[Combined glaucoma and diabetic retinopathy screening in Burgundy]

INTRODUCTION

The aim of this study was to evaluate the yield of glaucoma and ocular hypertension (OHT) screening in association with diabetic retinopathy (DR) screening in a rural population.

PATIENTS AND METHODS

676 patients were screened between 2004 and 2005. The four departments the Burgundy region were visited, divided into 39 areas with sparse medical services. Each patient had fundus photographs taken with a nonmydriatic camera and IOP measurement in each eye with a noncontact tonometer. Optic discs were classified into suspect or normal.

RESULTS

On the 676 screened patients, 41 presented an anomaly (6.1%): 31 with OHT (4.6%), 7 with a suspect optic disc (1.0%), and 3 with both anomalies (0.4%). After further control, we finally found 4 cases of OHT (0.6%) and 8 cases of glaucoma (1.2%). This screening program allowed the diagnosis of 2 new cases of OHT (0.3%) and 4 new cases of glaucoma (0.6%).

DISCUSSION

This screening improved the quality of the ophthalmic follow-up in rural areas for diabetics. Furthermore, it is a simple and not more expensive way to screen for OHT and glaucoma in these populations.

CONCLUSION

The itinerant screening of OHT and glaucoma combined with a diabetic retinopathy screening is effective. The screening campaign was renewed for 2 years in semi-rural zones.

Expression of secreted frizzled-related protein 4 (SFRP4) in primary serous ovarian tumours

OBJECTIVE

Serous ovarian cancer is the most prevalent type of ovarian cancer. The majority of women present at an advanced stage and patient survival is poor. Resistance to chemotherapy is thought to relate to failure of tumours to undergo apoptosis. Secreted frizzled-related protein 4 (SFRP4) has been demonstrated to be involved in apoptosis in the ovary but not in ovarian tumours as yet. This study examined SFRP4 expression in ovarian cancers and correlated this with expression of beta-catenin, a main component of the wNT-signalling pathway it inhibits.

METHODS

We examined 153 primary serous ovarian carcinomas for SFRP4 and B-catenin expression using immunohistochemistry on tissue microarrays and correlated this with clinical information.

RESULTS

SFRP4 expression was inversely associated with beta-catenin expression in 84% of samples. However, high-level SFRP4 expression was not significantly associated with patient survival (p = 0.08).

CONCLUSION

Elevated SFRP4 expression in serous ovarian tumours appears to correlate with reduced beta-catenin expression but long-term survival appears unaffected by this.

Improvements of knowledge and perception towards HIV/AIDS among secondary school students after two hours talk

Malaysia is confronted with an increasing incidence of HIV and AIDS among adolescents and young adults. The effectiveness of various programs offered to school going teenagers is unknown. The objective of this study is to measure the effectiveness of two hours talk on sex education offered by a non governmental organization (NGO) in improving youngsters' knowledge and perception towards HIV and AIDS. A cross sectional study was conducted among the adolescent students from a secondary school in Ipoh, Perak, a province of Malaysia. A total of 182 students participated in the study. A standard questionnaire consisting of demographic data, knowledge and perception towards HIV/ADIS were distributed before (pre-test) and after the intervention (post-test). Performance of participants was compared to establish the effectiveness of the intervention. Our findings suggests that there was a significant increase in participants' knowledge and perception after the intervention (p = 0.000). Knowledge improvement was found in both genders however, improvement in perception was higher among female students. Interestingly, 80% of participants disagree that sexual education will encourage sex among youngsters. NGOs are playing a supplementary role in providing sex education programs in schools. This program although of short duration but it is effective in enhancing adolescence awareness about HIV/AIDS.

Central Diabetes Insipidus: A Rare Perioperative Cause of Severe Hypernatraemia

In this case report we describe the management of severe hypernatraemia following inadvertent water restriction. A 21-year-old woman with no reported medical history presented on transfer from an outside hospital with a complex volar upper extremity injury. Management both operatively and postoperatively involved a prolonged period of fasting which limited her access to drinking water. Collateral history revealed that she had previously drunk copious amounts of water during the course of any given day and this had served to alleviate the dramatic symptoms of hypernatraemia that were rapidly manifest when her normal intake was curtailed. We outline the fluid management, administration of desmopressin and her subsequent recovery. A literature review of the management of central diabetes insipidus is also covered.

[Screening diabetic retinopathy in Burgundy with an itinerant nonmydriatic camera]

INTRODUCTION

The aim of this study was to assess the suitability of screening diabetic retinopathy (DR) with an itinerant nonmydriatic camera.

METHODS

This program required collaboration between ophthalmologists and general practitioners. Three professional organizations gave their support: L'union Professionnelle des Médecins Libéraux de Bourgogne (UPMLB), le Fonds d'Aide à la Qualité des Soins de Ville (FAQSV), et la Fédération des Associations des Diabétiques de Bourgogne (FADB). The screening programm took place from November 2004 to June 2005 throughout the Burgundy region. General practitioners, health professionals (pharmacists, nurses), local media, and health insurance offices informed patients of the DR screening. An orthoptist took photographs with a nonmydriatic digital camera. Each patient had four fundus photographs without pupillary dilatation. Photographs were analyzed in the Department of Ophthalmology of Dijon's General Hospital.

RESULTS

In this study, 676 diabetic patients were screened. Among these patients, 58 had DR, exclusively nonproliferative retinopathies. Nine percent of the photographs were ungradable. The mean age of patients with DR was 65 years. The mean onset of diabetes was 18 years before the study. Insulin therapy was followed by 27 patients (46.6%). Hemoglobin A1c was known in 26 patients (44.8%), with a mean value of 8.14%. Nearly 60% of patients with DR did not have their recommended annual consultation. After screening, 84% of patients consulted an ophthalmologist.

CONCLUSION

Screening DR with an itinerant nonmydriatic camera can improve ophthalmologic follow-up of diabetics in rural areas. This screening program has continued in 2006 with an adapted vehicle.

Caspase-14: a new player in cytotrophoblast differentiation

The human placenta is responsible for the exchange of nutrients, gas and wastes through the trophoblast maternal-fetal barrier, which is formed by the fusion of villous cytotrophoblasts to form the continuous multinucleated syncytiotrophoblast separating the maternal and fetal circulations. Caspase-14 is a seemingly non-apoptotic caspase involved in keratinocyte differentiation and cornification. It is proposed that caspase-14 has a conserved role in cellular differentiation and a role in differentiation and fusion in the trophoblast. The human choriocarcinoma BeWo cell line was treated with staurosporine and forskolin to induce apoptosis and differentiation respectively. Staurosporine initiated apoptosis within 3 h of treatment, while apoptosis was completed following 6 h treatment. Caspase-14 gene and protein expression was unchanged throughout this process. During BeWo differentiation, caspase-14 mRNA was elevated after 48 h forskolin treatment, while its protein was increased after 24 h. Therefore, caspase-14 is up-regulated during trophoblast differentiation, as represented by the BeWo cell line. Moreover, caspase-14 may interact with other signalling molecules to facilitate differentiation. This new data confirms the potential for the BeWo cell line in the functional dissection of this unusual caspase and its prospective role in trophoblast differentiation.

World without borders: integrating clinical perspectives into the coronial jurisdiction in Victoria, Australia

A professional world without borders would allow for more appropriate collaboration between the Coroner's office and the healthcare sector in their endeavours to improve patient safety. In Victoria (Australia), the Clinical Liaison Service draws on the distinct experiences and expertise of medical, nursing and research personnel to evaluate clinical evidence for the investigation of healthcare deaths reported to the State Coroner's Office. This approach allows for greater intersectoral collaboration between the Coroner's office and healthcare sector than a traditional English-style coronial system that relies on the expertise of coroners, forensic pathologists and police officers to investigate unexpected deaths. Encouraging collaboration between these two sectors may have averted or at least mitigated the atrocities caused by Harold Shipman or the events at Bristol's Royal Infirmary. This paper describes the work processes employed by the Clinical Liaison Service (CLS) to investigate healthcare deaths in a coronial setting. To describe how this work has fostered the advancement of patient care.

207. The expression of caspase-14 in the human placenta

Pro-apoptotic genes have a role in the differentiation process in the placenta leading to the fusion of cytotrophoblast cells to form the protective syncytiotrophoblast layer. The mechanisms of apoptosis in the human placenta are not clearly understood. However, a major placental apoptotic-signalling pathway is known to involve the caspases. Caspase-14 is the most recently discovered member of the caspase family members and has not previously been examined in the human placenta. The aim of the present study was to detect caspase-14 in the human placenta and study its role in apoptosis. Human placentae were collected from first trimester and term gestation. The study consisted of two parts. In the first part, first trimester and term placentae were assessed for caspase-14 by western blotting and mRNA analysis and localised with immunohistochemical studies. In the second part, apoptosis in first trimester placenta was inhibited in an in-vitro model of explant villi culture with superoxide dismutase (SOD) treatment and the genes assessed. The first study demonstrated caspase-14 to be a cytoplasmic protein localised in the cytotrophoblast cells, the mesenchyme and in the syncytiotrophoblast of the first trimester. In the term placenta, caspase-14 was expressed weakly in the syncytiotrophoblast. The immunostaining data suggest a higher expression of caspase-14 in the first trimester compared to the term placenta, and this observation was later confirmed by western blot analysis. Using the SOD in-vitro explant culture model, no significant difference in the caspase-14 protein levels were seen in either the SOD or control group. This novel study demonstrates for the first time that caspase-14 protein and mRNA are present in the human placenta. The function of caspase-14 in the human placenta is unclear.

Neonatal congenital microvillus atrophy

Congenital microvillous atrophy (CMVA) is the leading cause of neonatal secretory diarrhoea with onset either in the first 72 hours of life (early onset) or at 6-8 weeks after birth (late onset). To date over 30 cases have been reported worldwide. The prognosis for this life threatening condition continues to be poor. Therapeutic agents like somatostatin and epidermal growth factor are either ineffective or of marginal benefit. Overall five year survival after small bowel transplantation is currently approximately 50%. The following brief review is aimed towards helping neonatologists/perinatologists in the early diagnosis, and management of CMVA and in counselling the parents appropriately.

Effect of fatigue on performance measured by a driving simulator in automobile drivers

OBJECTIVE

To identify risk factors of performance decrement in automobile drivers.

METHODS

114 drivers (age <30 years, n=57; age > or =30 years, n=57) who stopped at a rest stop area on a freeway were recruited for the study. They filled out a questionnaire on their journey, sleep/wake patterns and performed a 30-min test on a driving simulator. The test evaluates, by computerized analysis, the lateral deviation of a virtual car from an appropriate trajectory on a virtual road. A sex/age matched control group was recruited in the community. Control subjects were studied at the same time of day as the index case driver. Controls had normal sleep wake schedule, absence of long driving and performed the same driving test.

RESULTS

Drivers performed significantly worse than controls on the driving test. Age and duration of driving were the main factors associated with decreased performance.

CONCLUSION

Our driving simulator can identify fatigue generated by driving but results must be considered in relation with age of subjects.

Retinoblastoma protein complexes with C/EBP proteins and activates C/EBP-mediated transcription

The retinoblastoma protein (RB) recruits histone deacetylase (HDAC) to repress E2F-mediated transactivation that plays a critical role in cell cycle regulation. RB is also involved in activation of expression of a number of tissue specific- and differentiation-related genes. In this study, we examined the mechanism by which RB stimulated the expression of a differentiation-related gene, the surfactant protein D (SP-D), which plays important roles in innate host defense and the regulation of surfactant homeostasis. We demonstrated that RB specifically stimulated the activity of human SP-D gene promoter. The RB family member, p107 but not p130, also increased SP-D promoter activity. Activation by RB was mediated through a NF-IL6 (C/EBP beta) binding motif in the human SP-D promoter, and this sequence specifically bound to C/EBP alpha, C/EBP beta, and C/EBP delta. RB formed stable complexes with all three C/EBP family members. RB small pocket (amino acid residues 379-792), but not the C-pocket (amino acid residues 792-928), was necessary and sufficient for its interaction with C/EBP proteins. Furthermore, we demonstrated that the complexes containing RB and C/EBP proteins directly interacted with C-EBP binding site on DNA. These findings indicate that RB plays a positive, selective, and direct role in the C/EBP-dependent transcriptional regulation of human SP-D expression.

cAMP modulates the excitability of immortalized H=hypothalamic (GT1) neurons via a cyclic nucleotide gated channel

GT1 cells are immortalized hypothalamic neurons that show spontaneous bursts of action potentials and oscillations in intracellular calcium concentration [Ca(2+)](i), as well as pulsatile release of GNRH: We investigated the role of cyclic nucleotide gated (CNG) channels in the activity of GT1 neurons using patch clamp and calcium imaging techniques. Excised patches from GT1 cells revealed single channels and macroscopic currents that were activated by either cAMP or cGMP. CNG channels from GT1 cells showed rapid transitions from open to closed states typical of heteromeric CNG channels, were selective for cations, and had an estimated single channel conductance of 60 picosiemens (pS). Ca(2+) inhibited the conductance of macroscopic currents and caused rectification of currents at increasingly positive and negative potentials. The membrane permeant cAMP analog Sp-cAMP-monophosphorothioate (Sp-cAMPS) increased the frequency of spontaneous Ca(2+) oscillations in GT1 cells, whereas the Rp-cAMPS isomer had only a slight stimulatory effect on Ca(2+) signaling. Forskolin, norepinephrine, and dopamine, all of which stimulate cAMP production in GT1 cells, each increased the frequency of Ca(2+) oscillations. The effects of Sp-cAMPS or NE on Ca(2+) signaling did not appear to be mediated by protein kinase A, since treatment with either H9 or Rp-cAMPS did not inhibit the response. The CNG channel inhibitor L-cis-diltiazem inhibited cAMP-activated channels in GT1 cells. Both L-cis-diltiazem and elevated extracellular Ca(2+) reversibly inhibited the stimulatory effects of cAMP-generating ligands or Sp-cAMP on Ca(2+) oscillations. These results indicate that CNG channels play a primary role in mediating the effects of cAMP on excitability in GT1 cells, and thereby may be important in the modulation of GnRH release.

Regulation of gonadotropin-releasing hormone release by cyclic AMP signalling pathways

The frequency and amplitude of gonadotropin-releasing hormone (GnRH) pulses are tightly regulated for the maintenance of reproductive cycles. Pulsatile GnRH release was shown to be an intrinsic property of murine GT1 GnRH neurons, and primate placodal GnRH neurons. GT1 neurons show spontaneous action potentials that are associated with Ca2+ oscillations and hormone secretion. Increased cyclic AMP (cAMP) levels in GT1 neurons appear to stimulate GnRH release by activation of cAMP-gated cation (CNG) channels. Activation of the CNG channels correlated with increased neuron excitability and Ca2+ oscillations. Activation of protein kinase A is not necessary for cAMP-induced stimulation of GnRH secretion, but appears to activate negative feedback pathways. Potential negative feedback pathways may decrease cAMP levels by inhibiting adenylyl cyclase V, and activating the phosphodiesterase, PDE4D3. These stimulatory and inhibitory cAMP-signalling pathways appear to regulate the excitability of the GT1 neurons, and may constitute a biological clock timing the pulsatile release of GnRH.

The role of comparative genomic hybridisation in prenatal diagnosis

The aims of this study were to assess the feasibility of using comparative genomic hybridisation instead of conventional cytogenetics in prenatal diagnosis and to determine the size of DNA loss that can be detected. Using comparative genomic hybridisation, six cases with standard aneuploidies were diagnosed correctly. This technique clearly identified a partial duplication of the long arm of chromosome 1 but was not capable of detecting the associated inversion. A small interstitial deletion on short arm of chromosome 10 also was detected precisely. Although the current comparative genomic hybridisation resolution is similar to the sensitivity of the highest resolution G banding, the latter is not a routine strategy in prenatal diagnosis. Comparative genomic hybridisation can allow full chromosome assessment equal to the highest resolution cytogenetic studies without the need for cell culture.