[4th universal definition of myocardial infarction 2018 : What is new?] / 4. Allgemeine Definition des Myokardinfarkts 2018 : Was ist neu?

The 4th universal definition of myocardial infarction consensus document is a further development of the document from 2012. It highlights the discrimination between myocardial injury and infarction and in particular the periprocedural occurrence of increased troponin levels. The chapter on cardiac biomarkers deals with the problems of comparison of various troponin assays and the kinetics of troponin in acute myocardial infarction. The definition of the 5 types of myocardial infarction underwent only minor changes. In the chapter on ECG interpretation high-risk constellations are described. A total of six new chapters were added to the consensus document including the takotsubo syndrome and myocardial infarction with non-obstructive coronary arteries (MINOCA), which are briefly discussed.

Exercise during short-term exposure to hypoxia or hyperoxia - novel treatment strategies for type 2 diabetic patients?!

Both hypoxia (decreased oxygen availability) and hyperoxia (increased oxygen availability) have been shown to alter exercise adaptations in healthy subjects. This review aims to clarify the possible benefits of exercise during short-term exposure to hypoxia or hyperoxia for patients with type 2 diabetes mellitus (T2DM). There is evidence that exercise during short-term exposure to hypoxia can acutely increase skeletal muscle glucose uptake more than exercise in normoxia, and that post-exercise insulin sensitivity in T2DM patients is more increased when exercise is performed under hypoxic conditions. Furthermore, interventional studies show that glycemic control can be improved through regular physical exercise in short-term hypoxia at a lower workload than in normoxia, and that exercise training in short-term hypoxia can contribute to increased weight loss in overweight/obese (insulin-resistant) subjects. While numerous studies involving healthy subjects report that regular exercise in hypoxia can increase vascular health (skeletal muscle capillarization and vascular dilator function) to a higher extent than exercise training in normoxia, there is no convincing evidence yet that hypoxia has such additive effects in T2DM patients in the long term. Some studies indicate that the use of hyperoxia during exercise can decrease lactate concentrations and subjective ratings of perceived exertion. Thus, there are interesting starting points for future studies to further evaluate possible beneficial effects of exercise in short-term hypoxia or hyperoxia at different oxygen concentrations and exposure durations. In general, exposure to hypoxia/hyperoxia should be considered with caution. Possible health risks-especially for T2DM patients-are also analyzed in this review.

[Pitfalls in retinal optical coherence tomography imaging]. / Fallstricke in der Netzhautbildgebung mittels optischer Kohärenztomographie.

Optical coherence tomography (OCT) imaging now plays an important role in the management of macular and retinal diseases. In addition to the many advantages of this noninvasive imaging modality, limitations and pitfalls should be taken into consideration. The aim of this review is to discuss several possible sources of error in the conduct and interpretation of OCT imaging. Ultimately, this article should add to a meaningful and focused use in clinical practice.

[Intraoperative OCT in ophthalmic microsurgery]. / Intraoperative OCT in der ophthalmologischen Mikrochirurgie.

Recent improvements in technology have enabled integration of SD-OCT into the optical path of an operating microscope. Here we present an overview of possible applications of iOCT (intraoperative optical coherence tomography) for retinal, glaucoma and corneal surgery. iOCT-based imaging can not only improve safety and quality of the surgery but also the learning curve of the surgeon. The ability to visualize barely visible or transparent structures with iOCT has achieved a significant added value intraoperatively, particularly in macular surgery, trabeculectomy and lamellar keratoplasty. Further, systematic assessment is warranted to define the usefulness of the iOCT more precisely.

Effects of Wearing Compression Stockings on the Physical Performance of T2DM Men with MetS.

Metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) are associated with macro- and microcirculatory complications that reduce physical performance. Wearing compression garments to potentially optimize hemodynamics has been discussed. This study investigates the effects of wearing compression stockings on physical performance-related variables in type 2 diabetic men with metabolic syndrome (n=9, 57±12 years, BMI: 36±4 kg/m(2)). Participants served as their own controls in a randomized 3*3 crossover study wearing below-knee stockings with either compression (24 or 30 mmHg ankle pressure) or no compression. Venous pooling and lower limb oxygenation profiles were determined with near-infrared spectroscopy and arterial oxygen saturation was determined using a pulse oxymeter. Measurements were performed in the supine lying position, during standing, following 10 tiptoe exercises and after submaximal intensity cycling. In addition, lactate and erythrocyte deformability were analyzed in capillary blood pre- and post-exercise. Erythrocyte deformability was analyzed using a laser-assisted optical rotational red cell analyzer. No significant differences in any variables when wearing different compression or regular stockings were evident at any point of measurement. This study did not reveal any beneficial effects of wearing compression stockings at rest and during acute bouts of moderately intense exercise in this particular patient group.

[Design of the ORCA module in the OCEAN study : Evaluation of SD-OCT results in daily routine practice]. / Design des ORCA-Moduls der OCEAN-Studie : Evaluierung der SD-OCT-Befunderhebung in der täglichen Praxisroutine.

BACKGROUND: The prevalence of blindness as defined by law could be reduced by the introduction of anti-vascular endothelial growth factor (VEGF) therapy. Because the treatment is governed by patient needs, mostly using morphological criteria, imaging diagnostics are of particular importance. The non-interventional OCEAN study investigates the treatment with ranibizumab in the clinical routine practice. In a subgroup of patients the interpretation of spectral domain optical coherence tomography (SD-OCT) scans by the treating physicians will be analyzed (ORCA module). METHODS: Over a period of 24 months data from patients with exudative age-related macular degeneration (AMD), macular edema due to retinal vein occlusion or diabetes mellitus, who are receiving intravitreal injections of ranibizumab, will be assessed. Information on examinations, visual acuity, treatment and recordings from imaging techniques will be documented using a questionnaire. The SD-OCT scans, fluorescence angiography and fundus photography will be independently analyzed by the ophthalmologist of the study center and by three reading centers (CIRCL Cologne, GRADE Bonn and M3 Münster). Automated measurements of retinal thickness by the manufacturers' software will be checked and if necessary manually corrected. A qualitative interpretation in terms of morphological criteria for (further) treatment will be performed. CONCLUSION: A thorough assessment of SD-OCT images during anti-VEGF therapy provides the basis for the best possible needs-oriented treatment regimen. The control of the quality of data from daily routine practice may indicate possible weaknesses allowing explicit training and therefore optimization of patient treatment.

Echocardiographic and biochemical analysis of cardiac function and injury among female amateur runners post-marathon.

BACKGROUND: Numerous studies with male amateur runners have determined negative changes in their cardiac function/of their myocard following long endurance loads. This study aims to examine such potential changes in women, specifically, after running a marathon. METHODS: A total of 18 female amateur runners (39.5 ± 10.5 years) were examined before (T1), immediately after (T2) and 24 h post-marathon (T3). An echocardiography was performed using Tissue Doppler (TD) imaging. In addition, the concentration of cardiac troponin T (cTnT) and the activity of the myocardial muscle creatine kinase (CK-MB) were determined at T1 and T2. RESULTS: The echocardiographic parameters revealed impairment of the diastolic function, without, however, documenting a diastolic dysfunction (in accordance with the classification of Nagueh (J Am Soc Echocardiogr, 22:107-33, 2009)). The ratio of blood flow velocity through the mitral valve during early versus late diastole (MV E/A ratio), for example, decreased. The values measured at T3 were similar to those measured at T1. The ratio of early transmitral diastolic filling velocity and of the transmitral diastolic filling velocity by TD imaging (MV E/E') did not indicate any change from T1 to T2, but a significant increase at T3 (in comparison with T1). The systolic function (measured by the left ventricular ejection fraction) did not change significantly. The cTnT concentration and CK-MB activity were significantly higher in T2 than in T1. CONCLUSION: The data collected does not provide any solid evidence of pathological changes in the cardiac function of female amateur runners post-marathon, although the lab values indicate a strongly increased myocardial stimulation.

Endurance training alters enzymatic and rheological properties of red blood cells (RBC) in type 2 diabetic men during in vivo RBC aging.

This study examines the effects of endurance training on red blood cells (RBC) in seventeen non-insulin-dependent type 2 diabetic men with a special focus on in vivo RBC aging. Venous blood was collected pre- and post-training at rest. RBC from whole blood and RBC separated according to cell age by density-gradient centrifugation were analyzed. RBC deformability was measured by ektacytometry. Immunohistochemical staining was performed to quantify the RBC-nitric oxide (NO) synthase activation (RBC-NOSSer1177) because RBC-NOS-produced NO can contribute to increased RBC deformability. The proportion of "young" RBC was significantly higher post-training. RBC deformability of all RBC (RBC of all ages) remained unaltered post-training. During RBC aging, RBC deformability decreased in both pre- and post-training. However, the training significantly increased RBC deformability in "young" and reduced their deformability in aging RBC. RBC-NOS activation remained unaltered in all RBC post-training. It tendentially increased in aging RBC pre-training, but did not change during aging post-training. The training significantly reduced RBC-NOS activation in "old" RBC. Endurance training may improve the RBC system (higher amount of "young" RBC which are more deformable). It remains speculative whether changes in older RBC (reduced RBC-NOS activation and deformability) could lead to more rapid elimination of aged RBC.

[Reliable recognition of glaucoma by spectral domain optical coherence tomography?]. / Zuverlässige Glaukomerkennung durch Spectral-Domain optische Kohärenztomographie?

BACKGROUND: The latest approach to diagnosing glaucoma by high resolution spectral domain optical coherence tomography (SD-OCT) is to assess the minimal rim width (MRW) of the retinal nerve fiber layer (RNFL) at the Bruch's membrane opening (BMO) in the optic disk margin. OBJECTIVE: This study was carried out to evaluate if this new parameter allows a more precise detection of glaucomatous damage to the RNFL. METHODS: This article presents clinical examples and differences in the measurement methods in glaucoma cases. RESULTS: The main advantage is the automated detection by software allowing precise landmark tracking and coherent follow-up investigations. There seem to be considerable differences between the funduscopically assumed margin and the detection of the margin by the new software. Likewise there is a difference between RNFL measurements taken at the BMO and the peripapillary scan by SD-OCT. DISCUSSION: Ongoing research should assess the potential of this new parameter for a more precise detection of nerve fiber defects and changes over time compared to other imaging techniques.

Endurance training alters skeletal muscle MCT contents in T2DM men.

Patients suffering from type 2 diabetes mellitus (T2DM) often exhibit chronic elevated lactate levels which can promote peripheral insulin resistance by disturbing skeletal muscle insulin-signaling. Monocarboxylate transporter (MCT) proteins transfer lactate molecules through cellular membranes. MCT-1 and MCT-4 are the main protein isoforms expressed in human skeletal muscle, with MCT-1 showing a higher affinity (lower Km) for lactate than MCT-4. T2DM patients have reduced membranous MCT-1 proteins. Consequently, the lactate transport between muscle cells and the circulation as well as within an intracellular lactate shuttle, involving mitochondria (where lactate can be further metabolized), can be negatively affected. This study investigates whether moderate cycling endurance training (3 times per week for 3 months) can change skele-tal muscle MCT contents in T2DM men (n=8, years=56±9, body mass index (BMI)=32±4 kg/m(2)). Protein content analyses (immuno-histochemical stainings) were performed in bio-psies taken from the vastus lateralis muscle. Intracellular MCT-1 proteins were up-regulated (relative increase+89%), while intracellular MCT-4 contents were down-regulated (relative decrease - 41%) following endurance training. Sarcolemmal MCT-1 and MCT-4 did not change. The question of whether the training-induced up-regulation of intracellular MCT-1 leads to an improved lactate transport (and clearance) in T2DM patients requires further research.

Detection of thermoactinomyces species in selected agricultural substrates from Queensland.

Selected overheated substrates commercially available for public use in sub-tropical Queensland, Australia were screened for the presence of Thermoactinomyces species using an air sampler. All substrates with the exception of tea tree mulch were found to contain Thermoactinomyces species. Subsequent 16S rDNA oligonucleotide sequencing of the selected eight isolates indicated that some of these species were closely related to previously reported allergenic Thermoactinomyces vulgaris and Laceyella sacchari. In view of this, the isolates were tested to determine their adhesion ability and cytotoxicity to human lung cells (calu-3 cells). The results indicated that all eight isolates were highly adherent and showed cytotoxicity to this cell line. These findings might indicate that the presence of such species in overheated agricultural materials may constitute a public health risk if storage and handling conditions are not optimal and do not meet criteria defined for sub-tropical climates.

Central foveal thickness before and after cataract surgery in normal and in diabetic patients without retinopathy.

BACKGROUND: This study aims to evaluate and compare central foveal thickness (CFT) changes after cataract surgery between normal and diabetic patients without retinopathy, using optical coherence tomography (OCT). PATIENTS AND METHODS: Ninety-eight patients (49 patients with type 2 diabetes and 49 healthy controls, sex- and age-matched) undergoing phacoemulsification in one eye were included. The presence of retinopathy was an exclusion criterion. The OCT examination was performed preoperatively as well as one, three, six and twelve months postoperatively. CFT was evaluated and compared between groups. RESULTS: Preoperative CFT showed no significant difference between the two groups (normals: 205 ± 18 µm vs. diabetics: 202 ± 23 µm, p > 0.1). Postoperative CFT in diabetics at all time-points of the follow-up period was significantly increased when compared to controls (first month, normals: 215 ± 28 µm vs. diabetics: 262 ± 33 µm, p < 0.05; third month, normals: 211 ± 19 µm vs. diabetics: 250 ± 27 µm, p < 0.05; sixth month, normals: 208 ± 12 µm vs. diabetics: 266 ± 13 µm, p < 0.05; and twelfth month, normals: 209 ± 13 µm vs. diabetics: 280 ± 11 µm, p < 0.05). The incidence of cystoid macular edema (CME) was 4.0 % and 28.6 % for the control group and the diabetic group, respectively, at the end of the follow-up period (p < 0.05). CONCLUSION: Eyes of diabetic patients without retinopathy present higher CFT and a higher incidence of CME after cataract surgery on OCT examination compared to eyes of healthy controls. This may explain the unsatisfactory visual acuity following cataract surgery in these patients.

Training alters the skeletal muscle antioxidative capacity in non-insulin-dependent type 2 diabetic men.

The present study analyzes the oxidative stress situation in the skeletal muscle of overweight/obese men suffering from non-insulin-dependent type 2 diabetes mellitus [T2DM, n=16, years=61±7, body mass index (BMI)=31±4 kg/m(2) ] and BMI-matched non-diabetic male control subjects (CON, n=7, years=53±6, BMI=30±4 kg/m(2) ). Furthermore, it investigates whether physical training can alter the skeletal muscle antioxidative capacity of T2DM patients at rest. Molecule content analyses (immunohistochemical stainings) of 8-iso-prostaglandin-F2α (8-Iso-PGF), superoxide dismutase-2 (SOD2), glutathione peroxidase-1 (GPX1), peroxiredoxin isoforms (PRDX 1-6) and heat-shock-protein-70 (HSP70) were performed in biopsies taken from the vastus lateralis muscle. Under basal conditions, 8-Iso-PGF was significantly decreased in T2DM patients (-35.7%), whereas PRDX2 and PRDX6 were significantly increased relative to CON (+82.6%; +82.3%). Differences were neither observed in SOD2 nor in GPX1 or PRDX1, 3, 4, 5 density. Regular physical activity (moderate endurance or resistance training twice a week for 3 months) did not alter PRDX1, 2, 3, 4, 6 in the skeletal muscle of T2DM patients, but significantly increased SOD2 (+65.9%), GPX1 (+62.4%), PRDX5 (+37.5%), and HSP70 (+48.5%). Overweight/obese men with non-insulin-dependent T2DM exhibit up-regulated cytosolic peroxiredoxin contents relative to BMI-matched controls. Regular training further up-regulates cytosolic and mitochondrial antioxidative enzymes in T2DM patients and improves their cellular protection systems. This may contribute to a retardation of the disease's progression.

Influence of glycemic status and physical fitness on oxidative stress and the peroxiredoxin system in the erythrocytes of non-insulin-dependent type 2 diabetic men.

UNLABELLED: Oxidative stress plays a leading role in the progression of diabetic secondary complications, e.g., of cardio-vascular illnesses. Physical activity has been shown to delay and even prevent the progression of type 2 diabetes by improving the antioxidative capacity and thereby decreasing systemic oxidative stress. Peroxiredoxins (PRDX) are important antioxidative components that are highly abundant in erythrocytes. The present study examines the influence of glycemic control and physical fitness on oxidative stress and the peroxiredoxin system in the erythrocytes of non-insulin-dependent type 2 diabetic men ( N=22, years=61 ± 10) at rest. Oxidative stress was measured by immunohistochemical stainings for 8-iso-prostaglandin-F2α (8-Iso-PGF) and the overoxidized form of peroxiredoxins (PRDX-SO (2-3)). Peroxiredoxin isoforms PRDX1 and PRDX2 were also quantified immunohistochemically. Physical fitness was determined during the WHO-step test. Regression analyses showed a positive relationship between 8-Iso-PGF plotted against HbA (1c) (hyperbolic curve (y=a+b/x), R (2)=0.346, P=0.013), a positive relationship between 8-Iso-PGF plotted against fasting glucose (hyperbolic curve (y=a+b/x), R (2)=0.440, P=0.003), as well as positive relationships between PRDX2 plotted against VO (2 peak) (S-curve (y=e(a+b/x)), R(2)=0.259, P=0.018) and between PRDX2 plotted against the workload corresponding to the 4 mmol/l blood lactate concentration (hyperbolic curve (y=a+b/x), R(2)=0.203, P=0.041). Further significant relationships were not found. CONCLUSIONS: Poor glycemic control may increase oxidative stress in the erythrocytes of type 2 diabetic men. Good physical fitness seems to be associated with increased peroxiredoxin contents. Therefore, it can be speculated that physical training can contribute to the improvement of the erythrocyte peroxiredoxin system to counteract free radicals in type 2 diabetic patients.

Preparation and comparison of cytotoxic complexes formed between oleic acid and either bovine or human α-lactalbumin.

α-Lactalbumin is a ubiquitous calcium-binding milk protein with a well-characterized function in regulating the synthesis of lactose. An entirely different activity has been shown to occur when a complex is formed between calcium-free α-lactalbumin and oleic acid. This complex shows strong cytotoxic action against several cancer cells, and several mechanisms have been suggested to account for this cell-killing activity. Most studies have been performed using the human protein, but bovine α-lactalbumin shows similar activity. A new and simple 2-step method for purification of calcium-free α-lactalbumin has been developed, and the resulting highly purified preparation was used to generate a complex with oleic acid. Using 3 different cell lines and 2 types of cell viability assays, the bovine and human α-lactalbumin showed comparable cytotoxic activity. The effect was apparent after 15 min of incubation and was inhibited by the presence of fetal bovine serum or bovine serum albumin. The bovine protein might be a useful alternative to the human protein, but also raises the question whether cytotoxic activity could be generated in different kinds of food containing α-lactalbumin.

[Clinical characteristics, progression and risk factors of geographic atrophy]. / Klinische Merkmale, Progression und Risikofaktoren bei geographischer Atrophie.

Geographic atrophy (GA) as the late stage manifestation of age-related macular degeneration (AMD) is a progressive disease process afflicting the retinal pigment epithelium, choriocapillaris and the outer neurosensory retina. GA represents a complex, multifactorial disease governed by the interdependence of genetic, endogenous and exogenous factors. Diagnosis and monitoring of GA progression is largely based on various retinal imaging modalities. After the breakthrough in the treatment of wet AMD GA represents a large clinical challenge. Recent studies have contributed to a better understanding of the pathophysiological pathways, natural history and predictive markers for progression.

Effect of brimonidine/timolol fixed combination on preventing the short-term intraocular pressure increase after intravitreal injection of ranibizumab.

BACKGROUND: The aim of this study was to evaluate the safety and efficacy of brimonidine 0.2 % and timolol 0.5 % instillation as a fixed combination (Combigan, Allergan Inc.) to prevent acute intraocular pressure (IOP) increase occurring after intravitreal injection of ranibizumab (Lucentis, Novartis Pharma AG). PATIENTS AND METHODS: A prospective double-blind placebo-controlled study was carried out. One eye of 88 consecutive normotensive age-related macular degeneration patients receiving Lucentis was randomized into placebo drops (artificial tears, 44 patients) or Combigan drops (44 patients) given twice a day the day before and the day of injection. IOP was measured before and 5, 10, 15 minutes and 1 hour after the intravitreal injection. RESULTS: The placebo group had the higher mean IOP at all time points after injection. Maximum IOP increase for both groups occurred at the 5-minutes time point. Mean post-injection IOP in the placebo group was 34.1 +/- 2.7 mmHg at 5 minutes post-injection versus 28.4 +/- 1.1 mmHg in the Combigan group (P < 0.001). IOP decreased to 24.9 +/- 1.8 mmHg (placebo group) and 19.9 +/- 1.1 mmHg (Combigan group) at 10 minutes post-injection. At 15 minutes post-injection, IOP was below 20 mmHg in all eyes of the Combigan group (100 %), whereas at the same time point these IOP levels were reached only by 34 % of the eyes of the placebo group (15 eyes). All eyes of both groups had a normal IOP 1 hour post-injection. No systemic or ocular side effect was recorded in either group. CONCLUSIONS: The use of Combigan drops twice a day the day before and the day of injection in eyes scheduled for intravitreal injection of Lucentis is a safe and effective prophylaxis to reduce the acute IOP spikes of the post-injection period.

Cilioretinal artery occlusion combined with central retinal vein occlusion - a report of two cases and review of the literature.

BACKGROUND: We describe the clinical findings and course of cilioretinal artery occlusion (CAO) combined with central retinal vein occlusion (CRVO) in two patients and present a review of the relevant literature. HISTORY AND SIGNS: Case 1: An otherwise healthy 24-year-old woman presented to the emergency unit with a painless visual decrease in her right eye. Fundus examination revealed retinal edema due to CAO in association with signs of venous stasis. Fluorescein angiography (FA) showed a patent cilioretinal artery. Case 2: A heavy smoker, hypertensive, 59-year-old man was referred for sudden visual loss in his left eye. Fundus examination and FA revealed CAO and CRVO. THERAPY AND OUTCOME: No treatment was applied for the first patient. Two weeks after diagnosis, retinal edema had subsided and only the signs of venous stasis were evident. The central scotoma remained unchanged. In the second patient, within the next three months, the development of retinal ischemia led to retinal neovascularization. Panretinal photocoagulation was applied. Visual acuity remained very low (light perception). CONCLUSIONS: The combination of CAO and CRVO comprises a discrete clinical entity. In both our cases, FA did not show full obstruction of the cilioretinal artery. Even though many hypotheses have been postulated about this entity, it seems that it ensues from the increased intraluminal pressure in the retinal capillaries (due to the CRVO), which exceeds the pressure in the cilioretinal artery. Thus, it is probably a functional obstruction of the cilioretinal artery, although its pathogenesis remains controversial.