], whereas type 1 diabetes, Addison's disease, autoimmune primary hypogonadism, alopecia areata, rheumatoid arthritis and Sjögren's syndrome were 'protective' for GD and thus linked to HT, OR = 0·49 (P < 0·001), 0·06 (P < 0·001), 0·25 (P < 0·001), 0·50 (P = 0·090) and 0·32 (P = 0·003), respectively. Of 610 (46·6%) AITD patients with TAO, 584 (95·7%) and 26 (4·3%) had GD and HT, respectively (P < 0·001). TAO was most prevalent in GD patients with coeliac disease (94%, OR = 1·87, P < 0·001). Multivariate analysis showed high OR for coeliac disease and autoimmune gastritis (3·4 and 4·03, both P < 0·001) pertaining to the association with TAO while type 1 diabetes, Addison's disease and alopecia areata were protective for TAO. In patients with TAO, coeliac disease is the most prevalent co-morbid autoimmune condition and rates are increased compared to GD patients without TAO.

[Ophthalmological aspects of the Gutenberg Health Study (GHS): an interdisciplinary prospective population-based cohort study]

The Gutenberg Health Study (GHS) is a prospective, single center, population-based cohort study. It is an interdisciplinary project for investigation of ocular, cardiovascular, psychosomatic and immune diseases in the population of the City of Mainz and the district of Mainz-Bingen in central Germany. The main goals of the ophthalmological branch of GHS are determination of the prevalence and incidence of major ocular risk factors and diseases, exploring the genetic determinants and assessing complex interdisciplinary associations. The study cohort includes 15,010 participants aged between 35 and 74 years at the time of inclusion. After completing the baseline investigations the 5-year follow-up of the whole study cohort started in April 2012. The GHS is the most extensive data set of major ophthalmological conditions and risk factors in Germany and will help researchers in understanding complex medical associations.

[Is there a connection between intraocular pressure and blood pressure? Results of the Gutenberg Health Study and review of the current study situation]

Intraocular pressure (IOD) is the most important risk factor for the occurrence and progression of glaucoma because it is the only measurable risk factor. There is a positive connection between IOD and both systolic and diastolic blood pressure. The clinical relevance is, however, limited because the moderate alterations in IOD are less than the known measurement error and daily physiological oscillation.

[Vascular anomaly of the iris]

A 48-year-old man presented with a vascular anomaly of the iris in the left eye. Slit-lamp microscopy revealed dilated and tortuous vessels of the iris between 12 and 4 o'clock. Fluorescein angiography confirmed a diagnosis of arteriovenous (AV) malformation of the iris. The vessel originated at the iris base, passed to the pupillary margin and returned to the base. Such AV-malformations of the iris are very rare, benign vascular anomalies that have to be distinguished from other, potentially malignant pathologies of the iris (e. g. tortuous vessels in iris melanoma).

[Peripheral exudative haemorrhagic chorioretinopathy: clinical and angiographic findings]

BACKGROUND

Peripheral exudative haemorrhagic chorioretinopathy (PEHCR) is a degenerative disease of the peripheral retina and choroid in the elderly. Although PEHCR is often seen by clinicians, this entity is underrepresented in the ophthalmological literature. This may be due to inconsistent naming.

PATIENTS

We present the clinical, ultrasonographic and angiographic findings of 11 eyes of 8 patients who were diagnosed with PECHR in our department between January 2006 and June 2008. In addition, we report the intra- and postoperative course of three eyes that have been vitrectomised because of a vitreous haemorrhage associated with PEHCR.

RESULTS

The mean age of the patients is 83.5 years (range: 75 - 95). The mean follow-up is 11 months (range: 0 to 20). The clinical and angiographic signs were dependent on the stage of the disease and may be seen as small asymptomatic peripheral subretinal bleeding and exudation. In advanced stages, vitreous haemorrhage and exudative retinal detachment may be observed. The temporal periphery of the fundus appears to be more often affected than other locations. Three patients were affected bilaterally. Vitreous haemorrhage was the reason for presentation in three eyes (27 %) that were treated successfully by vitrectomy.

CONCLUSIONS

Peripheral exudative hemorrhagic chorioretinopathy should be considered in the differential diagnosis of vitreous haemorrhage and peripheral subretinal tumors in the elderly.

Intravitreal bevacizumab versus combined bevacizumab-triamcinolone versus macular laser photocoagulation in diabetic macular edema

PURPOSE

To evaluate the additive effect of triamcinolone to bevacizumab in comparison to standard macular laser photocoagulation versus bevacizumab in the management of diabetic macular edema (DME).

METHODS

In a prospective, randomized clinical trial, 130 eyes of 110 patients with type 2 diabetes with DME were included. Eligible eyes were randomly assigned to 1.25 mg intravitreal bevacizumab (42 eyes) (IVB group) or combination of 1.25 mg bevacizumab and 2 mg triamcinolone acetonide (41 eyes) (IVB+IVT group) or macular laser photocoagulation (47 eyes) (MPC). Central macular thickness (CMT) and visual acuity changes at week 6 and 16 were assessed.

RESULTS

The mean age of the patients was 57 -/+7 years. Patients were followed 16 weeks. At week 6, all the three groups showed significant reduction in CMT but the reductions for IVB and IVB+IVT were significantly more than MPC (p<0.001). At week 16, the response was not stable for IVB (p<0.001), but IVB+IVT maintained its superior status to MPC (p<0.001). At week 16, visual acuities were essentially unchanged for the two groups of MPC and IVB and improvement for IVB+IVT was marginal and at most was 0.1 log MAR. No patient developed uveitis, endophthalmitis, or thromboembolic event.

CONCLUSIONS

Single intravitreal bevacizumab or triamcinolone plus bevacizumab injection brought about significantly greater macular thickness reduction in diabetic patients in comparison to standard laser treatment. However, the response for bevacizumab alone was short-lived. Reduction in macular thickness was only marginally associated with visual acuity improvement in the triamcinolone plus bevacizumab injection group.

Nonpenetrating glaucoma surgery with goniosynechiolysis ab interno: a surgical technique

PURPOSE

To present a surgical technique for treatment of peripheral anterior synechiae (PAS or goniosynechiae) at the operative field during nonpenetrating glaucoma surgery.

METHODS

After usual preparation of a superficial and a deep scleral flap with externalization of the Schlemm's canal and peeling the juxtacanalicular trabecular meshwork, the goniosynechia is transected by a spatula introduced to the anterior chamber through a paracentesis. A Descemet's window provides full visual control at the peripheral cornea at the basis of the superficial scleral flap.

RESULTS

With this surgical technique, selective treatment of goniosynechiae is possible exactly at the area where creation of low outflow resistance is intended by the surgeon during nonpenetrating glaucoma surgery.

CONCLUSIONS

This technique enables the surgeon to perform nonpenetrating glaucoma surgery even in the presence of peripheral anterior synechiae.

[Arteriovenous dissection for branch retinal vein occlusion]

Arteriovenous dissection (AVD) is a surgical maneuver to separate the retinal artery and vein at the crossing site in patients with branch retinal vein occlusion (BRVO). The published studies showed an evidence level 3. AVD seems to be maintainable in patients with recent onset of BRVO and decimal visual acuity < or =0.4.

Biometric indices evaluation in central retinal vein occlusion using partial coherence laser interferometry

PURPOSE

To evaluate the association of axial length and posterior segment length with central retinal vein occlusion (CRVO) using optical coherence interferometry.

METHODS

The study group consisted of 29 patients (13 female and 16 male) with unilateral CRVO who were referred to Farabi Eye Hospital. Patients with macular edema were excluded. The mean keratometry (mean K), axial lengths (AL), anterior chamber depths (ACD), and posterior segment lengths (PSL, defined by AL - ACD) of affected and fellow eyes were measured using optical coherence interferometry.

RESULTS

Age range was 45 to 74 years (mean 59.2 +/- 7.5 years). The mean K of affected eyes was not statistically significantly lower than that of unaffected eyes in the CRVO group. This was also true for ACD. Although affected eyes had shorter axial length (23.26 mm vs 23.33 mm), the difference was not significant. There was a statistically significant difference in PSL affected and unaffected eyes (20.15 mm vs 20.26 mm) (p=0.008).

CONCLUSIONS

Posterior segment length of eyes with CRVO may be shorter than unaffected eyes. This may predispose them to more crowding of central retinal vein and artery in lamina cribrosa, and developing CRVO.

Hinterabschnittskomplikationen der Laser-in-situ-Keratomileusis (LASIK) - Eine Literaturübersicht

During the past years refractive surgical procedures and particularly laser IN SITU keratomileusis (LASIK) have become established by clinical and experimental studies and are performed worldwide in a high number. This paper provides a survey of the published posterior segment complications of LASIK that may occur albeit very rarely. Additionally, current clinical and experimental hypotheses regarding the pathogenesis of those complications are discussed. Currently a cause-effect relationship between LASIK and reported posterior segment complications has not been proven although a very high number of LASIK procedures have been performed worldwide.

[Macular translocation after photodynamic therapy: a case report]

BACKGROUND

Photodynamic therapy (PDT) and surgical macular translocation are concurrent treatment options for exudative age-related macular degeneration (ARMD). PDT is currently favoured because of positive study results and the non-invasive technique. We report a case of macular translocation with 360 degrees retinotomy after unsuccessful previous PDT for treatment of ARMD.

CASE REPORT

PDT with verteporfin was performed in the left eye of a 79-year-old patient with exudative ARMD and predominantly classic juxtafoveal choroidal neovascularisation (CNV). Because of continuing visual loss and deteriorating angiographic signs three months after PDT, a surgical macular translocation with 360 degrees retinotomy was performed successfully. During the surgery increased adhesion between the CNV and the retina was observed in contrast to patients without previous PDT. In a second step three months later, counter-rotation of the ocular globe was achieved by muscle surgery and the silicone oil was removed in the same session. The best spectacle corrected visual acuity improved from 0.1 before the surgery to 0.4 nine months thereafter (six Snellen lines). No CNV recurrence was observed. Patient satisfaction with the surgery outcome is high.

CONCLUSIONS

Macular translocation may be considered in cases of continuing deterioration after a previous PDT for treatment of exudative ARMD. Possible complications must be discussed with the patient. Intraoperatively, increased adhesion of CNV to the retina was observed, which might increase the risk of inadvertent damage to the retina during surgery.

Surgical induction of chorioretinal venous anastomosis in ischaemic central retinal vein occlusion: a non-randomised controlled clinical trial

AIM

To evaluate the safety and efficacy of surgical induction of chorioretinal venous anastomosis in the management of ischaemic central retinal vein occlusion (CRVO).

METHODS

In a comparative clinical trial, 28 patients with ischaemic CRVO were included, of whom 18 who declined surgery were considered as controls. The 10 surgical cases underwent standard vitrectomy with incisions into the choroids adjacent to the partially cut major retinal veins. Mersilene suture insertion was done to induce chorioretinal venous shunt. Mild endolaser was applied. Patients were followed up for 6-18 (mean 10) months.

RESULTS

Clinical success in shunt development was 90%. Surgical cases had a significantly better visual acuity improvement compared with controls (mean difference: 1.5 logMAR, p = 0.001) with 80% of them showing improvement (compared with 28% of the controls, p = 0.016). Neovascularisation developed in 39% of the control group compared with 0% of the surgical cases (p = 0.03). In multivariate analysis, surgery remained the sole significant predictor of visual improvement. There were three re-operations for vitreous cavity haemorrhage, cataract, and retinal detachment.

CONCLUSIONS

Surgical induction of chorioretinal venous anastomosis may result in visual acuity improvement and prevent neovascularisation in ischaemic CRVO. Randomised studies are needed to compare the current study modality with the natural course of CRVO and emerging procedures, such as optic neurotomy, in the management of ischaemic CRVO.

Laser-in-situ-Keratomileusis zur Korrektur von Hyperopie und hyperopem Astigmatismus mit Scanning-Spot-Excimer-Laser

PURPOSE

The purpose of this investigation was to evaluate the safety, efficacy, predictability, stability and complications of LASIK for the treatment of hyperopia and hyperopic astigmatism using a scanning spot excimer laser.

PATIENTS AND METHODS

A total of 64 consecutive LASIK operations (37 patients, mean age 41 years, range 22-68 years) have been evaluated. The Hansatome microkeratome producing a superior hinge (flap diameter 9.5 mm) and a scanning spot excimer laser with an optical zone of 6.0 mm were used. Examinations were performed preoperatively, after 1 day, 7 days, 1 month, 4 and 12 months.

RESULTS

One year after the primary procedure only 1 eye lost 2 or more lines of best-corrected visual acuity, 91% were within +/-1 line and 4 eyes gained 2 lines. Of these eyes 50 (86%) reached an uncorrected visual acuity of > or=0.5, 32 (55%) > or=0.8, 16 (28%) > or=1.0, 24 eyes (41%) needed a refractive correction of +/-0.5 D, 44 eyes (76%) of +/-1.0 D and 55 eyes (95%) of +/-2.0 D. The mean spherical equivalent after 1 year was +0.17+/-0.85 D.

CONCLUSIONS

LASIK is suitable for the correction of hyperopia (up to a maximum of +5 D) and for hyperopic astigmatism (up to a maximum of -5 D). However, results were better in lower hyperopia (up to +3 D) than in the moderate hyperopia. The refractive results showed overall a good stability during the 12-month study period, but higher regression occurred in a few cases.

[Scientific evaluation and quality assurance in refractive surgical interventions. Evaluation of the Datagraph med computer program]

BACKGROUND

During recent years refractive surgical procedures have been increasingly used to correct refractive errors. Exact saving and assessment of pre-, intra- and postoperative results for scientific evaluation are desired and are necessary for quality management. The purpose of this investigation was to evaluate the database program Datagraph med (version 2.5) which has been developed for data processing and assessment in refractive surgery.

MATERIAL AND METHODS

Pre-, intra- and postoperative data of 169 eyes treated with different refractive surgical methods (laser in situ keratomileusis, photorefractive keratectomy, laser thermal keratoplasty, phacic IOL) were collected, entered in the database and then evaluated by the above-mentioned program (with a follow-up of up to 12 months). The exactness of the Datagraph results was compared by means of manual recalculation.

RESULTS

Datagraph med was able to precisely process the patient data and save them in a database. Statistics and graphs presented by Datagraph were as data has been entered. Furthermore all standard graphs requested by the international consensus for evaluation of refractive surgical data (stability, predictability, efficacy, safety and complications) could be imaged.

CONCLUSIONS

Datagraph med is a helpful and precisely functioning program for processing and evaluation of refractive surgical data. It can be used for both scientific studies and for quality control. A continuous development and improvement of the program as well as the addition of statistical functions will be necessary due to the on-going progress in refractive surgery.

[LASIK with a superior hinge and scanning spot excimer laser ablation for correction of myopia and myopic astigmatism. Results of a prospective study on 100 eyes with a 1-year follow-up]

PURPOSE

Recently laser-in-situ-keratomileusis (LASIK) has been increasingly used to correct refractive errors. The purpose of this investigation was to evaluate the safety, efficacy, predictability, stability and complications using the scanning spot excimer LASIK technology.

PATIENTS AND METHODS

The results of 100 consecutive LASIK operations carried out between 2/1998 and 2/1999 on 60 patients (mean age 37 years, range 20-55 years) have been evaluated. The Hansatome microkeratome with a superior hinge (flap diameter: 9.5 mm) and a scanning spot excimer laser (Technolas C-Lasik 217) were used in all cases. The mean spherical equivalent of the subjective manifest refraction was -6.96 +/- 2.87 diopters (D), the mean sphere was -6.47 +/- 2.71 D and the mean astigmatism was -0.98 +/- 0.94 D. In 6% of the eyes preoperative visual acuity was not better than 20/40. Examinations were performed preoperatively, after 1 and 7 days, after 1,4 and 12 months. Safety, efficacy, predictability, stability and complications were calculated using the datagraph software (version 1.11).

RESULTS

All 100 eyes were examined after 1 day and 1 week, 96 after 1 month, 95 after 4 months and 92 after 1 year. Following 1 year none of the eyes lost 2 or more lines of best corrected visual acuity, 99% were within +/- 1 line and 1% gained 2 lines (safety index 1.03). In 92% of all eyes an uncorrected visual acuity of > or = 0.5 was reached, in 77% > or = 0.8 and in 51% > or = 1.0 (efficacy index 0.89). For 60 eyes (65.21%) a refractive correction of +/- 0.5 D was necessary, for 82 eyes (89.13%) +/- 1.0 D and for 91 eyes (98.91%) +/- 2.0 D. The mean spherical equivalent after 1 year was -0.15 +/- 1.31 D. Between 1 and 12 months a mean regression of -0.14 D occurred. On the request of the patients, 5 eyes were retreated during the study period for under- or over-correction. Complications due to the microkeratome did not occur. Corneal infections were not observed, a diffuse lamellar keratitis (DLK) was seen in 12 cases, but all cases healed with no loss of visual acuity. In 7 eyes a slight decentration of the ablation was observed using corneal topography, which in one case caused an increase in glare sensitivity.

CONCLUSIONS

LASIK with superior hinge and scanning spot excimer photoablation is suitable for the correction of myopia (up to a maximum of -12 D) and for myopic astigmatism (up to a maximum of -5 D). The refractive results showed a high stability during the 12-month study period but there is still room for improvement of the predictability.

1,25-Dihydroxyvitamin D(3) downregulates the rat intestinal vitamin D(3)-25-hydroxylase CYP27A

The vitamin D(3)-25-hydroxylase CYP27A is located predominantly in liver, but its expression is also detected in extrahepatic tissues. Our aim was to evaluate the regulation of CYP27A by vitamin D(3) (D(3)) or its metabolites in rat duodena. Vitamin D-depleted rats were repleted with D(3), 25-hydroxyvitamin D (25OHD), or 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)] or acutely injected 1,25(OH)(2)D(3) to investigate the mechanisms of action of the hormone. All D(3) compounds led to a progressive decrease in CYP27A mRNA, with levels after D(3) representing 20% of that observed in D depletion. 25OHD decreased CYP27A mRNA by 55%, whereas 1,25(OH)(2)D(3) led to a 40% decrease, which was accompanied by a 31% decrease in CYP27A protein levels and an 89% decrease in enzyme activity. Peak circulating 1,25(OH)(2)D(3) concentrations were, however, the highest in D(3)-repleted, followed by 25OHD- and 1,25(OH)(2)D(3)-repleted animals. 1,25(OH)(2)D(3) resulted in a decrease in both CYP27A mRNA half-life and transcription rate. Our data illustrate that the intestine expresses the D(3)-25-hydroxylase and that the gene is highly regulated in vivo through a direct action of 1,25(OH)(2)D(3) or through the local production of D(3) metabolites.

A new X-ray based osteoporosis screening tool provides accurate and precise assessment of phalanx bone mineral content

Many devices currently available for the assessment of osteoporosis require a significant capital investment, are not portable, and require specially trained operators. The objective of this study was to assess the accuracy and precision of a new tabletop dual-energy computed digital absorptiometry (CDA) device (accuDEXA, Schick Technologies, Long Island City, NY) designed to automatically and instantaneously assess bone mineral content (BMC) and bone mineral density (BMD) of the middle finger. BMC and BMD of 26 cadaveric forearms were measured by dual-energy X-ray absorptiometry, radiographic absorptiometry (RA), and CDA. accuDEXA measurements were repeated five times with and without repositioning on 10 forearms. The portion of the finger evaluated by accuDEXA was then excised, measurements of the specimen were again obtained using the accuDEXA device, and the specimen was incinerated to determine ash weight. BMC assessed by accuDEXA and by RA were strongly correlated with ash weight of the excised phalanx specimens (r2 = 0.94 and r2 = 0.96, respectively). Short-term precision for BMD assessed by the accuDEXA device was 0.9% without repositioning, and 1.8% with repositioning. BMD determined by the accuDEXA device was strongly correlated with BMD of the hand and forearm (r2 = 0.56-0.69). Dual-energy CDA is a new bone densitometry technique that provides rapid, precise, and accurate measurements of the middle phalanx of the third finger. The technique may be useful for widespread testing of osteoporotic patients.

Immunological detection of potential signal-transduction proteins expressed during wheat somatic tissue culture

An immunochemical approach was used to detect the expression of putative guanine nucleotide-binding proteins (G-proteins), arrestin, and nucleoside diphosphate kinases during wheat (Triticum aestivum) tissue culture initiated from immature embryos. Both the soluble and membrane extracts from the immature embryos revealed bands of 58, 40, and 16 kD with antibodies to G-protein (alpha subunit), arrestin, and nucleoside diphosphate kinase, respectively. These proteins were overexpressed in vitro in both nonembryogenic callus and embryogenic cultures. An additional soluble protein (32 kD) was detected by anti-G alpha antibodies in cultured tissues but not in immature embryos, suggesting a possible function in cell multiplication. Moreover, somatic embryogenesis was associated with the appearance of a 29-kD protein reactive with anti-arrstin antibodies, both in soluble and membrane fractions. Tissue-cultured genetic stocks of Chinese Spring wheat, including the disomic, 36 ditelosomic, and 6 nullisomic-tetrasomic wheat lines, were used to ascertain the chromosomal location of the genes encoding the 29-kD arrestin-like protein. The lack of a signal with the nonembryogenic ditelosomic 3 D short chromosome arm line suggests that the 3 D long chromosome arm possesses at least one gene involved in the expression of the 29-kD protein. The putative role of the 29-kD protein in signal-transduction regulating embryogenesis is discussed.

Immunochemical demonstration of the mineralocorticoid receptor in ocular tissues

We studied the presence of the mineralocorticoid receptor (MCR) in the eye with the aid of a number of immunochemical techniques. Immunoblotting with a polyclonal antibody, directed against the rat renal MCR, revealed a single band of about 102 kD in extracts prepared from whole bovine or rat retina similar to that observed in cytosol from the kidney and myocardium from these species. Isolated cells of the bovine retinal pigment epithelium (RPE) similarly exhibited a 98- to 102-kD band in Western blots developed with the aid of anti-MCR antiserum. The 98- to 102-kD band was also obtained following autoradiography of RPE cytosol irradiated in the presence of 3H-R 5020. This fluorographic pattern was abolished when RU 26752, an antagonist specific to the MCR, was allowed to compete with radiolabelled promegestone. The MCR-3H-RU 26752 complex in RPE cytosol underwent heat activation, as judged by binding to DNA cellusose, and could also be precipitated by anti-MCR IgG. In primary cultures, the proliferation of the RPE cells was inhibited by the two MCR-specific antagonists RU 26752 and ZK 91587. The loss of the MCR-specific immunofluorescence in RPE cells after only 3 passages in culture was associated with refractoriness to the inhibitory effect of both of these spironolactones. Immunohistochemistry, using MCR-specific antiserum, revealed strong fluorescence in specific areas of the rat eye. In the retina, immunopositivity was observed in Müller cells, external and internal limiting membranes, the vitreous base lining and in the pigment epithelium. Epithelial cells of the ciliary body, iris and cornea also exhibited strong MCR-specific immunofluorescence. Thus, both the epithelial and the nonepithelial compartments of the ocular tissues form interesting new targets to delineate the mechanism of action of mineralotropic hormones.

Effect of interferon gamma and TNF alpha on the differentiation/activation of human glial cells: implication for the TNF alpha receptor 1

This study focused on the activation/differentiation of human microglial cells and astrocytes, which is a prerequisite for HIV1 replication. In vitro, IFN gamma induced a differentiation-like morphological change in embryonic microglia and astrocytes, in both primary and in purified culture. This effect was enhanced by TNF alpha which in itself had no effect. IFN gamma did not increase the low level of endogenous TNF alpha, which is not secreted by embryonic cells, but stimulated the expression of TNF alpha R1, although to a relatively low extent. IFN gamma facilitated TNF alpha response through an increase in TNF alpha R1 expression, but probably also through interaction with different intracellular signal transduction pathways.

The mineralocorticoid hormone receptor and action in the eye

Immunoblotting with a polyclonal antibody, directed against the mineralocorticoid receptor protein purified from rat kidney in presence of the receptor-specific ligand RU 26752, labeled a single 98-102 kDa band in soluble extracts from bovine retina and from cultured bovine retinal pigment epithelial cells, identical to the receptor in several other tissues from the rat. The antibody also immunoprecipitated the receptor-3H-RU 26752 complex in bovine retinal extract. The growth of the isolated pigment epithelial cells was inhibited by RU 26752 and ZK91587, two ligands specific to the mineralocorticoid receptor. Successive passages in culture led to the disappearance of immunoreactivity in Western blots, concurrently with the refractoriness of the cells to growth inhibition by the two antagonists. On sections of the human eye, mineralocorticoid receptor-specific immunofluorescence was observed in retinal cone cells, pigment epithelium, epithelium of ciliary body, iris, cornea and lens. To our knowledge, this is the first ever demonstration of the mineralocorticoid receptor in ocular tissues.

Evidence from in vivo manipulations of lipid composition in mutants that the delta 3-trans-hexadecenoic acid-containing phosphatidylglycerol is involved in the biogenesis of the light-harvesting chlorophyll a/b-protein complex of Chlamydomonas reinhardtii

The phosphatidylglycerol containing the unusual delta 3-trans hexadecenoic fatty acid is specifically found in photosynthetic membranes of eukaryotic organisms. Its involvement in the biogenesis and the structure of the light-harvesting chlorophyll a/b-protein complex has been evidenced by in vivo targeting this lipid to photosynthetic membranes of Chlamydomonas reinhardtii mutants lacking this lipid. In the mf1 and mf2 mutants, this deficiency results in (a) the absence of the oligomeric light-harvesting complex of photosystem 2; (b) an extensive destacking of thylakoid membranes; (c) a very low 77-K fluorescence emission in the photosystem-2 region. We show in this paper that these deficiencies result from modifications in the pigment and polypeptide compositions of the photosystem-2 light-harvesting complex; it contains less chlorophyll b and some of its constitutive polypeptides are absent or reduced in amount, while immunologically related polypeptides of lower molecular mass accumulate. The direct involvement of the lack of trans-C16: 1-phosphatidylglycerol in these deficiencies is evidenced by the partial restoration of normal characteristics of the light-harvesting complex (pigment and polypeptide composition, oligomerization) after liposome-mediated, in vivo incorporation of this lipid into the photosynthetic membranes of the mf2 mutant. Trans-C16:1-phosphatidylglycerol, therefore, is involved in the biogenesis of the photosystem-2 light-harvesting chlorophyll a/b-protein complex through a mechanism that may prevent degradation processes. Its contribution to the structural conformation of neosynthesized monomers and to their organization into stable oligomeric form is discussed.

Receptor mediated mineralocorticoid action in alga cell mutants

The multiplication of Chlamydomonas cells can be arrested by the spirolactone derivative RU 26752 and this is fully reversible by the natural hormone aldosterone. Continuous growth in the presence of RU 26752 led to the isolation of a population subsequently resistant to the action of mineralocortoid analogues, due possibly to the selection of mutant cells. Immunophotochemical evidence is provided for a 52 kDa protein that possesses functional steroid and DNA binding domains. Alga cells therefore appear to respond to steroid hormones in a manner similar to the mammalian systems, possibly via a receptor that may represent a pygmy ancestor of the latter day steroid receptor superfamily.

Mineralocorticoid hormone action in plant cells

The multiplication of Chlamydomonas reinhardtii wild type cells can be arrested by the spirolactone RU 26752 and this is fully reversible by the natural mineralocorticoid aldosterone. Evidence is presented for a 52 kDa protein that possesses functional DNA and ligand binding domains and tests positive for mineralocorticoid receptor-like activity by immuneprecipitation, macroaggregation, and photoaffinity. The regulation of trans-activation by steroid hormones in the animal world would therefore appear to be just as valid for the plant kingdom, thereby providing a new model for genetic analysis.

Generation of polyclonal antibodies against the mineralocorticoid receptor and analysis of mineralocortin in rat myocardium by immunophotochemistry

Fawn, Burgundy rabbits were immunized with the mineralocorticoid receptor (MCR) purified biochemically from rat kidney by a simple, two step procedure. High anti-MCR titers were observed in radioimmunoassays just 3 weeks after the initial injection and increased further with time. Western blot analysis revealed a single band of 94-98 kDa in renal and cardiac cytosol from the rat, like the antigen prepared biochemically. The two atria from beef heart exhibited far greater MCR-positivity compared to the two ventricles, suggesting physiological relevance. The receptor was also photolabelled for the first time with promegestone in this very 94-98 kDa region which could be displaced by the antagonist RU 26752 specific to MCR. The immune IgG precipitated 3H-aldosterone or 3H-RU 26752-MCR complexes from rat heart, and displaced the MCR-antagonist complex to high molecular weight regions during gel permeation chromatography on Sephacryl columns. Immunofluorescent labelling showed that MCR was widely distributed in the cytoplasm in rat myocardium with limited staining in what appeared to be the nuclear compartment. These open up the possibility of large scale purification of the endogenous mineralocorticoid binding protein, mineralocortin, for detailed physicochemical characterization. The technique of photoaffinity labelling presented here should also help delineate the nature of the steroid binding domain in the MCR.

[Presence of arrestin (S-antigen)-like proteins in vegetable cells]

Arrestin (or S-antigen) is a protein that regulates phototransduction in photoreceptor cells of the retina. Homologous proteins have been recently detected in other, non-photosensitive, cells of vertebrates, where they are thought to be associated with other systems of signal transduction. Proteins crossreactive with retinal arrestin were detected in soluble cell extracts from Nicotiana tabacum and Chlamydomonas reinhardtii by immunoblotting using several antibodies against arrestin. Variations of the immunoreactive protein pattern were associated with the growth cycle of tobacco cells. These observations suggest that analogs of arrestin exist in the vegetal kingdom, where they could be involved in transduction processes.