Excisional goniotomy vs trabecular microbypass stent implantation: a prospective randomized clinical trial in eyes with mild to moderate open-angle glaucoma.

PURPOSE: To compare reduction in intraocular pressure (IOP) and IOP-lowering medication in eyes undergoing excisional goniotomy with Kahook Dual Blade (KDB) vs iStent microbypass implantation, both combined with phacoemulsification, in eyes with mild to moderate open-angle glaucoma (OAG). SETTING: Nine practices in the United States. DESIGN: Prospective, randomized, active-controlled, parallel-group clinical trial. METHODS: Eyes were randomized to KDB-Phaco or iStent-Phaco group. Demographics, corrected distance visual acuity, IOP, IOP-lowering medications, and adverse events were collected at baseline and at day 1, week 1, and months 1, 3, 6, and 12 postoperatively. The primary outcome measure was the proportion of eyes at 12 months with IOP reduction of 20% or greater or IOP medication reduction of 1 or more compared with baseline. RESULTS: For this study, 164 eyes of 164 patients were analyzed (82 in each group). Mean IOP was reduced at 12 months compared with baseline from 18.5 (standard of error 0.4) to 15.4 (0.4) mm Hg in the KDB-Phaco group and from 18.5 (0.3) to 16.1 (0.4) mm Hg in the iStent-Phaco group (P = .24). Mean IOP-lowering medications were reduced from 1.3 (0.1) to 0.3 (0.1) in the KDB-Phaco group and from 1.4 (0.1) to 0.4 (0.1) in the iStent-Phaco group (P = .17). Among study completers, the primary outcome was attained in 74 (93.7%) of 79 patients of KDB-Phaco eyes and 65 (83.3%) of 78 patients of iStent-Phaco eyes (P = .04). Both procedures had similar safety profiles. CONCLUSIONS: Both procedures lowered both IOP and the need for IOP-lowering medications effectively and safely in eyes with mild to moderate OAG and cataract. Significantly, more KDB-Phaco eyes than iStent-Phaco eyes met the primary outcome of 20% or greater IOP reduction or 1 or more medication reduction at 12 months.

The juxtaparanodal proteins CNTNAP2 and TAG1 regulate diet-induced obesity.

Despite considerable effort, the identification of genes that regulate complex multigenic traits such as obesity has proven difficult with conventional methodologies. The use of a chromosome substitution strain-based mapping strategy based on deep congenic analysis overcame many of the difficulties associated with gene discovery and led to the finding that the juxtaparanodal proteins CNTNAP2 and TAG1 regulate diet-induced obesity. The effects of a mild Cntnap2 mutation on body weight were highly dependent on genetic background, as both obesity-promoting and obesity-resistant effects of Cntnap2 were observed on different genetic backgrounds. The more severe effect of complete TAG1 deficiency, by decreasing food intake, completely prevented the weight gain normally associated with high-fat-diet feeding. Together, these studies implicate two novel proteins in the regulation of diet-induced obesity. Moreover, as juxtaparanodal proteins have previously been implicated in various neurological disorders, our results suggest a potential genetic and molecular link between obesity and diseases such as autism and epilepsy.

Increased mitochondrial oxidative phosphorylation in the liver is associated with obesity and insulin resistance.

Obesity is the result of excess energy intake relative to expenditure, however little is known about why some individuals are more prone to weight gain than others. Inbred strains of mice also vary in their susceptibility to obesity and therefore represent a valuable model to study the genetics and physiology of weight gain and its co-morbidities such as type 2 diabetes. C57BL/6J mice are susceptible to obesity and insulin resistance when fed an obesogenic diet, whereas A/J mice are resistant despite increased caloric intake. Analysis of B6- and A/J-derived chromosome substitution strains and congenic strains revealed a complex genetic and physiological basis for this phenotype. To improve our understanding of the molecular mechanisms underlying susceptibility to metabolic disease we analyzed global gene expression patterns in 6C1 and 6C2 congenic strains. 6C1 is susceptible whereas 6C2 is resistant to diet-induced obesity. In addition, we demonstrate that 6C1 is glucose intolerant and insulin resistant relative to 6C2. Pathway analysis of global gene expression patterns in muscle, adipose, and liver identified expression level differences between 6C1 and 6C2 in pathways related to basal transcription factors, endocytosis, and mitochondrial oxidative phosphorylation (OxPhos). The OxPhos expression differences were subtle but evident in each complex of the electron transport chain and were associated with a marked increase in mitochondrial oxidative capacity in the livers of the obese strain 6C1 relative to the obesity-resistant strain 6C2. These data suggests the importance of hepatic mitochondrial function in the development of obesity and insulin resistance.

The measurement of haemoglobin concentrations in St. Kitts and Nevis - abstract

In St. Kitts blood for haemoglobin (HB) measurement is collected from the clinics and analyzed in a central laboratory. In Nevis each clinic has a Spencer Haemoglobinometer and the nurses make the measurement in the clinic. The Spencer instrument, despite its many advantages is only of use if the results are reasonably accurate and precise under the conditions prevailing in rural health clinics. This was assessed in two ways. (1) The reports from the clinics were examined: they showed a consistantly higher mean Hb concentration reported from Nevis, suggesting either a real difference between the islands or a systematic error in measurement. (2) A single unit of blood was diluted to give six different stock bloods which were measured using a coulter counter. The stocks were aliquoted according to a random 6 x 6 latin square design so that batches of 36 coded samples were made. Each batch contained hextuplicates of the six stock bloods. Sixteen batches were taken from Jamaica to St. Kitts and Nevis. The four laboratory technicians in St. Kitts each measured the Hb concentrations of a batch using the cyanomethaemoglobin spectrophotometric method. Nine public health nurses and two laboratory technicians in Nevis each measured a batch using their own Spencer instruments. One batch was brought back to Jamaica and analyzed on the coulter counter. This served as a reference for the St. Kitts and Nevis measurements and demonstrated that the specimen transport had not altered the Hb concentration (table provided). The results from the coulter counter and the Cyanomethaemoglobin method used in St. Kitts were in close agreement. However, the Spencer instrument was grossly inaccurate and unacceptably imprecise. The systematic error in the instrument as used in Nevis fully accounts for the differences in mean Hb concentrations between the islands. A system of central measurement of Hb concentrations with quality control has been established in Nevis (AU)

Food and nutrition surveillance: a methodology for use in small developing Caribbean territories part 2: establishment of pilot project in St. Kitts-Nevis

This paper gives an account of the actual establishment of the pilot scheme, showing how the process of collecting, analysing and evaluating surveillance data can quickly define trends affecting the "quality of life" (including nutritional status) of groups of people in St. Kitts-Nevis. The simplest method of monitoring this is by a series of graphs and control charts - regularly updated - which have warning and action limits clearly marked in each case. The need for an effective policy-making machinery to monitor these findings, and to deal with any food and nutrition crisis, is an underlying theme to this paper. The importance of sharing analysed data with local field workers has also been stressed

Food and nutrition surveillance: a methodology for use in small developing Caribbean territories, part 1 - a methodological approach to surveillance

Food and Nutrition Surveillance implies the continuous monitoring of factors relating to food supply, food demand and marketing, food consumption and the ensuing nutritional status of the population. By monitoring data at key points in the food chain, it should be possible to achieve an 'early warning system' of changes likely to affect the vulnerable (and marginal) groups within the community. This paper describes an attempt to produce a methodology for food and nutrition surveillance appropriate to small developing economies in the Commonwealth Caribbean. It introduces the concepts used to develop a pilot surveillance system in the East Caribbean islands of St. Kitts and Nevis

Food and nutrition surveillance: a methodology for use in small developing Caribbean territories, part 1 - a methodological approach to surveillance

Food and Nutrition Surveillance implies the continuous monitoring of factors relating to food supply, food demand and marketing, food consumption and the ensuing nutritional status of the population. By monitoring data at key points in the food chain, it should be possible to achieve an 'early warning system' of changes likely to affect the vulnerable (and marginal) groups within the community. This paper describes an attempt to produce a methodology for food and nutrition surveillance appropriate to small developing economies in the Commonwealth Caribbean. It introduces the concepts used to develop a pilot surveillance system in the East Caribbean islands of St. Kitts and Nevis

Food and nutrition surveillance: a methodology for use in small developing Caribbean territories part 2: establishment of pilot project in St. Kitts-Nevis

This paper gives an account of the actual establishment of the pilot scheme, showing how the process of collecting, analysing and evaluating surveillance data can quickly define trends affecting the "quality of life" (including nutritional status) of groups of people in St. Kitts-Nevis. The simplest method of monitoring this is by a series of graphs and control charts - regularly updated - which have warning and action limits clearly marked in each case. The need for an effective policy-making machinery to monitor these findings, and to deal with any food and nutrition crisis, is an underlying theme to this paper. The importance of sharing analysed data with local field workers has also been stressed