Intrastromal corneal ring implantation for the correction of myopia: 12-month follow-up

PURPOSE: To evaluate the efficacy, predictability, and stability of refraction obtained after intrastromal corneal ring segment (ICRS) implantation for low to moderate myopia. SETTING: Single-center clinical practice. METHODS: In this prospective 2-surgeon study, 9 patients (15 eyes) with low to moderate myopia were recruited to receive ICRS implants. RESULTS: At 1 day, 10 of the 15 eyes had an uncorrected visual acuity (UCVA) of 20/40 or better. At 12 months, all eyes had this UCVA and 66.6% had 20/25 or better. The mean manifest refraction stabilized after the first week at <-0.5 diopter (D). At 12 months, all eyes were within +/-1.0 D of the intended manifest refraction; 67% were within +/-0.5 D. Sixty percent of eyes had no change from the preoperative best corrected visual acuity; 13.3% improved by 1 line, and 26.6% lost 1 line. The postoperative complications included lamellar channel deposits (n = 12), ICRS dislocation (n = 2), corneal infiltrates (n = 2), bleeding in the positioning ring hole (n = 1), 0.3 mm segment decentration (n = 1), and prolonged wound healing (n = 1). CONCLUSIONS: Intrastromal corneal ring segment implantation for the correction of low to moderate myopia afforded good visual recovery and efficacy similar to that with laser in situ keratomileusis and superior to that with photorefractive keratectomy. However, light or blunt trauma and insufficient hygiene can have serious consequences and there is the potential for induced astigmatism. Corneal infiltrates can occur and must be treated immediately. The ring implantation technique is demanding. Advantages of ICRS implantation include rapid and stable visual recovery as well as reversibility.     

Moderate alcohol consumption enhances vaccine-induced responses in rhesus macaques

We have recently shown that chronic alcohol consumption in a rhesus macaque model of ethanol self-administration significantly modulates the serum cytokine profile. In this study, we extended these observations by investigating the impact of chronic ethanol exposure on the immune response to Modified Vaccinia Ankara (MVA). All animals were vaccinated with MVA before ethanol exposure to ethanol and then again after 7 months of 22 h/day of “open-access” drinking of 4% (w/v) ethanol. Our results indicate that animals whose blood ethanol concentration (BEC) chronically exceeded 80 mg/dl had lower CD4 and CD8 T cell proliferation as well as IgG responses following MVA booster than control animals. In contrast, relatively moderate drinkers whose BEC remained below 80 mg/ml exhibited more robust MVA-specific IgG and CD8 T cell responses than controls. To begin to uncover mechanisms underlying the differences in MVA-specific responses between the three groups, we analyzed plasma cytokine levels and microRNA expression in peripheral blood mononuclear cells following MVA booster. Our findings suggest that moderate ethanol consumption results in higher levels of antiviral cytokines and an expression profile of microRNAs linked to CD8 T cell differentiation. In summary, moderate alcohol consumption enhances recall vaccine responses, whereas chronic alcohol intoxication suppresses this response.     

Sepsis durch Raoultella ornithinolytica bei einem immunkompetenten Patienten

Raoultella ornithinolytica is a species of gram-negative encapsulated and aerobic bacteria belonging to the family Enterobacteriaceae and is mainly found in fish. The most distinctive feature of this bacterium is the ability to convert histidine to histamine; therefore, the consumption of decomposing fish infected by R. ornithinolytica causes rashes, diarrhea, flushing, sweating and vomiting. This food poisoning is also called histamine fish poisoning; however, human infections with R. ornithinolytica are extremely rare and have so far only affected patients with diseases suppressing the immune system. The current case report describes for the first time sepsis with evidence of bloodstream infection by R. ornithinolytica in an immunocompetent male patient and the successful antibiotic treatment.     

Different relationships between the first 2 years on growth hormone treatment and the d3-growth hormone receptor polymorphism in short small-for-gestational-age (SGA) children

Background There has been controversy in recent years on whether the d3 polymorphism of the GH receptor is associated with a better growth response to GH in idiopathic short children born small for gestational age (SGA). Methods In this prospective study, we evaluated exon 3‐GHR polymorphisms in 142 (62 f, 80 m) short prepubertal children born SGA (birth length and/or weight of ≤?2 SD for GA) and treated with rhGH (mean dose of 0·30 mg/kg/week) in 24 centres in Germany. A growth prediction for the first year of therapy was calculated for each child according to Ranke and co‐workers. The index of responsiveness (IOR) was calculated by dividing the response (observed growth minus predicted growth) by the standard error of the prediction. All analyses were performed in one centre on samples collected and shipped on filter paper. The DNA fragment containing or missing exon 3 of the GHR was amplified by multiplex PCR. Results The fl‐GHR isoform was most common with a frequency of 47·8%, followed by the d3/fl isoform with 38% and the d3‐GHR isoform with 14·2%. There were no significant differences regarding gestational age, birth weight and birth length, mid parental height‐SDS, chronological age at start of therapy, height‐SDS, BMI‐SDS, height velocity and GH dose between the different subgroups according to the genotype. After the first treatment year, height (H)‐SDS (P < 0·05), height velocity (HV) (P < 0·01), HV‐SDS (P < 0·001) and delta‐H‐SDS (P < 0·05) were significantly higher in patients with d3‐GHR than in those with fl‐GHR. The mean IOR was above 0 in children with at least one d3 allele, and highest, with 0·54, in those with the d3‐GHR isoform. After the second year on GH, no differences between the different GHR‐isoforms were found. Conclusions According to our results, the exon 3‐deleted GHR explains the better growth response to GH only for the first and not for the second year.     

Global food demand and the sustainable intensification of agriculture

Global food demand is increasing rapidly, as are the environmental impacts of agricultural expansion. Here, we project global demand for crop production in 2050 and evaluate the environmental impacts of alternative ways that this demand might be met. We find that per capita demand for crops, when measured as caloric or protein content of all crops combined, has been a similarly increasing function of per capita real income since 1960. This relationship forecasts a 100-110% increase in global crop demand from 2005 to 2050. Quantitative assessments show that the environmental impacts of meeting this demand depend on how global agriculture expands. If current trends of greater agricultural intensification in richer nations and greater land clearing (extensification) in poorer nations were to continue, ~1 billion ha of land would be cleared globally by 2050, with CO(2)-C equivalent greenhouse gas emissions reaching ~3 Gt y(-1) and N use ~250 Mt y(-1) by then. In contrast, if 2050 crop demand was met by moderate intensification focused on existing croplands of underyielding nations, adaptation and transfer of high-yielding technologies to these croplands, and global technological improvements, our analyses forecast land clearing of only ~0.2 billion ha, greenhouse gas emissions of ~1 Gt y(-1), and global N use of ~225 Mt y(-1). Efficient management practices could substantially lower nitrogen use. Attainment of high yields on existing croplands of underyielding nations is of great importance if global crop demand is to be met with minimal environmental impacts.