Purpose: Automated metabolic analyzers are frequently utilized to measure maximal oxygen consumption (). However, in portable devices, the results may be influenced by the analyzer’s technological approach, being either breath-by-breath (BBB) or dynamic micro mixing chamber mode (DMC). The portable metabolic analyzer K5 (COSMED, Rome, Italy) provides both technologies within one device, and the authors aimed to evaluate differences in between modes in endurance athletes. Methods: Sixteen trained male participants performed an incremental test to voluntary exhaustion on a cycle ergometer, while ventilation and gas exchange were measured by 2 structurally identical COSMED K5 metabolic analyzers synchronously, one operating in BBB and the other in DMC mode. Except for the flow signal, which was measured by 1 sensor and transmitted to both devices, the devices operated independently. was defined as the highest 30-second average. Results: and were significantly lower in BBB compared with DMC mode (−4.44% and −2.71%), with effect sizes being large to moderate (ES, Cohen d = 0.82 and 1.87). Small differences were obtained for respiratory frequency (0.94%, ES = 0.36), minute ventilation (0.29%, ES = 0.20), and respiratory exchange ratio (1.74%, ES = 0.57). Conclusion: was substantially lower in BBB than in DMC mode. Considering previous studies that also indicated lower values in BBB at high intensities and a superior validity of the K5 in DMC mode, the authors conclude that the DMC mode should be selected to measure in athletes.

Purpose To evaluate the intra-unit (REL INTRA ) and inter-unit reliability (REL INTER ) of two structurally identical units of the metabolic analyser K5 (COSMED, Rome, Italy) that allows to utilize either breath-by-breath (BBB) or dynamic mixing chamber (DMC) technology. Methods Identical flow- and gas-signals were transmitted to both K5s that always operated simultaneously either in BBB- or DMC-mode. To assess REL INTRA and REL INTER , a metabolic simulator was applied to simulate four graded levels of respiration. REL INTRA and REL INTER were expressed as typical error (TE%) and Intraclass Correlation Coefficient (ICC). To assess also inter-unit differences via natural respiratory signals, 12 male athletes performed one incremental bike step test each in BBB- and DMC-mode. Inter-unit differences within biological testing were expressed as percentages. Results In BBB, TE% of REL INTRA ranged 0.30–0.67 vs. REL INTER 0.16–1.39 and ICC ranged 0.57–1.00 vs. 0.09–1.00. In DMC, TE% of REL INTRA ranged 0.38–0.90 vs. REL INTER 0.03–0.86 and ICC ranged 0.22–1.00 vs. 0.52–1.00. Mean inter-unit differences ranged -2.30–2.20% (Cohen’s ds (ds) 0.13–1.52) for BBB- and -0.55–0.61% (ds 0.00–0.65) for DMC-mode, respectively. Inter-unit differences for and RER were significant (p < 0.05) at each step. Conclusion Two structurally identical K5-units demonstrated accurate REL INTRA with TE < 2.0% and similar REL INTER during metabolic simulation. During biological testing, inter-unit differences for and RER in BBB-mode were higher than 2% with partially large ES in BBB. Hence, the K5 should be allocated personally wherever possible. Otherwise, e.g. in multicenter studies, a decrease in total reliability needs to be considered especially when the BBB-mode is applied.

Purpose The following is a comparative analysis on the treatment outcomes of corneal perforations using amniotic membrane transplantation (AMT) or penetrating keratoplasty (PK). Methods This monocentric retrospective study was performed at the Department of Ophthalmology, University Hospital Ulm, Germany. A total of 78 eyes of 78 patients were included. Thirty-nine eyes received an AMT, and 39 patients were treated with a PK. Primary outcome was recurrence of perforation. Secondary outcomes were patient mortality and visual acuity. Results No statistically significant difference was observed with regard to a recurrence of perforation between the two groups (26% in AMT vs 23% in PK, p > 0.99). The time of recurrences was within the first two years and did not differ statistically (p = 0.97). In addition, a proportional hazards model with cox regression regarding recurrent perforation showed no significant differences (p = 0.5). After AMT, 41% and after KP, 28% of the patients died during follow-up (p = 0.2), respectively. The Charlson Comorbidity Index (p < 0.0001) and the age at the time of surgery (p = 0.0002) were statistically significantly higher in those who were deceased. A mean follow-up of 485 ± 517 days was recorded. Conclusion Both surgical methods show good results and no statistically significant difference regarding recurrent perforation rate. About a third of the patients died during the follow-up period. The decision regarding the appropriate method should therefore be based on a combination of all factors.