Behandelte Frühgeborenenretinopathie in Deutschland Walz, J. M.; Bemme, S.; Reichl, S. ...
Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft,
06/2018, Letnik:
115, Številka:
6
Journal Article
Zusammenfassung
Hintergrund
Die Frühgeborenenretinopathie ist eine der häufigsten kindlichen Erblindungsursachen. Dennoch ist die Zahl behandlungsbedürftiger Kinder pro Zentrum gering. Eine sinnhafte ...Auswertung von Behandlungsverläufen ist daher nur im Verbund möglich. Hierfür wurde das Retina.net ROP-Register gegründet.
Ziel der Arbeit
Die vorliegende Arbeit analysiert Behandlungsmuster über 5 Jahre.
Material und Methoden
Ausgewertet wurden alle Kinder der Geburtsjahrgänge 2011 bis 2015, die an den teilnehmenden 12 Zentren behandelt und in das Register eingegeben wurden.
Ergebnisse
Insgesamt wurden 150 Kinder (292 Augen) ausgewertet. Die häufigste Behandlungsindikation war Stadium 3+ in Zone II. Gestationsalter und Geburtsgewicht blieben über die Jahre konstant. Allerdings änderte sich das Behandlungsmuster. Die Anti-VEGF-Behandlung mit Bevacizumab bzw. Ranibizumab machte im Jahr 2011 nur 10 % der Behandlungen aus, in den Jahren 2014 und 2015 dagegen 56 % bzw. 30 %. Nahezu alle Augen mit AP-ROP und Zone-I-Erkrankung wurden mit Anti-VEGF behandelt, die meisten Zone-II-Erkrankungen mit Laser. Rezidive traten nach Anti-VEGF-Therapie häufiger und später auf als nach Lasertherapie (23 %/60 Tage vs. 17 %/23 Tage). Perioperative Komplikationen waren gleich verteilt.
Diskussion
Die ausgewerteten Daten repräsentieren ca. 10–15 % der behandelten Frühgeborenen in Deutschland. Sie belegen einen Trend zur zunehmenden Verwendung von Anti-VEGF-Therapeutika. Sehr deutlich zeigt sich eine Selektion der Anti-VEGF-Therapie bei den aggressiven Formen der Frühgeborenenretinopathie. Dies muss bei der Interpretation der Daten, insbesondere der Rezidivhäufigkeit, beachtet werden. Von besonderer klinischer Relevanz ist das Risiko für späte Rezidive nach Anti-VEGF-Therapie.
The high affinity IgE receptor (Fc epsilon RI) is a tetrameric hetero-oligomer composed of an alpha chain, a beta chain, and two disulfide-linked gamma chains. The beta chain contains four ...transmembrane (TM) segments and long cytoplasmic domains that are thought to play an important role in intracellular signaling. We now report the structural characterization and the sequence of the complete human beta gene and cDNA. The gene spans approximately 10 kilobases and contains seven exons. There is a single transcription initiation site preceded by a TATA box. The first exon codes for the 5'-untranslated region and a portion of the N-terminal cytoplasmic tail. TM-1 is encoded in exons 2 and 3, TM-2 in exons 3 and 4, TM-3 in exon 5, and TM-4 in exon 6. The seventh and final exon encodes the end of the C-terminal cytoplasmic tail and the 3'-untranslated sequence. The human beta gene appears to be a single copy gene. Two corresponding transcripts, detected as a doublet around 3.9 kilobases, are present in cells of mast cell and basophil lineage from different individuals, but not in the other hematopoietic cells tested here. The human beta protein is homologous to rodent beta. The consensus amino acid sequences of human, mouse, and rat beta show 69% identical residues. Analysis of the surface expression of transfected receptors indicates that human alpha gamma and alpha beta gamma complexes are expressed with comparable efficiency. Human beta interacts with human alpha more efficiently than does rat beta, and both rat and mouse beta interact with their corresponding alpha more efficiently than does human beta, demonstrating a species specificity of the alpha/beta interaction.
Granulocyte and natural killer (NK) cell Fc receptors for immunoglobulin G (CD16) differ in only a few amino acids, yet have phosphatidylinositol glycan (PIG) or polypeptide membrane anchors, ...respectively. Mutagenesis shows that anchoring is regulated by a serine residue near the PIG anchor attachment site in the extracellular domain. The NK cell isoform was not expressed on the surface of COS cells unless cotransfected with a subunit that was expressed in NK cells and that was identical to the $\gamma $ subunit of the high affinity IgE Fc receptor (Fc$\epsilon $RI). However, the CD16 sequence and not expression of the $\gamma $ subunit is dominant in regulating PIG reanchoring.
Background: Since an objective description is essential to determine infant’s postnatal condition and efficacy of interventions, two scores were suggested in the past but weren’t tested yet: The ...Specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone.
Methods: Scores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated.
Results: Of 2150 eligible newborns, data on 1855 infants with a mean GA of 286/7± 23/7 weeks were analyzed. At 1 minute, the Combined-Apgar was significantly better in predicting poor outcome than the Specified- or Expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively.
Conclusion: The Combined-Apgar allows a more appropriate description of infant’s condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions.
Background: Since an objective description is essential to determine infant’s postnatal condition and efficacy of interventions, two scores were suggested in the past but weren’t tested yet: The ...Specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone.
Methods: Scores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated.
Results: Of 2150 eligible newborns, data on 1855 infants with a mean GA of 286/7± 23/7 weeks were analyzed. At 1 minute, the Combined-Apgar was significantly better in predicting poor outcome than the Specified- or Expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively.
Conclusion: The Combined-Apgar allows a more appropriate description of infant’s condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions.
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