E2 decay strength of the M1 scissors mode of

The E2/M1 multipole mixing ratio δ_{1→2} of the 1_{sc}^{+}→2_{1}^{+} γ-ray decay in ^{156}Gd and hence the isovector E2 transition rate of the scissors mode of a well-deformed rotational nucleus has been measured for the first time. It has been obtained from the angular distribution of an artificial quasimonochromatic linearly polarized γ-ray beam of energy 3.07(6) MeV scattered inelastically off an isotopically highly enriched ^{156}Gd target. The data yield first direct support for the deformation dependence of effective proton and neutron quadrupole boson charges in the framework of algebraic nuclear models. First evidence for a low-lying J^{π}=2^{+} member of the rotational band of states on top of the 1^{+} band head is obtained, too, indicating a significant signature splitting in the K=1 scissors mode rotational band.

Foldable vs rigid lenses after phacoemulsification for cataract surgery: a randomised controlled trial.

PURPOSE: To compare the outcomes of phacoemulsification with either a 2.5-mm clear corneal incision and a foldable intraocular lens (IOL) or a 5-mm sclerocorneal tunnel incision and a rigid polymethyl methacrylate (PMMA) IOL. METHODS: In a prospective, randomised clinical trial of phacoemulsification cataract surgery, 1200 patients received either a foldable hydrophilic acrylic IOL through a 2.5-mm corneal incision or an inexpensive rigid PMMA IOL via a 5-mm sclerocorneal tunnel. Intra- and post-operative data and visual acuity at discharge, 6 weeks, and 1 year follow-up were analysed. RESULTS: At 1 year after surgery, 996 (83.0%) patients were followed up with an uncorrected visual acuity of 6/18 or better in 90.3% of the foldable and 94.3% in the rigid IOL group (risk ratio (RR) 0.96, 95% confidence intervals (CI) 0.92-0.99). Poor outcome (best-corrected acuity 6/60 or worse) occurred in 1.0% and 0.4%, respectively (RR 4.28, 95% CI 0.48-38.18). The surgical cost of consumables and overall surgical time were similar in both groups; however, the cost of the foldable IOL was eight times higher than the PMMA IOL. Posterior capsule opacification was more common in the rigid IOL group at 12 months (36.1% vs 23.3%); however, this did not affect post-operative vision. CONCLUSION: In the hands of experienced cataract surgeons, phacoemulsification with implantation of a foldable or a rigid IOL gives excellent results. Using an inexpensive rigid PMMA IOL will make phacoemulsification more affordable for poor patients in low- and middle-income countries.

Cytosolic calcium, hydrogen peroxide and related gene expression and protein modulation in Arabidopsis thaliana cell cultures respond immediately to altered gravitation: parabolic flight data.

Callus cell cultures of Arabidopsis thaliana (cv. Columbia) were exposed to parabolic flights in order to assess molecular, short-term responses to altered gravity fields. Using transgenic cell lines, hydrogen peroxide (H2 O2 ) and cytosolic Ca(2+) were continuously monitored. In parallel, the metabolism of samples was chemically quenched (RNAlater, Ambion for RNA; acid/base for NADPH, NADP) at typical stages of a parabola [1 g before pull up; end of pull up (1.8 g), end of microgravity (20 s) and end of pull out (1.8 g)]. Cells exhibited an increase in both Ca(2+) and H2 O2 with the onset of microgravity, and a decline thereafter. This behaviour was accompanied by a decrease of the NADPH/NADP redox ratio, indicating Ca(2+) -dependent activation of a NADPH oxidase. Microarray analyses revealed concomitant expression profiles. At the end of the microgravity phase, 396 transcripts were specifically up-, while 485 were down-regulated. Up-regulation was dominated by Ca(2+) - and ROS-related gene products. The same material was also used for analysis of phosphopeptides with 2-D SDS PAGE. Relevant spots were identified by liquid chromatography-MS. With the exception of a chaperone (HSP 70-3), hypergravity (1.8 g) and microgravity modified different sets of proteins. These are partly involved in primary metabolism (glycolysis, gluconeogenesis, citrate cycle) and detoxification of ROS. Taken together, these data show that both gene expression and protein modulation jointly respond within seconds to alterations in the gravity field, with a focus on metabolic adaptation, signalling and control of ROS.

Profile of the glaucomas and intervention in a large eye care centre in south-east Nepal.

INTRODUCTION: Glaucoma is the second leading cause of blindness worldwide. OBJECTIVE: To estimate the prevalence and risk factors of glaucoma and modes of therapeutical intervention in a rural population of a developing country. PATIENTS AND METHODS: A single centre-based cross-sectional study was carried out over a seven-month period in Sagarmatha Choudhary Eye Hospital (SCEH), Lahan/NEPAL, including the patients with glaucoma. OUTCOME MEASUREMENT: The patients' demography, type of the glaucomas, visual acuity, vertical cup-disc ratio, intra-ocular pressure and visual field findings were the parameters studied. RESULTS: A total of 3986 eyes with suspected glaucoma were identified. 53.7% of the patients were between 41-60 years of age. 53.9% were male. 26.5% were blind or severely visually impaired. 37.2% had IOP more than 35 mmHg. 46.4% had vertical cup-disc ratio (VCDR) higher than 0.8. Severe visual field defects were found in 28.4% eyes. 35.3% eyes had primary angle-closure glaucoma, 22.6% eyes primary open-angle glaucoma, and 14.6% eyes normaltension glaucoma. 10.2% eyes suffered from lens induced glaucoma. Only in 9 eyes was pseudoexfoliation syndrome with glaucoma diagnosed. 25.7% eyes were advised for trabeculectomy. 11.5% eyes underwent extra-capsular cataract surgery. IOP lowering medication was prescribed in 5.9% patients. CONCLUSIONS: The most common glaucoma seen in the out-patient department of a large eyecare centre in South-East Nepal is primary angle-closure glaucoma. 25% of the glaucoma patients are visually impaired or blind at the time of presentation. In more than one-fourth of the patients, trabeculectomy is the therapy of choice.

Outcome of probing under topical anesthesia in children below 18 months of age with congenital nasolacrimal duct obstruction.

Congenital Nasolacrimal Duct Obstruction (CNLDO) is one of the commonest causes of Childhood epiphora. This study was carried outat Sagarmatha Chaudhary Eye Hospital (SCEH), Lahan to determine the success rate of probing and syringing in children below 18 months of age with CNLDO. A hospital based prospective interventional study of 106 children with age 4 to 18 months (Mean 7.67, SD 4.37) who underwent probing and syringing under topical anesthesia in minor procedure room of OPD. The children were divided into 3 age groups, Group A (age d" 6 months), Group B (age = 7-12 months) and Group C (age = 13-18 months). Success of probing was defined as complete relief of signs and symptoms on follow up at 3-6 weeks. Out of 106 children with CNLDO below 18 months of age, 97 (91.5%) children had better outcome with first attempt of probing. First attempt of probing resulted in resolution in 92.3% (108 out of 117) eyes; 95.6%, 92.7%, 87.1% in the age group less than 6 months, 7-12 and 13-18 months respectively. 9 eyes underwent a repeat procedure of which 6 eyes were cured. Probing and syringing below 6 months of life has shown to be very effective with almost 100% success. The overall success of probing and syringing among children less than 18 months was 97.4%.

Nucleus management with Fishhook.

The fishhook technique developed at the Lahan eye hospital is widely used in Nepal and other countries. Its specialty is the extraction of the nucleus with a bent 30-G needle (Fishhook) out of the capsular bag and the self-sealing tunnel. All sizes of nuclei can be extracted. The fishhook technique has a short learning curve, a low complication rate and provides excellent immediate visual outcome. It is cost-effective and has proved to be useful also for high-volume cataract surgery and thus can play an important role in the reduction of cataract blindness.

Loupe magnification for small incision cataract surgery--an alternative to microscope magnification?

A Prospective randomized controlled study was conducted to compare outcome of Small Incision Cataract Surgery (SICS) using microscope or loupe magnification. Two hundred fifty one patient with mature cataract were randomly allocated to SICS-Fishhook Technique with either microscope (127 eyes) or loupe (124 eyes) magnification. Intra- and postoperative complications and immediate visual outcome were analyzed. Nearly two third (microscope 65% and magnifying loupe 62.9%) of all patients had good visual outcome on first postoperative day. Poor outcome (<6/60) was recorded in 8% (microscope group) and 7% (magnifying loupe group). Mean visual acuity with Snellen was 0.39 (SD 0.2) in microscope group and 0.38 (SD 0.2) in magnifying loupe group. Intra operative complications were comparable in both groups. Mean surgery time with loupe magnification was significantly shorter. Comparatively equivalent good surgical outcome was achieved with loupe as well as with microscope magnification. However performing SICS with loupe magnification is significantly faster. Small incision cataract surgery with loupe magnification is safe and effective procedure for cataract surgery so it can play a role in reducing cataract blindness in developing countries of the world.

[Transcriptome analyses in renal cell carcinoma. Combination of laser microdissection and microarrays]. / Transkriptomanalysen beim Nierenzellkarzinom. Kombination von Lasermikrodissektion und Microarrays.

BACKGROUND: The objective of this study was to test the feasibility of combined laser microdissection and microarray-based expression analysis in renal cell carcinoma (RCC) and to detect the most strongly deregulated genes. METHODS: Laser microdissection of tumor areas and subsequent gene expression analysis (47,000 transcripts) was performed on snap-frozen primary tumor samples from 15 patients with clear cell RCC. Four normal kidney samples served as controls. Validation was performed for one gene with quantitative RT-PCR on additional samples. RESULTS: Isolation of intact RNA from microdissected tissue was successful; 179 transcripts were significantly deregulated by a factor of 5 or more. Upregulation of FABP7 was confirmed by quantitative RT-PCR. CONCLUSION: In RCC the combination of laser microdissection and subsequent microarray analysis provides reliable data from precisely defined material. This is an optimal starting point for the development of novel therapeutic and diagnostic options.

Contact angle hysteresis: study by dynamic cycling contact angle measurements and variable angle spectroscopic ellipsometry on polyimide.

The phenomenon of contact angle hysteresis was studied on smooth films of polyimide, a polymer type used in the microelectronic industry, by dynamic cycling contact angle measurements based on axisymmetric drop shape analysis-profile in combination with variable angle spectroscopic ellipsometry (VASE). It was found that both advancing and receding contact angles became smaller with increasing the number of cycles and are, therefore, not a property of the dry solid alone. The changes of the wetting behavior during these dynamic cycling contact angle measurements are attributed mainly to swelling and/or liquid retention. To reveal the water-induced changes of the polymer film, the polyimide surface was studied before and after the contact with a water droplet by VASE. Both the experimental ellipsometric spectrum for Delta and that for Psi as well as the corresponding simulations show characteristic shifts due to the contact with water. The so-called effective medium approximation was applied to recover information about the thickness and effective optical constants of the polymer layer from the ellipsometrically measured values of Delta and Psi. On the basis of these results, the swelling and retention behavior of the polyimide films in contact with water droplets were discussed.

[Restoration of Class V cavities with the Ormocer-based filling system Admira]. / Die Versorgung von Klasse-V-Kavitäten mit dem Ormocer-basierenden Füllungssystem Admira.

The aim of this study was to evaluate the clinical effectiveness of an Ormocer-based restorative system for treatment of mixed carious and non-carious class V cavities. 70 restorations in 25 patients were placed with the condensable material Admira (group 1). In a second group of eight patients, the treatment of 25 cavities took place with the flowable material Admira Flow in combination with composite-bonded to-flowable technique or with the flowable material alone. The clinical evaluation was carried out using a modified clinical criteria system (Böhm et al. 1991) after Lutz et al. (1977) and Ryge (1980). Restorations of group 1 reached the two-year-level, those of group 2 the one-year-level. Good results were obtained with both condensable material and flowable material despite the small number of failures in the various clinical criteria. The retention rate of the flowable composite was 100% after six and twelve months and was the only parameter superior to those of the condensable material (98.6% resp. 93.9%). After two years, group 1 showed significant differences to base line with respect to volume behaviour and surface texture. No significant differences were determined with respect to of colour match, bond zone morphology and clinical acceptance. A SEM evaluation of replicas confirmed clinical results but also revealed clinically invisible failures of bond zone morphology.

[Stenosing gastric laryngitis in infancy]. / Stenosierende Laryngitis gastrica im Säuglingsalter.

A 2 month old female infant presented an aphonic voice and increasing inspiratory stridor due to a stenosing granulating laryngitis. A pathologically elevated gastroesophageal reflux was measured by means of 24-h pH-metry. After antireflux therapy (Cisaprid, sodium alginate and upright body positioning), the laryngitis was completely healed. This case confirms that an elevated gastroesophageal reflux in infants can cause chronic inflammatory diseases of the upper respiratory tract, especially of the larynx.

Sutureless cataract surgery with nucleus extraction: outcome of a prospective study in Nepal.

AIM: To report the short and medium term outcome of a prospective series of sutureless manual extracapsular cataract extractions (ECCE) at a high volume surgical centre in Nepal. METHODS: Cataract surgery was carried out, on eyes with no co-existing diseases, in 500 consecutive patients who were likely to return for follow up. The technique involved sclerocorneal tunnel, capsulotomy, hydrodissection, nucleus extraction with a bent needle tip hook, and posterior chamber intraocular lens (PC-IOL) implantation according to biometry findings. Surgical complications, visual acuity at discharge, 6 weeks, and 1 year follow up, and surgically induced astigmatism are reported. RESULTS: The uncorrected visual acuity at discharge was 6/18 or better in 76.8% of eyes, and declined to 70.5% at 6 weeks' follow up, and 64.9% at 1 year. The best corrected visual acuity was 6/18 or better in 96.2% of eyes at 6 weeks and in 95.9% at 1 year. Poor visual outcome (<6/60) occurred in less than 2%. Intraoperative complications included 47 (9.4%) eyes with hyphaema, and one eye (0.2%) with posterior capsule rupture and vitreous in the anterior chamber. Surgery led to an increase in against the rule astigmatism, which was the major cause of uncorrected visual acuity less than 6/18. Six weeks postoperatively, 85.5% of eyes had against the rule astigmatism, with a mean induced cylinder of 1.41 D (SD 0.8). There was a further small increase in against the rule astigmatism of 0.66 D (SD 0.41) between 6 weeks and 1 year. The mean duration of surgery was 4 minutes and the average cost of consumables, including the IOL, was less than $10. CONCLUSION: Rapid recovery of good vision can be achieved with sutureless manual ECCE at low cost in areas where there is a need for high volume cataract surgery. Further work is required to reduce significant postoperative astigmatism, which was the major cause of uncorrected acuity less than 6/18.

[Morphological and functional results of Palisade Cartilage Tympanoplasty]. / Morphologische und funktionelle Ergebnisse der Knorpelpalisadentympanoplastik.

BACKGROUND AND OBJECTIVE: The application of cartilage in tympanoplasty has been generally accepted, because cartilage as a bradytrophic tissue allows stable and functionally reliable reconstruction of the eardrum even in difficult pathological conditions (such as subtotal defects, tympanosclerosis etc.). A special surgical technique using small cartilaginous chips for the reconstruction of the eardrum has been developed by J. Heermann, who introduced it as Palisade Cartilage Tympanoplasty (PCT). Although being increasingly applied in otosurgery, this technique has to date neither been evaluated regarding morphological and hearing results nor regarding its combination with titanium ossicular reconstruction prostheses. PATIENTS AND METHODS: Therefore we reviewed 84 of 94 ears (92 patients, 58 female, 34 male) 12 to 36 months after PCT. RESULTS: A recurrent defect was seen in 2 ears (1 adhesive otitis, 1 subtotal defect). There were no extrusions of prostheses. Preoperatively an ear-bone-gap of 0-10 dB was seen in 2 ears, 11-30 dB in 48 and 31-59 dB in 34 ears. Postoperatively the corresponding numbers were 25, 50 and 9 ears. CONCLUSIONS: The low rate of recurrent tympanic membrane defects (2.4%) shows that palisade cartilage tympanoplasty is particularly appropriate for the management of difficult indications in middle ear surgery. Further, it could be demonstrated that the PCT can be combined safely with titanium ossicular reconstruction prostheses. Regarding postoperative hearing results the negative preselection of pathological conditions has to be considered.

Long term clinical outcome of a randomised controlled trial of anterior chamber lenses after high volume intracapsular cataract surgery.

BACKGROUND: Age related cataract remains the major cause of blindness throughout the world. In many countries, the majority of cataract surgery continues to be done by the intracapsular cataract extraction (ICCE) method. The results of a large randomised controlled trial of multiflex open loop anterior chamber intraocular lenses (ACIOL) were reported from a busy eye hospital in Nepal. METHODS: There was a randomised controlled trial of 2000 people with bilateral cataract reducing vision to less than 6/36. Interventions were ICCE with an ACIOL compared with ICCE with aphakic spectacles (+11 dioptres). Participants were followed at discharge, 6 weeks, 1 year, and 1 1/2-5 years after surgery. Visual acuity and clinical outcome were measured. A poor outcome was defined as vision <6/60. RESULTS: Visual outcome was comparable in the two groups. More of the control group experienced functional blindness due to loss of aphakic spectacles at 1 year. The majority of cases of poor outcome occurred in the first year after surgery. There was no indication of any lens related problems after 1 year. CONCLUSION: Multiflex open loop anterior chamber lenses are safe for up to 1 year of follow up when used by experienced surgeons, and the available evidence of 2-5 years of follow up suggests that the complication rate is reasonably low. An ACIOL at the time of cataract surgery offers benefits over routine ICCE surgery with aphakic spectacle correction as it avoids the problem of replacing lost and broken spectacles.

A prospective study of 413 cases of lens-induced glaucoma in Nepal.

PURPOSE: To determine the frequency and types of lens-induced glaucoma (LIG), reasons for late presentation and outcome of current management. METHODS: Prospective case series of 413 patients/eyes with LIG over a 12-month period in 1998; 311 of these patients underwent cataract surgery. Visual acuity and intraocular pressure (IOP) were pre- and postoperatively assessed. RESULTS: Four hundred and thirteen (1.5%) of 27,073 senile cataracts seen in the outpatient department of Sagarmatha Choudhary Eye Hospital, Lahan, Nepal presented with LIG. There were 298 (72%) phacomorphic cases and 115 (28%) phacolytic glaucoma. Pain for more than 10 days was reported by 293 (71%) patients. The majority, 258 (62.4%), travelled a distance of more than 100 kms to the hospital. The major reasons for late presentation were "no escort" in 143 (34.6%) and "lack of money" in 128 (31.0%) cases. At presentation the IOP was more than 30 mm Hg in 327 (79%) eyes. Following cataract surgery, 251 (80.7%) had 21 mm Hg or less at discharge. The visual acuity was hand-movement or less before surgery in all eyes; at discharge 120 of 311 operated eyes (38.6%) achieved 6/60 or better, 97 (31.2%) less than 6/60, and 94 (30.2%) less than 3/60. The main causes for poor outcome in 94 cases were optic atrophy in 32 (34%) eyes, uveitis in 25 (26.6%)eyes and corneal oedema in 24 (25.5%) eyes. CONCLUSION: The results highlight the importance of early diagnosis and treatment of visually disabling cataract. There is a need to educate both the patient and the cataract surgeon of the dangers of lens-induced glaucoma and of the poor outcome if treatment is delayed.

Postoperative astigmatism after intracapsular cataract surgery: results of a randomised controlled trial in Nepal.

PURPOSE: Postoperative astigmatism following intracapsular cataract extraction with or without anterior chamber intraocular lens implantation is reported as an outcome from a randomised controlled trial. METHODS: Five hundred and two of 1002 eyes randomised to intracapsular cataract extraction with anterior chamber intraocular lens (ICCE/AC IOL) and 417 of 998 eyes to intracapsular cataract extraction with aphakic spectacles (ICCE/AS) were seen for objective refraction one year after surgery. The prevalence and axis of astigmatism were evaluated using univariate analysis. Logistic regression was used to compare the postoperative astigmatism between the groups. RESULTS: Acceptable astigmatism (-0.5 to 0.0 DCyl) in the AC IOL group was found in 60 (12.0%) patients (95% CI 9.1%-14.9%) and in the aphakic spectacles group (AS) in 69 (16.5%) patients (95% CI 12.9%-20.1%), moderate astigmatism (-1.0 to-1.5 DCyl) was found in 153 (30.4%) patients (95% CI 26.4-34.6%) in ACIOL group and in 288 (69.1%) patients (95% CI 64.6%-73.6%) in AS group; and large astigmatism (-2.0 to - 8.0 D Cyl) was found in 289 (57.6%) patients (95% CI 53.1%-61.6%) in ACIOL group and in 60 (14.4%) patients (95% CI 11.0% 17.8%) in AS group. Large astigmatism was approximately four times more common in the ICCE/AC IOL group compared to ICCE/AS group. In both groups, most patients had "against-the-rule" astigmatism, 446 (88.8%) (95%CI 86.0%-91.6%) in AC IOL group and 348 (83.5%) (95%CI 79.9%-87.1%) in AS group. CONCLUSION: Astigmatism is common after intracapsular cataract extraction. Insertion of an anterior chamber IOL increases the risk of astigmatism.