Longitudinal changes in optic disc topography of adult patients after trabeculectomy

OBJECTIVE

To study longitudinal changes in optic disc topography after trabeculectomy in adult patients.

DESIGN

Prospective case series.

PARTICIPANTS

Twenty-five eyes of 25 patients undergoing trabeculectomy were enrolled.

INTERVENTION

Images of the optic disc were obtained preoperatively and approximately 2 weeks, 4 months, and 8 months after surgery by use of a confocal scanning laser ophthalmoscope (Heidelberg Retina Tomograph).

MAIN OUTCOME MEASURES

The topographic optic disc parameters (cup volume, cup area, rim volume, rim area, cup-disc area ratio, mean cup depth, maximum depth, cup shape, and height variation contour) were measured automatically for each image with the Heidelberg Retina Tomograph Software (version 1.11).

RESULTS

Approximately 2 weeks after surgery, the mean preoperative intraocular pressure (IOP) of 19.3 mmHg (SD, 6.4 mmHg) decreased to 6.0 mmHg (SD, 3.6 mmHg), cup volume and mean cup depth decreased, height variation contour increased, and the cup shape parameter became more negative. Approximately 4 months after surgery, mean IOP was 9.7 mmHg (SD, 4.2 mmHg), and the only statistically significant change from preoperative values of optic disc parameters was in the cup shape measure. Approximately 8 months after surgery, there was no statistically significant change in any of the optic disc parameters compared with preoperative values, although IOP was 10.4 mmHg (SD, 5.9 mmHg).

CONCLUSIONS

Changes in the optic disc that may be present 2 weeks after a trabeculectomy do not appear to persist 4 and 8 months later in eyes with advanced glaucomatous optic nerve damage, except for cup shape, which was different from preoperative values at 4 months but not at 8 months.

Regulation of angiotensin II receptors and PKC isoforms by glucose in rat mesangial cells

It has been shown that glomerular angiotensin II (ANG II) receptors are downregulated and protein kinase C (PKC) is activated under diabetic conditions. We, therefore, investigated ANG II receptor and PKC isoform regulation in glomerular mesangial cells (MCs) under normal and elevated glucose concentrations. MCs were isolated from collagenase-treated rat glomeruli and cultured in medium containing normal or high glucose concentrations (5.5 and 25.0 mM, respectively). Competitive binding experiments were performed using the ANG II antagonists losartan and PD-123319, and PKC analysis was conducted by Western blotting. Competitive binding studies showed that the AT1 receptor was the only ANG II receptor detected on MCs grown to either subconfluence or confluence under either glucose concentration. AT1 receptor density was significantly downregulated in cells grown to confluence in high-glucose medium. Furthermore, elevated glucose concentration enhanced the presence of all MC PKC isoforms. In addition, PKCbeta, PKCgamma and PKCepsilon were translocated only in cells cultured in elevated glucose concentrations following 1-min stimulation by ANG II, whereas PKCalpha, PKCtheta, and PKClambda were translocated by ANG II only in cells grown in normal glucose. Moreover, no changes in the translocation of PKCdelta, PKCiota, PKCzeta, and PKCmu were detected in response to ANG II stimulation under euglycemic conditions. We conclude that MCs grown in high glucose concentration show altered ANG II receptor regulation as well as PKC isoform translocation compared with cells grown in normal glucose concentration.

DNA content by flow cytometry in gastric carcinoma: pathology, ploidy and prognosis

BACKGROUND/AIMS

The prognostic relevance of histopathologic findings in gastric carcinoma is well established. Studies on DNA-ploidy are still scanty and contradictory.

METHODOLOGY

Histopathologic parameters, DNA ploidy and S-phase were evaluated in 78 cancer patients curatively resected, using formalin-fixed paraffin-embedded tissue.

RESULTS

Thirty-nine tumors (50%) were aneuploid. No significant correlation was found between histologic data and ploidy, but tumors with nodal involvement were more frequently aneuploid. In univariate analysis, tumor location (p=0.05), tumor size (p=0.01), differentiation grade (p=0.02), Lauren classification (p=0.01), deeper infiltration of gastric wall (p=0.001), nodal affectation (p=0.0000) and number of lymph nodes (p=0.01), TNM stage (p=0.0000), type of gastrectomy performed (p=0.04), and DNA ploidy (p=0.04) significantly influenced survival. S-phase values had no effect on prognosis. In the multiple regression model, factors independently associated with survival were TNM stage (p=0.0009), nodal affectation (p=0.01) and, marginally, ploidy (p=0.08).

CONCLUSIONS

In gastric carcinoma curatively resected, the more relevant prognostic factors were stage and nodal involvement. Fifty percent of the tumors were aneuploid. Aneuploidy was significantly associated with poorer prognosis.

Preventing human rabies before and after exposure

Rabies is a viral disease that can be transmitted from animals to humans. Recently, most human deaths from rabies have been caused by transmission from bats, in many cases without a documented bite or exposure. Rabies is fatal if untreated prior to onset of symptoms. Deaths from human rabies in the United States are rare, largely because of animal control measures and postexposure prophylaxis of people who have been bitten or exposed to the virus. Primary care providers play a pivotal role in the prevention of rabies. Preexposure prevention involves education and immunization of persons at high risk for rabies exposure. Rabies is difficult to diagnose antemortem because of the nonspecific presentation of signs and symptoms that may mimic those of respiratory or abdominal infections. Diagnosing rabies once symptoms begin will not save the victim's life but will help to minimize exposure to others, allow for identification and prophylaxis of those who may have been exposed, and identify the animal vector.

Constitutive activation of the JAK2/STAT5 signal transduction pathway correlates with growth factor independence of megakaryocytic leukemic cell lines

The factor-independent Dami/HEL and Meg-01 and factor-dependent Mo7e leukemic cell lines were used as models to investigate JAK/STAT signal transduction pathways in leukemic cell proliferation. Although Dami/HEL and Meg-01 cell proliferation in vitro was independent of and unresponsive to exogenous cytokines including granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-3 (IL-3), IL-6, thrombopoietin (TPO), and tumor necrosis factor-alpha (TNF-alpha), the growth of Mo7e cells was dependent on hematopoietic growth factors. When these cell lines were cultured in medium without cytokines, a constitutively activated STAT-like DNA-binding factor was detected in nuclear extracts from both Dami/HEL and Meg-01 cells. However, the STAT-like factor was not detectable in untreated Mo7e cells, but was activated transiently in Mo7e cells in response to cytokine treatments. The constitutively activated and cytokine-induced STAT-like DNA-binding factor in these three cell lines was identified as STAT5 by oligonucleotide competition gel mobility assays and by specific anti-STAT antibody gel supershift assays. Constitutive activation of JAK2 also was detected in the factor-independent cell lines, but not in Mo7e cells without cytokine exposure. Meg-01 cells express a p185 BCR/ABL oncogene, which may be responsible for the constitutive activation of STAT5. Dami/HEL cells do not express the BCR/ABL oncogene, but increased constitutive phosphorylation of Raf-1 oncoprotein was detected. In cytokine bioassays using growth factor-dependent Mo7e and TF-1 cells as targets, conditioned media from Dami/HEL and Meg-01 cells did not show stimulatory effects on cell proliferation. Our results indicate that the constitutive activation of JAK2/STAT5 correlates with the factor-independent growth of Dami/HEL and Meg-01 cells. The constitutive activation of JAK2/STAT5 in Dami/HEL cells is triggered by a mechanism other than autocrine cytokines or the BCR/ABL oncoprotein.

Regulation of natriuretic peptide secretion by the heart

Secreted by the heart, more specifically by atrial cardiomyocytes under normal conditions but also by ventricular myocytes during cardiac hypertrophy, natriuretic peptides are now considered important hormones in the control of blood pressure and salt and water excretion. Studies on natriuretic peptide secretagogues and their mechanisms of action have been complicated by hemodynamic changes and contractions to which the atria are constantly subjected. It now appears that atrial stretch through mechano-sensitive ion channels, adrenergic stimulation via alpha 1A-adrenergic receptors, and endothelin via its ETA receptor subtype are major triggering agents of natriuretic peptide release. With several other stimuli, such as angiotensin II and beta-adrenergic agents, modulation of natriuretic peptide release appears to be linked to local generation of prostaglandins. In all cases, intracellular calcium homeostasis, controlled by several ion channels, is considered a key element in the regulation of natriuretic peptide secretion.

Opposite effects of lateral septal LTP and lateral septal lesions on contextual fear conditioning in mice

The effect of fimbrial high-frequency stimulation (HFS)-induced long-term potentiation (LTP) in the lateral septum (LS) on contextual fear conditioning was studied in mice. Mice were conditioned for fear toward a novel context through the use of footshocks. The 1st experiment showed that pretraining HFS reduced significantly conditional freezing to contextual stimuli. The 2nd experiment was designed to determine whether the reduction of freezing produced by fimbrial HFS resulted from LTP in the LS rather than from LTP in other brain structures. Accordingly, mice with lesions of the LS were used and submitted to the same protocol as in the 1st experiment. Results showed that LS lesions completely abolished the impairing effect of fimbrial HFS and, as a whole, potentiated the freezing response. These data suggest that contextual fear conditioning is strongly modulated by the level of hippocampal-LS synaptic neurotransmission.

An analysis of sports knee evaluation instruments

This study examined four commonly used sports knee evaluation instruments to establish normative data. A total of 91 volunteers who had not sought treatment for knee pain or any other knee complaint at any time in the past underwent a detailed medical history and examination of both of their knees. Three numerical systems (Feagin and Blake Knee Score, Lysholm Knee Score, and the Hospital for Special Surgery Knee Disability Assessment) and one nonnumerical system (the International Knee Documentation Committee Quick Knee Profile) were evaluated. A significant difference in the proportion of knees with excellent/normal ratings was seen among the four evaluation systems (P<.0001): Hospital for Special Surgery Knee Disability Assessment, 99.5%; Feagin and Blake Knee Score, 84.6%; Lysholm Knee Score, 84.1%; and the International Knee Documentation Committee Quick Knee Profile, 50.5%. Results showed that three objective component scores for the International Knee Documentation Quick Knee Profile were significantly lower than all other component scores (P<.05). These components included: overall ligament examination, Lachman, and total AP translation. These data may be useful as a baseline by which investigators studying patients following knee reconstructive procedures have a basis for comparison of their results.

Cell proliferation in nasal respiratory epithelium of people exposed to urban pollution

The nasal passages are a common portal of entry and are a prime site for toxicant-induced pathology. Sustained increases in regenerative cell proliferation can be a significant driving force in chemical carcinogenesis. The atmosphere in Mexico City contains a complex mixture of air pollutants and its residents are exposed chronically and sequentially to numerous toxicants and potential carcinogens. We were concerned that exposure to Mexico City's atmosphere might induce cytotoxicity and increase nasal respiratory epithelial cell proliferation. Nasal biopsies were obtained for DNA cell cycle analysis from 195 volunteers. The control population consisted of 16 adults and 27 children that were residents in a Caribbean island with low pollution. The exposed Mexico City population consisted of 109 adults and 43 children. Sixty-one of the adult subjects were newly arrived in Mexico City and were followed for 25 days from their arrival. Control children, control adult and exposed Mexico City children all had similar percentages of cells in the replicative DNA synthesis phase (S phase) of the cell cycle (%S). A significant increase in %S in nasal epithelial cells was seen in exposed adult residents in Mexico City biopsied at three different dates compared with control adults. Newly arrived adults exhibited a control level of cell turnover at day 2 after coming to the city. However, at days 7, 14 and 25 they exhibited significant increases in %S. These data demonstrate an increased and sustained nasal cell turnover rate in the adult population observable in as little as 1 week of residence in Mexico City. This increase in cell proliferation is in agreement with other reports of induced pathological changes in the nasal passages of Mexico City dwellers. These observations suggest an increased potential risk factor of developing nasal neoplasms for residents of large cities with heavy pollution.

Renal angiotensin II receptor regulation and renin-angiotensin system inhibition in one-kidney, one clip hypertensive rats

OBJECTIVE

To characterize glomerular and preglomerular vascular angiotensin II receptors during the acute phase of nonrenin-dependent one-kidney, one clip hypertension in rats, using the angiotensin II antagonists losartan and PD 123319, and to investigate their regulation after renin-angiotensin system blockade with either an angiotensin converting enzyme inhibitor, captopril, or an angiotensin II receptor antagonist, TCV-116.

MATERIALS AND METHODS

One-kidney, one clip hypertension was produced in male Sprague-Dawley rats by placing a silver clip (internal diameter 0.2 mm) on the left renal artery and removing the contralateral kidney. After 1, 2 or 4 weeks, the rats were killed, and their glomerular and preglomerular vascular membranes were purified. Competitive binding studies were performed using specific angiotensin II antagonists. Similarly, one-kidney, one clip hypertension was allowed to develop for 2 weeks before treatment with captopril or TCV-116 for 2 weeks.

RESULTS

Competitive binding studies showed that only the angiotensin II type 1 (AT1) receptor was detected on both glomeruli and preglomerular vessels of all groups. The vascular AT1 receptor density was significantly higher in the 1 and 2 week one-kidney, one clip groups, but the glomerular receptor density was not different in these rats compared with age-matched uninephrectomized controls. The glomerular receptor density was significantly higher in captopril-treated rats and significantly lower in TCV-116-treated rats compared with untreated and control rats, but no significant changes were detected in any groups in vascular AT1 receptor density.

CONCLUSIONS

Angiotensin II receptors on preglomerular vessels and glomeruli are differentially regulated during the early phase of hypertension and after renin-angiotensin system blockade. Vascular angiotensin II receptors are upregulated in the early phase of hypertension whereas glomerular angiotensin II receptors are not However, after renin-angiotensin system blockade, glomerular but not vascular angiotensin II receptors were differentially regulated according to the type of blockade.

Thyroid transcription factor-1: immunohistochemical evaluation in pulmonary neuroendocrine tumors

Thyroid transcription factor-1 (TTF-1), a nuclear transcription protein selectively expressed in the thyroid, the diencephalon, and respiratory epithelium, is expressed in more than 90% of pulmonary small cell carcinomas (SCLCs) and in almost 75% of pulmonary non-small cell carcinomas (NSCLCs), but it is absent in typical pulmonary carcinoids (TCs). Therefore, it was thought that SCLC and NSCLC might share a common lineage, different from that of TC. TTF-1 expression in atypical pulmonary carcinoids (ACs) and large-cell neuroendocrine carcinomas (LCNECs) was not studied previously. We examined TTF-1 expression in 51 TCs, 9 ACs, 8 LCNECs, and 21 SCLCs with use of formalin-fixed material and heat-induced epitope retrieval. TTF-1 expression was seen in 18 (35%) of 51 TCs, all of the 9 ACs, 6 (75%) of the 8 LCNECs, and 20 (95%) of the 21 SCLCs. These results reinforce earlier findings of the excellent sensitivity of TTF-1 for SCLC, and they show similar sensitivity for AC and LCNEC, but they argue against the hypothesis that SCLC and TC are of different cell lineages. The ubiquity of TTF-1 expression in pulmonary NECs demonstrated in this study also argues against its use in their subclassification.

Synthesis and hypolipidaemic evaluation of a series of alpha-asarone analogues related to clofibrate in mice

A series of alpha-asarone analogues related to clofibrate, containing an acetic acid group at C-2 of the aromatic ring, has been prepared as the acids or as the ethyl and methyl esters. The corresponding alcohols were also synthesized by reduction of the ethyl esters. The compounds were examined in hyperlipidaemic male mice to evaluate their ability to modify serum lipoprotein cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides after oral administration of 40 and 80 mg kg(-1) for 6 days. Except for methyl 2-methoxy-5-nitro-4-(2-propenyl)phenoxyacetate at either dose, these clofibrate-related phenoxyacetic acid derivatives were found to have significant hypocholesterolaemic activity. Levels of low-density lipoprotein cholesterol and triglycerides were significantly reduced and those of high-density lipoprotein cholesterol were elevated. 2-Methoxy-5-nitro-4-(2-propenyl)phenoxyacetic acid was active at both doses in all the tests. Clofibrate (150 mg kg(-1)) was more potent at reducing low-density lipoprotein cholesterol. No activity was detected for the alcohol derivatives. These preliminary results suggest that this class of compound might have more promise as potential hypolipidaemic agents than other alpha-asarone derivatives. Further investigation and characterization should be performed to determine the mode of action of these agents on lipid metabolism.

Nonselective debridement and antimicrobial cleansing of a venting ductal breast carcinoma

A woman with a moderately differentiated carcinoma that erupted through the skin and amputated her breast was treated with whirlpool, topical antimicrobials, radiation, and chemotherapy. The draining, necrotic, and septic wound was treated for 5 months with a whirlpool containing dilute povidone-iodine solution and intravenous chemotherapy. Wet bandages, necrotic tissue, and softened eschar were removed by whirlpool agitation or mechanically debrided. To start treatment the wound was dressed with Debrisan crystals and sterile gauze for 1 week. Afterwards, wet-to-dry dressings wetted with Dakin's solution were applied. Tissue ingrowth at the wound margin started after 2 weeks, with whirlpool treatments effecting a tissue-reddening hyperemia. Wound drainage ceased after 2 months, with granulation and revascularization resulting. Eleven months later the wound was closed, aseptic, and undergoing dry flaking. The patient was cancer free with a completely healed wound 2 years after treatment. In this case, nonspecific debridement using whirlpool and topical antimicrobials promoted healing of an open fungating wound from a breast carcinoma.

Vasoactive peptide receptors in the rat kidney

The kidney is composed of different complex structures regulating--among others--renal blood flow and glomerular filtration rate. Several vasoactive peptide systems are involved in that regulation, including atrial natriuretic peptides, the renin-angiotensin system, endothelin and their respective receptors. In this review, we will briefly describe the characteristics, location and regulation of these receptors in the rat kidney.

Immunolocalization of natriuretic peptide receptor B in the rat kidney

The natriuretic peptide receptor (NPR) family consists of three receptor subtypes: two transmembrane forms that contain a guanylyl cyclase intracellular domain (NPR-A and NPR-B), and one truncated form (NPR-C). Because of the lack of specific agonists and antagonists for each receptor subtype and to the difficulty to detect the presence of small quantities of NPR-B by ligand binding studies, polyclonal antibodies against a peptide whose sequence was chosen from a region of the extracellular domain of rat NPR-B that is not homologous to sequences in NPR-A and NPR-C were developed. Western blotting with affinity-purified anti-NPR-B (413-426)-Tyr revealed a polypeptide of approximately 120 kD on COS-1 cell membranes transfected with rat NPR-B cDNA. The antibody recognized a second polypeptide, approximately 5 to 10 kD smaller, which probably represents the unglycosylated receptor. Anti-NPR-B (413-426)-Tyr did not show crossreactivity to any other NPR. Western blotting analysis with anti-NPR-B (413-426)-Tyr also identified a protein of appropriate size in renal vascular membranes. These results were supported by immunohistochemistry findings that demonstrated staining for NPR-B on papillary and medullary capillaries, glomeruli, and renal arteries. This study concludes that NPR-B is present in the rat kidney, although it was only detected in vascular structures.

Clinical and radiological features of pulmonary disease caused by rapidly growing mycobacteria in cancer patients

The role of rapidly growing mycobacteria in the pathogenesis of pulmonary disease is being increasingly recognized; however, the clinical significance of these mycobacteria in patients with underlying malignancy has not been well studied. Over a 6-year period, 37 cancer patients with rapidly growing mycobacteria isolated from respiratory specimens were identified at our center. Mycobacterium chelonae group was isolated in 24 cases and Mycobacterium fortuitum in 13 cases. Of the 24 cases with cultures yielding Mycobacterium chelonae group, eight met the study criteria for infection and were determined to be clinically significant, whereas only one of the Mycobacterium fortuitum isolates was determined to represent infection. An average of two antimicrobial agents were used for treatment, most commonly clarithromycin, ciprofloxacin, and trimethoprim/sulfamethoxazole. Although the isolation of rapidly growing mycobacteria represents colonization in most cases, these bacteria, especially the Mycobacterium chelonae group, may cause pulmonary disease in cancer patients. The clinical and radiological findings are usually non-specific in this population, and patients with respiratory cultures yielding rapidly growing mycobacteria should be assessed carefully to distinguish infection from colonization. Effective therapy can be provided with oral regimens that include at least two antibiotics to which the organism is susceptible.

How dentition status and masticatory function affect nutrient intake

The authors examined nutrient intake in relation to the number of teeth, denture type and masticatory function among 638 men in the U.S. Department of Veterans Affairs Dental Longitudinal Study. They found that calorie-adjusted nutrient intakes decreased with progressively impaired dentition status, independently of age, smoking status and alcohol use. Intakes of fiber and most vitamins and minerals were inversely correlated with masticatory function. The findings suggest that prevention of tooth loss and prosthodontic replacement of missing teeth could improve diets of older adults.

Using focus groups to identify diabetes care and education issues for Latinos with diabetes

The purpose of this study was to identify diabetes care and education issues for Latinos with diabetes. Four focus groups of Latinos with diabetes were held in the Detroit area; these sessions were audiotaped. An expert panel of bilingual health professionals from the United States and Mexico reviewed the audiotapes and identified and prioritized 47 issues using a modified Delphi technique. The highest priority issue identified by a wide margin was the difficulty many Latina women with diabetes have with self-care because of other family responsibilities. Universal diabetes care issues have a specific cultural expression which, when identified, can be incorporated into diabetes care and education programs for a particular cultural group. Focus groups are a useful means for identifying and illuminating such issues.