MEMS for Diabetic Retinopathy

As the worldwide prevalence of diabetes mellitus continues to increase, diabetic retinopathy remains the leading cause of visual impairment and blindness in many developed countries. Between 32 to 40 percent of about 246 million people with diabetes develop diabetic retinopathy. Approximately 4.1 million American adults 40 years and older are affected by diabetic retinopathy. This glucose-induced microvascular disease progressively damages the tiny blood vessels that nourish the retina, the light-sensitive tissue at the back of the eye, leading to retinal ischemia (i.e., inadequate blood flow), retinal hypoxia (i.e., oxygen deprivation), and retinal nerve cell degeneration or death. It is a most serious sight-threatening complication of diabetes, resulting in significant irreversible vision loss, and even total blindness.

Unfortunately, although current treatments of diabetic retinopathy (i.e., laser therapy, vitrectomy surgery and anti-VEGF therapy) can reduce vision loss, they only slow down but cannot stop the degradation of the retina. Patients require repeated treatment to protect their sight. The current treatments also have significant drawbacks. Laser therapy is focused on preserving the macula, the area of the retina that is responsible for sharp, clear, central vision, by sacrificing the peripheral retina since there is only limited oxygen supply. Therefore, laser therapy results in a constricted peripheral visual field, reduced color vision, delayed dark adaptation, and weakened night vision. Vitrectomy surgery increases the risk of neovascular glaucoma, another devastating ocular disease, characterized by the proliferation of fibrovascular tissue in the anterior chamber angle. Anti-VEGF agents have potential adverse effects, and currently there is insufficient evidence to recommend their routine use.

In this work, for the first time, a paradigm shift in the treatment of diabetic retinopathy is proposed: providing localized, supplemental oxygen to the ischemic tissue via an implantable MEMS device. The retinal architecture (e.g., thickness, cell densities, layered structure, etc.) of the rabbit eye exposed to ischemic hypoxic injuries was well preserved after targeted oxygen delivery to the hypoxic tissue, showing that the use of an external source of oxygen could improve the retinal oxygenation and prevent the progression of the ischemic cascade.

The proposed MEMS device transports oxygen from an oxygen-rich space to the oxygen-deficient vitreous, the gel-like fluid that fills the inside of the eye, and then to the ischemic retina. This oxygen transport process is purely passive and completely driven by the gradient of oxygen partial pressure (pO₂). Two types of devices were designed. For the first type, the oxygen-rich space is underneath the conjunctiva, a membrane covering the sclera (white part of the eye), beneath the eyelids and highly permeable to oxygen in the atmosphere when the eye is open. Therefore, sub-conjunctival pO₂ is very high during the daytime. For the second type, the oxygen-rich space is inside the device since pure oxygen is needle-injected into the device on a regular basis.

To prevent too fast or too slow permeation of oxygen through the device that is made of parylene and silicone (two widely used biocompatible polymers in medical devices), the material properties of the hybrid parylene/silicone were investigated, including mechanical behaviors, permeation rates, and adhesive forces. Then the thicknesses of parylene and silicone became important design parameters that were fine-tuned to reach the optimal oxygen permeation rate.

The passive MEMS oxygen transporter devices were designed, built, and tested in both bench-top artificial eye models and in-vitro porcine cadaver eyes. The 3D unsteady saccade-induced laminar flow of water inside the eye model was modeled by computational fluid dynamics to study the convective transport of oxygen inside the eye induced by saccade (rapid eye movement). The saccade-enhanced transport effect was also demonstrated experimentally. Acute in-vivo animal experiments were performed in rabbits and dogs to verify the surgical procedure and the device functionality. Various hypotheses were confirmed both experimentally and computationally, suggesting that both the two types of devices are very promising to cure diabetic retinopathy. The chronic implantation of devices in ischemic dog eyes is still underway.

The proposed MEMS oxygen transporter devices can be also applied to treat other ocular and systemic diseases accompanied by retinal ischemia, such as central retinal artery occlusion, carotid artery disease, and some form of glaucoma.

The ecological impact of different mechanisms of chronic sub-lethal toxicity on feeding and respiratory physiology

Sub-lethal toxicity tests, such as the scope-for-growth test, reveal simple relationships between measures of contaminant concentration and effect on respiratory and feeding physiology. Simple models are presented to investigate the potential impact of different mechanisms of chronic sub-lethal toxicity on these physiological processes. Since environmental quality is variable, even in unimpacted environments, toxicants may have differentially greater impacts in poor compared to higher quality environments. The models illustrate the implications of different degrees and mechanisms of toxicity in response to variability in the quality of the feeding environment, and variability in standard metabolic rate. The models suggest that the relationships between measured degrees of toxic stress, and the maintenance ration required to maintain zero scope-for-growth, may be highly nonlinear. In addition it may be possible to define critical levels of sub-lethal toxic effect above which no environment is of sufficient quality to permit prolonged survival.

Effect of some environmental factors on the acute toxicity of deltamethrin to common carp: a laboratory study under aerobic condition

The toxicity of xenobiotic in aquatic ecosystems is influenced by many factors such as ambient temperature, water hardness, pond soil type, etc. In the present study, it was observed that air temperature, water hardness and soil sediment have profound influence on the toxicity of deltamethrin to common carp fry (ay. length 3.5 ± 0.5 cm, ay. weight 0.58 ± 0.25 g); 96h LC(sub)50 values for common carp at 38.07 ± 2.20°C maximum and 27.86 ± 1.22°C minimum air temperature in soft and very hard water were 0.102 and 0.495 µg lˉ¹, respectively. This value had increased significantly to 2.37 and 3.02 µg at 30.55 ± 1.21°C maximum and 26.04 ± 0.61°C minimum air temperature, respectively. When sediment was included, 96h LC(sub)50 at 38.07°C maximum temperature in very hard water was 1.808 µg 1ˉ¹ and this had increased to 8.073 µg 1ˉ¹ when tested at 30.55°C maximum temperature. Due to the 7.5°C increase in maximum and 1.7°C in minimum temperature, toxicity increased significantly. Lower toxicity in very hard water in comparison to soft water may be due to the lower solubility of deltarnethrin and high level of calcium. Adsorption reaction of deltamethrin with clay, humus, FeOOH, MnOOH and particulate organic carbon, and complexation reaction with dissolved organic carbon were responsible for the lowered toxicity in the experiment with sediment. Exposure time had no significant effect on acute toxicity of deltamethrin.

Influence of some abiotic factors on the acute toxicity of cadmium to Cyprinus carpio

Hardness of water had significant effect on the acute toxicity of cadmium to common carp, Cyprinus carpio. The 96h LC sub(50) and safe application rate increased from 43.17 and 22.77 mg 1 super(-1) in soft water (0.9 mM Ca super(2+) l super(-1)) to 310.48 and 177.66 mg l super(-1), respectively, in very hard water (6.0 mM Ca super(2+) l super(-1)). In medium hard and hard water, 96h LC sub(50) values were 48.39 and 116.45 mg l super(-1). When sediments were included in the medium hard, hard and very hard water treatments, the 96h LC sub(50) were 111.20, 133.71 and 334.47 mg l super(-1), respectively. Among these values, the one for medium hard water with sediment treatment was significantly higher than medium hard water treatment; values for the other two treatments were non-significant when compared with respective water treatments. Sediment was able to reduce the acute toxicity of cadmium mainly due to the complexation of cadmium with dissolved organic carbon (DOC). At the lower hardness level, cadmium complexed with DOC and the acute toxicity was reduced significantly. At higher hardness, most of the DOC sites were occupied by calcium and the acute toxicity of cadmium was not significantly reduced in hard water with sediment and very hard water with sediment experiments in comparison to respective water treatments.

Effect of contact time on the acute toxicity of mercury to scale carp

The behaviour of metals in aquatic ecosystems is dependent on various environmental factors. Experiments were conducted in five different contact times (0.5, 2, 12, 24 and 48h) between soil sediment and mercury on Cyprinus carpio var communis. It was observed that contact time with soil sediment had significant effect in reducing the toxicity of mercury. Higher the time of contact, greater the effect. Medium hard water (150 mg/L CaC0 sub(3) of total hardness) had the highest effect as compared to other water in reducing the toxicity of mercury when combined with underlying soil sediment. With the increase in contact time, complexation and adsorption of inorganic mercury ions with the dissolved and particulate phases of water and soil sediment were increased; thereby bioaccumulation of mercury ions by scale carp was more. Applicability of the result of this experiment in natural ecosystems was also suggested.

Acute toxicity of metasystox to wedge clam, Donax cuneatus from west coast

96h acute toxicity tests were performed using commercial grade metasystox on the marine wedge clam, Donax cuneatus during summer 1985. The behaviour and mortality rates were recorded periodically. Most of the dams responded in opening the shell valves and extending the siphons quicker in low test concentrations (0.004-0.0052 p.p.m) but this was slow and late in high concentrations (0.0056-0.008 p.p.m). Mortality began to occur in 0.008 p.p.m. from 12 h, whereas, in 0.0052 p.p.m. from 60 h onwards. The observed LC sub(0) value was 0.004 p.p.m. and LC sub(50) 0.0064 p.p.m. The regression equation established was Y = 79.0891 + 33.4523 X. The rate of oxygen concentration increased at LC sub(0) and LC sub(50) values compared to control indicating the disturbed physiological adjustment. The results are correlated with physico-chemical parameters of seawater and discussed in the light of pesticide toxicity to the dam.

Acute toxicity of unionized ammonia to milkfish (Chanos chanos Forsskal) fry

The study was conducted to determine the effects of varying concentrations of ammonia to milkfish fry. Two runs of static 96h bioassays were conducted to determine the median lethal concentration (LC 50) of unionized ammonia (NH₃) to milkfish fry. Test concentrations were based on exploratory 24h and 48h bioassays and were made in three replicates. Reagent grade ammonium chloride (NH₄Cl) was used to adjust the level of unionized ammonia. The 96h median lethal concentration, determined by the Reed Muench method was calculated at 28.029 ppm NH₃ 29.69 ppm. Even at high concentrations of unionized ammonia, most of the fry mortality occurred after 48 to 96 hours exposure. Severe gill damage occurs only at concentrations above 20 ppm, especially above the LC 50. The high LC 50 value obtain shows that milkfish fry has great tolerance to ammonia, that even fry with severely-damaged gills can still recover days after it is returned to favorable culture condition. The result suggest that observed mortalities of milkfish fry under culture conditions are not due to ammonia toxicity.

Report of the sub-regional workshop to validate the scoping study of nutrient pollution on the coastal and marine systems of South Asia, Colombo, Sri Lanka, 21-22 May, 2014

The workshop agenda included: presentations from collaborative institutions, national governments and resource persons; a draft scoping study on nutrient loading; and an ecosystem approach to pollution management was tested.

Activity in Geriatric acute CARe (AGECAR): Rationale, design and methods

The Activity in GEriatric acute CARe (AGECAR) is a randomised control trial to assess the effectiveness of an intrahospital strength and walk program during short hospital stays for improving functional capacity of patients aged 75 years or older. Patien

Genetic predisposition to acute respiratory distress syndrome in patients with severe sepsis

The objective of this study was to analyze the association between candidate gene polymorphisms and susceptibility to acute respiratory distress syndrome (ARDS) in patients with severe sepsis. Patients older than 18 years admitted to the intensive care un

Reduction of quantity smoked predicts future cessation among older smokers.

AIM: To examine whether smokers who reduce their quantity of cigarettes smoked between two periods are more or less likely to quit subsequently. STUDY DESIGN: Data come from the Health and Retirement Study, a nationally representative survey of older Americans aged 51-61 in 1991 followed every 2 years from 1992 to 1998. The 2064 participants smoking at baseline and the first follow-up comprise the main sample. MEASUREMENTS: Smoking cessation by 1996 is examined as the primary outcome. A secondary outcome is relapse by 1998. Spontaneous changes in smoking quantity between the first two waves make up the key predictor variables. Control variables include gender, age, education, race, marital status, alcohol use, psychiatric problems, acute or chronic health problems and smoking quantity. FINDINGS: Large (over 50%) and even moderate (25-50%) reductions in quantity smoked between 1992 and 1994 predict prospectively increased likelihood of cessation in 1996 compared to no change in quantity (OR 2.96, P<0.001 and OR 1.61, P<0.01, respectively). Additionally, those who reduced and then quit were somewhat less likely to relapse by 1998 than those who did not reduce in the 2 years prior to quitting. CONCLUSIONS: Reducing successfully the quantity of cigarettes smoked appears to have a beneficial effect on future cessation likelihood, even after controlling for initial smoking level and other variables known to impact smoking cessation. These results indicate that the harm reduction strategy of reduced smoking warrants further study.

Tiflocolitis syndrome acute for "Klebsiella" sp. in a spanish pure breed horse. A case report

Were study a horse (Equus caballus), Purebred Spanish Horse, 6 years old, intact male sex, weight about 550kg, from equestrian center in Fregenal Sierra-Extremadura, Spain. History of acute diarrhea, are apply conventional treatment (hydration, anti-inflammatory and antibiotic). Physical examination showed severe profuse, fetid diarrhea deep red, tachypnea. The physiological parameters were: heart rate 60 bpm, respiratory rate 39 rpm and mucous cyanotic. Temperature: 40°C. Hematological examination showed severe leucopenia, decreased total serum protein, albumin and globulin also diminished. Serum chemistry evidenced severe hyponatremia and hypokalemia, with high levels of chlorine indicating metabolic acidosis. A stool analysis, which was negative and showed no eggs or larvae in the samples studied was performed. The microbial culture allowed the isolation of Klebsiella sp. and susceptibility testing showed sensitivity to ampicillin, Cetafzidine, Ciprofloxacin, Cefepine, gentamicin, imipenem, meropenem, Piperaciclina, piperacillin / tazobactam and trimethoprim sulfa resistance. The horse presented systemic complications associated with endotoxemia and death 36 hours after the onset of diarrhea. At necropsy, severe bleeding was observed enterotiflocolitis. The histological sections showed proliferative enteritis characterized by lymphocyte and mononuclear inflammatory infiltrate plasmocytorious mucosa and submucosa, coagulation necrosis, bacteria and short rod type morphology with no specific grouping. In conclusion a case of acute syndrome enterotiflocolitis reported Klebsiella sp. on a horse Purebred Spanish.

Metabolic effects of sub-chronic ablation of the incretin receptors by daily administration of (Pro(3))GIP and exendin(9-39)amide in obese diabetic (ob/ob) mice

Effects of chemical ablation of the GIP and GLP-1 receptors on metabolic aspects of obesity-diabetes were investigated using the stable receptor antagonists (Pro(3))GIP and exendin(9-39)amide. Ob/ob mice received a daily i.p. injection of saline vehicle, (Pro(3))GIP, exendin(9-39)amide or a combination of both peptides over a 14-day period. Non-fasting plasma glucose levels were significantly (p <0.05) lower in (Pro(3))GIP-treated mice compared to control mice after just 9 days of treatment. (Pro(3))GIP-treated mice also displayed significantly lower plasma glucose concentrations in response to feeding and intraperitoneal administration of either glucose or insulin (p <0.05 to p <0.001). The (Pro(3))GIP-treated group also exhibited significantly (p <0.05) reduced pancreatic insulin content. Acute administration of exendin(9-39) amide immediately prior to re-feeding completely annulled the beneficial effects of sub-chronic (Pro(3))GIP treatment, but non-fasting concentrations of active GLP-1 were unchanged. Combined sub-chronic administration of (Pro(3)GIP) with exendin(9-39)amide revealed no beneficial effects. Similarly, daily administration of exendin(9-39)amide alone had no significant effects on any of the metabolic parameters measured. These studies highlight an important role for GIP in obesity-related forms of diabetes, suggesting the possible involvement of GLP-1 in the beneficial actions of GIP receptor antagonism.