Selective distribution of porphyrins in skin thick basal cell carcinoma after topical application of methyl 5-aminolevulinate

Topical photodynamic therapy (PDT) of superficial basal cell carcinoma (BCC) with 5-aminolevulinic acid (ALA) has achieved promising clinical results. However, the efficacy of this therapy for thick BCC is dramatically decreased by a limited diffusion of hydrophilic ALA into the tumor. Lipophilic esters of ALA may enhance their penetration into the lesion. In this randomized, open clinical study, microscopic fluorescence photometry incorporating a light-sensitive thermo-electrically cooled charge-coupled device (CCD) camera was employed to investigate the penetration of methyl 5-aminolevulinate-induced porphyrin fluorescence in thick BCC lesions. Both the distribution pattern and the amount of porphyrins in 32 lesions of 16 patients were studied after topical application of 16, 80 or 160 mg/g of methyl 5-aminolevulinate for 3 or 18 h. A highly selective and homogeneous distribution of methyl 5-aminolevulinate-induced porphyrin fluorescence was seen in all lesions studied, with much less fluorescence in the adjacent normal skin tissues. In lesions of up to 2 mm thickness the application of 160 mg/g methyl 5-aminolevulinate for 3 h showed the highest ratio of porphyrin fluorescence depth to tumor depth (0.98+/-0.04), thus providing a biologic rationale for a clinical PDT trial with this regimen.

[Postoperative opacification of posterior chamber intraocular lenses - a review]

Postoperative opacification of intraocular lenses (IOLs) is a very unpleasant complication for the ophthalmic surgeon and the patient. We report on our experiences with opacification of different foldable IOL designs and rigid poly (methyl methacrylate) (PMMA) posterior chamber lenses.1. Snowflake degeneration of PMMA IOLs: This condition is an unanticipated and surprising late postoperative finding 8 to 15 years after implantation. In our opinion, this complication is probably not related to the PMMA biomaterial itself, but rather it appears to represent a manufacturing problem that has affected a selected, albeit large number of lenses manufactured in the 1980s-mid 1990s.2. Degeneration of UV absorber material and calcium deposits within the optic of hydrophilic IOLs: Two years postoperatively degenerations of UV absorber material and calcium deposits within the optic of single piece hydrophilic acrylic lenses SC60B-OUV manufactured by MDR (Medical developmental research Inc. Clearwater FL, USA) can occur. Although the precise mechanism is not fully known, it was assumed that these opacifications are due to premature aging of the UV blocking agent incorporated in the lens biomaterial and calcification.3. Calcification on the surface of the Bausch & Lomb Hydroviewtrade mark IOLs: Twelve to 15 months postoperatively granular surface calcifications in Hydroviewtrade mark IOLs occured. The mechanism is not fully understood. According to Bausch and Lomb studies, part of the components of the packaging contained silicone, which may have come off the packaging onto the lens optic, where it then appears to be a catalyst for calcium precipitation. The manufacturer has correlated a change in packaging with the appearance of the opacification. The manufacturer now believes that this problem has been solved. However, final verification will require a careful 1 - 2 years clinical study.4. Glistenings in the hydrophobic acrylic AcrySoftrade mark IOLs: The time frame of glistenings in the AcrySoftrade mark IOLs is highly variable. It has been suggested that the occurrence of glistenings may be related to variations in the temperature of the lens just prior to and or during insertion into the eye. Formation of vacuoles may occur within the submersed acrylic polymer when there is a transient increase and then decrease in temperature during the surgical procedure. "Glistenings" may then subsequently form by ingress of anterior chamber fluid. Contrast sensitivity can been decreased in some patients, but clinically significant decrease of visual acuity has been rare.

[Determination of trace amount of cadmium with vapor generation and atomic absorption spectrometry]

OBJECTIVE

This study aimed to establish a sensitive method for the determination of trace amount of cadmium.

METHODS

The reaction systems for the generation of volatile cadmium species were investigated with vapor generation and atomic absorption spectrometry.

RESULTS

It was found that potassium ferricyanide with hydroxylamine hydrochloride greatly enhanced the generation efficiency of the volatile species. The reaction parameters using ferricyanide-hydroxyamine-tetrahydroborate in acidic acqueous solution were optimized for efficient generation of volatile cadmium species. A detection limit (3 sigma blank, peak height mode) of 11 pg/ml was obtained under optimized conditions. The RSD of the determinations for 0.2 ngCd/ml was 3.4%. The effects of 33 diverse ions on the generation of the cadmium volatile species were investigated. The method was applied to the determination of cadmium in standard reference materials, the results obtained were in good agreement with the certified values.

CONCLUSION

The method can be applied to the determination of trace cadmium in environment and food samples.

Evaluation of protoporphyrin IX production, phototoxicity and cell death pathway induced by hexylester of 5-aminolevulinic acid in Reh and HPB-ALL cells

Production of protoporphyrin IX (PpIX) in human B-cell leukemia cell line (Reh) and T-cell lymphoma cell line (HPB-ALL) was studied by flow cytometry after incubation with 5-aminolevulinic acid (ALA) or its hexylester in vitro. Cell survival and cell death pathway were also investigated in these two cell lines by cell growth curves, flow cytometry, and electron microscopy after ALA hexylester-mediated photodynamic therapy. Both ALA and its hexylester could induce PpIX production in the two cell lines, but ALA hexylester was about 100 times more efficient than ALA. Reh cells appear to be more sensitive than HPB-ALL cells to ALA hexylester-mediated phototoxicity. Apoptosis was the major cell death pathway of Reh cells, while necrosis played a major role in the case of HPB-ALL cells.

Antitumor effect of 5-aminolevulinic acid-mediated photodynamic therapy can be enhanced by the use of a low dose of photofrin in human tumor xenografts

Practically all of the exogenous photosensitizers used for clinical photodynamic therapy (PDT) target mainly vasculature. Although effective in tumor destruction, they also, unavoidably, induce phototoxicity of normal tissues. Porphyrins synthesized endogenously from 5-aminolevulinic acid (ALA) accumulate within cells. Tumor eradication would be more efficient if both cellular components and vascular stroma of a tumor could be targeted. Thus, PDT with a mixture of ALA and Photofrin (Pf, a vessel-targeted sensitizer) may simultaneously destroy the two elements. Using chemical extraction assays, pharmacokinetics of ALA and ALA-induced porphyrins were studied in the plasma and tumors of nude mice bearing human WiDr and KM20L2 colonic carcinomas after an i.p. injection of 250 mg/kg body weight of ALA. Subsequently, PDT efficacy of the two tumor models with ALA, Pf, or with the two drugs in combination was evaluated. The phototoxic effects on tumor cells in vitro with the combined drugs was also determined. Moreover, histological and ultrastructural alterations of the treated tumors were investigated, and tumor cell clonogenicity was assessed as a function of time after in vivo PDT using an in vitro colony formation assay. Finally, the photosensitivity of normal skin tissue treated according to various protocols was compared. The amounts of ALA peaked at 0.5 h after administration in both plasma and WiDr tumor. The rates of ALA clearance seemed to follow a one-compartment model with half-lives of approximately 18 and 58 min in the plasma and tumor, respectively. About 100 and 60 times higher concentrations of ALA were needed to induce a given concentration of porphyrins in the plasma and tumor, respectively, although the plasma porphyrins may not only be released from blood cells but also from other organs. Similar kinetics of distribution patterns of ALA- and ALA methylester-induced porphyrins were found in the plasma and tumors, and the elimination rates were consistent with a two-compartment model. ALA induced much more porphyrins than ALA methylester in both plasma and tumors. Tumors PDT-treated with ALA plus Pf at a low dose (1 mg/kg) grew significantly more slowly than those treated with either of the drugs in both WiDr and KM20L2 models. However, the enhanced antitumor effect was not found in the tumor cells under in vitro conditions. Morphological studies demonstrated that PDT with the combined regimen resulted in necrosis of neoplastic cells and severe disruption of tumor microvasculature. This was supported by the findings obtained from the studies of in vivo PDT and in vitro clonogenic assay that showed a progressive reduction in tumor cell viability with times following PDT. Such a combined PDT protocol did not induce any phototoxicity in normal skin tissue. These data indicate that targeting both neoplastic cells and stroma with ALA and Pf (a low dose) can potentiate antitumor PDT effect with no risk of prolonged skin photosensitivity.

Dilation of Schlemm's canal in viscocanalostomy: comparison of 2 viscoelastic substances

PURPOSE

To study the injection of viscoelastic material into Schlemm's canal adjacent to and 6.0 mm from the scleral flap during viscocanalostomy in an autopsy eye model.

SETTING

Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.

METHODS

Viscocanalostomy was performed in 8 postmortem human globes. Sodium hyaluronate (Healon GV or Healon5) was injected into 1 side of Schlemm's canal, with the other side serving as a control in some eyes. The eyes were prepared for light microscopic analysis, and serial pathologic sections were taken adjacent to the flap and 6.0 mm circumferentially from the flap. The area of Schlemm's canal was calculated and compared using t tests.

RESULTS

Injecting viscoelastic material enlarged the area of Schlemm's canal adjacent to and 6.0 mm from the flap significantly more than not injecting viscoelastic material. While there was no difference between the viscoelastic materials in dilating Schlemm's canal at the flap, with Healon5 there was a small but statistically significantly greater dilation 6.0 mm from the flap. No full-thickness breaks in the trabecular meshwork were noted adjacent to or 6.0 mm from the flap.

CONCLUSION

Injecting viscoelastic material significantly increased the cross-sectional area of Schlemm's canal and may play a role in the success of viscocanalostomy. Further study is needed to elucidate the mechanism of this procedure.

[Influence of surgery-related factors on the Nd:YAG laser capsulotomy rates of 3-piece silicone IOLs - analysis of 457 pseudophakic human globes obtained post mortem]

BACKGROUND

The purpose of this study was to analyze any possible surgical reasons which may have had caused posterior capsule opacification in 3-piece silicone IOLs that had required Nd:YAG laser treatment. Special attention was given to 1) quality of cortical clean up, 2) type of haptic fixation, and 3) continuous curvilinear capsulorhexis (CCC) size and shape.

MATERIALS AND METHODS

Human eyes obtained post-mortem implanted with 3-piece silicone optic - PMMA haptic (SI 40 NB) and 3-piece silicone optic - Prolene haptic (SI 30 NB) designs IOLs, accessioned between January 1993 and December 2000 were evaluated by gross examination from behind under an operating microscope using the Miyake-Apple posterior photographic technique. The area and intensity of Soemmerring's ring and type of fixation was studied in 457 eyes. The mean diameter of the CCC and relation of the CCC edge to the optic rim were analyzed in 221 eyes.

RESULTS

1) The amount of Soemmerring's ring formation was significantly larger in the group of IOLs requiring Nd:YAG capsulotomy in both the SI 40 NB and SI 30 NB design than in the IOLs without capsulotomies. 2) The percentage of not in-the-bag fixated IOLs in both the SI 40 NB and SI 30 NB design was larger in the "Nd:YAG groups", without being statistically significant. 3) The "Nd:YAG groups" showed a significant higher amount of non overlapping clock hours of the CCC edge in relation to the optic rim.

CONCLUSION

1) The data confirm the clinical assumption that the incidence of PCO is correlated with the cortical clean up. 2) Our findings also support the clinical assumption, that poor IOL fixation increases the risk of PCO. 3) This study also verifies the relation of the CCC to PCO, namely a relatively small CCC covering the entire optic rim is best to reduce the Nd:YAG laser rate.

[Analysis of the lineshape of laser frequency modulation]

In this paper, we analyze the dependence of the output signal spectral lineshape and intensity on the modulation, waveform and modulation index in first- and second-harmonic detection of triangle modulation, square demodulation and saw modulation square demodulation. The signal lineshape in the case of saw modulation, square demodulation is quite different from, whereas the signal lineshape in the case of triangle modulation, square demodulation is similar to that in traditional sine modulation, sine demodulation. Experiments of tunable IR laser frequency modulation absorption spectrum of methane are also done to verify the theoretical analysis. Then we reach a conclusion; the lineshape and intensity of frequency modulation spectrum can be influenced by modulation waveform, demodulation waveform and modulation index. Calculation results can be used to choose better experimental parameters and optimize experimental designs.

Eradication of posterior capsule opacification: documentation of a marked decrease in Nd:YAG laser posterior capsulotomy rates noted in an analysis of 5416 pseudophakic human eyes obtained postmortem

OBJECTIVE

(1) To report the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy rate (%) of eight rigid and foldable intraocular lens (IOL) designs in a series of 5416 pseudophakic human eyes obtained postmortem, accessioned in our center between January 1988 and January 2000. (2) To identify factors that are instrumental in reducing the incidence of posterior capsule opacification, (PCO, secondary cataract) and hence the need for Nd:YAG laser posterior capsulotomy.

DESIGN

Comparative autopsy tissue analysis.

PARTICIPANTS

A total of 5416 globes with posterior chamber intraocular lens (PC-IOLs) obtained postmortem received from Lions Eye Banks between 1988 and 2000.

METHODS

Miyake-Apple posterior photographic technique. Special reference was given to the presence or absence of Nd:YAG laser posterior capsulotomy orifice on the posterior capsule of each eye.

MAIN OUTCOME MEASURES

The Nd:YAG laser posterior capsulotomy rate (%) as of January 2000 was documented. In addition, the Nd:YAG laser posterior capsulotomy rate for each lens was plotted on a monthly basis for the same period, creating a computerized trend or "timeline" for each IOL style.

RESULTS

Relatively high Nd:YAG laser posterior capsulotomy rates ranging from 20.3% to 33.4% were noted with four relatively older designs (high incidence of implantation between 1988 and the early 1990s). Four modern foldable IOLs manufactured from silicone and acrylic materials had significantly lower Nd:YAG laser posterior capsulotomy rates ranging from 0.9% (Alcon Acrysof) to 17.1%. The difference in Nd:YAG rates among the eight IOL designs was found to be significant (P < 0.0001, chi-square test). Comparing foldable versus rigid designs, the foldable IOLs were associated with a much lower Nd:YAG laser posterior capsulotomy rate (14.1% vs. 31.1%).

CONCLUSIONS

By use of the six factors regarding surgical technique and IOL choice described in this article, we strongly believe that the overall incidence of PCO and hence the incidence of Nd:YAG laser posterior capsulotomy is now rapidly decreasing from rates as high as 50% in the 1980s to early 1990s. Surgical tools and IOLs are now available to bring these rates down to single digits. Careful application and use of these tools by surgeons can genuinely lead in the direction of virtual eradication of secondary cataract, the second most common cause of visual loss worldwide.

Endogenous production of protoporphyrin IX induced by 5-aminolevulinic acid in leukemia cells

AIM

To explore the photosensitization of 5-aminolevulinic acid (ALA) in myeloid leukemia cell line.

METHODS

Using the technique of fluorescence spectra, the A LA induced protoporphyrin IX (Pp IX) was measured in myeloid leukemia JCS cells. Cofocal laser scanning microscopy (CLSM) combined with fluorescence organelle probe was used to detect the localization of Pp IX in JCS cells at the subcellular levels. MTT assay was used to measure the cell survival after light irradiation.

RESULTS

ALA successfully produced endogenous PpI X in leukemia JCS cells. PpIX was observed to be distributed in the cytoplasm and mitochondria was exhibited as the one of binding sites of PpIX. As a photosensitizer, PpIX initiated photodynamic reaction after light irradiation and effectively photodamaged leukemia cells.

CONCLUSION

ALA-based photosensitization could be used for inactivation of leukemia cells.

Linkage analysis of the 5q31-33 candidate region for asthma in 240 UK families

Atopy and asthma are complex genetic diseases resulting from the interactions of a number of genetic and environmental factors. We had previously reported allelic association between the IL9 marker on chromosome 5q31-33 and atopy. In order to further investigate the role of susceptibility genes on 5q31-33 in the development of atopy and asthma we have studied 240 UK families comprising 131 families selected at random, 60 multiplex families with affected sib pairs, and 49 single proband nuclear families. Polymorphic markers on 5q31-33 were genotyped and both single and multipoint linkage analysis was undertaken using the BETA program. We have used both affection status and quantitative scores for atopy and asthma for phenotypic variables, combining data into scores for asthma and atopy. The strongest suggestion of linkage using multipoint analysis was centred around D5S410 with a maximum Lod of 1.946 at location 171.3 cM and a standard error of 3.3 for the asthma quantitative score. There was no evidence of linkage with atopy, the atopy quantitative score or total serum IgE.

Anatomical study of the synovial plicae of the hip joint

Observations and measurements of the synovial plicae of the hip joints were made on 63 embalmed cadavers. The cadavers were divided equally among three age groups (fetuses, children, and adults). Our observations showed that the plicae appeared in two forms (flat and villous) and were mainly confined to the external surface of the lower medial part of the acetabular labrum (labral plicae), the base of the ligament of the head of the femur (ligamental plicae), and along the reflecting line of the synovial membrane on the base of the femoral neck (neck plicae). The ligamental plicae were well padded with a fibroelastic pad of fat filling the acetabular fossa, and the neck plicae were far away from the articular surfaces of the joint; as a result, neither was likely to be injured or entrapped during joint movements. The labral plicae were larger than the ligamental or neck plicae and had an incidence of 73.8% in the fetal group. The fetal plicae were found only after the fetal age of 5 months. In nine cases of the child and adult groups, the labral plicae extended between the articular surface of the femoral head and the lower part of the acetabulum during medial rotation of the thigh. When the thigh was rotated laterally, the plicae in six of the same cases could be returned to their original positions. In the remaining three cases, there was continual impingement.

Pycnogenol protects vascular endothelial cells from beta-amyloid-induced injury

The neuropathological hallmarks of Alzheimer's disease (AD) are senile plaques, cerebrovascular beta-amyloidosis, neurofibrillary tangles, and selective neuronal loss. Beta-amyloid (Abeta) has been shown to cause vascular damage mediated by generation of reactive oxygen species and this damage is considered an early event in the development of AD. In this study, we determined the effect of pyenogenol, a potent antioxidant phytochemical, on Abeta-induced cellular injury. Pulmonary artery endothelial cells (PAEC) were exposed to Abeta for 24 h. Cell injury was assessed by measuring cell viability with methylthiazol tetrazolium (MTT) assay, and by determining the release of intracellular lactate dehydrogenase (LDH). Lipid peroxidation products of PAEC were determined by measuring thiobarbituric acid-reactive substances (TBARS). Exposure of PAEC to Abeta resulted in a decrease in cell viability, an increase of LDH release indicating membrane damage, and an elevated level of TBARS. Preincubation of PAEC with pycnogenol significantly minimized these changes. This study demonstrated that pycnogenol can protect vascular endothelial cells from Abeta-induced injury. The data suggest that pycnogenol may be useful for the prevention and/or treatment of vascular or neurodegenerative diseases associated with Abeta toxicity.

Pycnogenol inhibits tumor necrosis factor-alpha-induced nuclear factor kappa B activation and adhesion molecule expression in human vascular endothelial cells

The transcriptional regulatory protein nuclear factor kappa B (NF-kappa B) participates in the control of gene expression of many modulators of inflammatory and immune responses, including vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1). The heightened expression of these adhesion molecules has been reported to play a critical role in atherosclerosis, inflammation, ischemic vascular disorders, diabetes, and cancer metastasis. In the present study, we investigated the effect of pycnogenol, an antioxidant phytochemical, on the activation of NF-kappa B and the induction of VCAM-1 and ICAM-1 in tumor necrosis factor (TNF)-alpha-treated human umbilical vein endothelial cells (HUVECs). Gel-shift analysis of HUVEC demonstrated that pretreatment with pycnogenol exhibited a concentration-dependent suppression of TNF-alpha-induced activation of NF-kappa B. Induction of VCAM-1 and ICAM-1 surface expression by TNF-alpha was dose-dependently reduced by pycnogenol. TNF-alpha significantly increased the release of superoxide anion and hydrogen peroxide from HUVECs. Pycnogenol dose-dependently inhibited their release. The ability of pycnogenol to inhibit NF-kappa B activation and VCAM-1 and ICAM-1 expression suggests that this phytochemical may play an important role in halting or preventing the atherogenic process.

Anterior capsule opacification: a histopathological study comparing different IOL styles

OBJECTIVE

To compare the degree of anterior capsule opacification (ACO) in human eyes obtained post-mortem containing various rigid and foldable posterior chamber intraocular lens (PC-IOL) designs.

DESIGN

Comparative autopsy tissue study with clinicopathologic correlations.

MATERIALS

Four hundred sixty human globes containing the following PC-IOL styles were analyzed: (1) one-piece polymethylmethacrylate (PMMA) optic-PMMA haptic (n = 50), (2) one-piece silicone-plate IOL, large hole (n = 40), (3) one-piece silicone-plate IOL, small hole (n = 67), (4) three-piece PMMA optic-PMMA/Prolene haptic (n = 51), (5) three-piece acrylic optic-PMMA haptic (n = 96), (6) three-piece silicone optic-PMMA haptic (n = 24), (7) three-piece silicone optic-polyimide haptic (n = 40), and (8) three-piece silicone optic-prolene haptic (n = 92).

TESTING

The globes were sectioned in the equatorial plane for gross examination and then processed through paraffin; sectioned, and stained with hematoxylin-eosin, periodic acid-Schiff, and Masson's trichrome stains; and examined by light microscopy.

MAIN OUTCOME MEASURES

Anterior capsule opacification was scored in each eye by grading the histologic sections from 0 to III, according to the amount (thickness) of proliferative tissue and cells measured in sagittal sections on the inner surface of the anterior capsule at the capsulorhexis margin.

RESULTS

The difference among the eight groups was significant (P < 0.0001). Mean ACO scores were highest with the large and small hole one-piece silicone-plate lenses (1.77 +/- 0.86 and 1.28 +/- 0.77, respectively). The lowest mean score was observed in the group of three-piece acrylic optic-PMMA haptics lenses (0.51 +/- 0.52).

CONCLUSIONS

Our results confirm previous clinical observations that the rate of ACO is relatively high with plate-haptic silicone IOLs. The lowest rate was noted with the three-piece acrylic optic-PMMA haptic IOL. The IOL design and IOL material are significant factors in the development of ACO.

Creating cataracts of varying hardness to practice extracapsular cataract extraction and phacoemulsification(2)

We describe a method to harden the nucleus of crystalline lenses in postmortem human globes by intralenticular injection of a mixture of paraformaldehyde and glutaraldehyde (Karnovsky's solution). Evaluation of the nuclear manipulations, using the Miyake-Apple posterior video/photographic technique, shows that the method provides suitable specimens for practicing extracapsular cataract extraction and phacoemulsification.

Interlenticular opacification: clinicopathological correlation of a complication of posterior chamber piggyback intraocular lenses

PURPOSE

To present a clinicopathological correlation of 2 pairs of piggyback posterior chamber intraocular lenses (PC IOLs) explanted because of opacification between the lens optics.

SETTING

Gayton Health Center, Eyesight Associates of Middle Georgia, Warner Robins, Georgia, and Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.

METHODS

Two pairs of piggyback AcrySof lenses were explanted from 2 patients with significant visual loss related to opacification between the optics. They were submitted for pathological analysis. Gross and histopathological examinations were performed, and photomicroscopy was used to document the results.

RESULTS

Gross examination showed accumulation of a membrane-like white material between the lenses. Histopathological examination revealed that the tissue consisted of retained/proliferative lens epithelial cells (bladder cells or pearls) mixed with lens cortical material.

CONCLUSION

Piggyback PC IOLs were explanted in 2 cases because of a newly described complication, interlenticular opacification. Three surgical means may help prevent this complication: meticulous cortical cleanup, especially in the equatorial region; creation of a relatively large continuous curvilinear capsulorhexis to sequester retained cells peripheral to the IOL optic within the equatorial fornix; insertion of the posterior IOL in the capsular bag and the anterior IOL in the ciliary sulcus to isolate retained cells from the interlenticular space.

Surgical prevention of posterior capsule opacification. Part 2: Enhancement of cortical cleanup by focusing on hydrodissection

PURPOSE

To experimentally analyze the role and efficacy of hydrodissection in achieving maximal cortical cleanup.

SETTING

Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA.

METHODS

Phacoemulsification and irrigation/aspiration were performed in 10 pairs of human eyes (20 eyes) obtained postmortem. Ten eyes had previous hydrodissection and 10 eyes, no hydrodissection. The time (seconds) required for complete lens substance removal in each procedure was measured. In addition, a qualitative evaluation of difficulty of surgery was noted.

RESULTS

Phacoemulsification required 28.6% less time in eyes with previous hydrodissection than in those without. Irrigation/aspiration time was reduced by 50.9% when hydrodissection was performed. The total time of each procedure required for complete evacuation of the capsular bag was reduced by an average of 37.7% in eyes with hydrodissection. Furthermore, qualitatively the procedure was far easier, less stressful, and caused less posterior capsule stress or rupture when copious hydrodissection was performed.

CONCLUSIONS

Hydrodissection enhances the general safety and efficiency of cortical cleanup, especially at 12 o'clock. Hydrodissection is the best available, practical, immediately implementable, and inexpensive means to help remove equatorial E-cells and thus alleviate the incidence of posterior capsule opacification.

Surgical prevention of posterior capsule opacification. Part 1: Progress in eliminating this complication of cataract surgery

PURPOSE

To evaluate over almost 2 decades the success of a component of cataract surgery that represents a critical step in reducing the incidence of posterior capsule opacification (PCO); namely, the efficacy of cortical cleanup.

SETTING

Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA.

METHODS

Accessioned from the early 1980s to 1997, 3320 eyes obtained postmortem with posterior chamber intraocular lenses were analyzed with respect to formation of a postoperative Soemmering's ring. This anatomic lesion, the precursor of clinical PCO, represents an important and measurable indication of the quality of cortical cleanup. Its formation was documented using Miyake-Apple posterior photographic analysis.

RESULTS

The quality and thoroughness of cortical cleanup and overall effectiveness in eliminating retained and/or regenerating cortical cells, as measured by scoring of Soemmering's rings, showed virtually no net change since the early 1980s. The intensity of Soemmering's ring was higher in the most recent specimens than in those in the early 1980s.

CONCLUSION

The results indicate that renewed attention to cortical cleanup in cataract surgery is warranted for significant reduction in incidence or the elimination of PCO. More attention to the hydrodissection (cortical cleaving hydrodissection) step of the procedure is likely a practical, immediately implementable, and inexpensive remedy.

[The effective dielectric function of porous SiO2 glass]

In this paper, we discussed the effective dielectric function of porous SiO2 glass with pore size 7.5 nm. We briefly discussed different formulae proposed by different theoretical models of porous systems, and compared the relationship of effective dielectric functions changing with different porosity of porous SiO2 of each formula. Through comparing the experimental spectra and the theoretical spectra of each formula, we found the equation ln epsilon e = theta 1 ln epsilon 1 + theta 2 + theta 2 ln epsilon 2 best indicates the effective dielectric function of porous SiO2. This work is helpful in selecting special absorption materials.

Surgical prevention of posterior capsule opacification. Part 3: Intraocular lens optic barrier effect as a second line of defense

PURPOSE

To emphasize an important aspect of preventing posterior capsule opacification (PCO), the barrier effect established by the optic of a posterior chamber intraocular lens (PC IOL), and present a new classification regarding capsular bag status after extra-capsular cataract extraction, including phacoemulsification.

SETTING

Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.

METHODS

This analysis included 150 consecutive eyes obtained postmortem with United States-manufactured PC IOLs including (1) poly(methyl methacrylate), (2) silicone, and (3) hydrophobic acrylic designs that were accessioned in the Center from September 1995 to January 1, 1998. Gross photographs from behind (Miyake-Apple views) were taken and serial histologic sections prepared.

RESULTS

Microscopic analysis of the 150 eyes showed that the morphologic appearance of the capsular bag could be grouped into 2 categories: (1) those with little or no evidence of retained cortical material and cells, and (2) those with retained cortical material and cells in which a Soemmering's ring formed. With the latter, when a distinct barricade to cellular migration created by the IOL optic was noted, 2 discrete configurations occurred, depending on the different geometries of the optic components. With a classic biconvex optic with a curved and tapered edge, in many instances some ingrowth of cells proceeded posteriorly around the edge of the IOL optic in the direction of the central axis. With a lens optic that had a squared, truncated, and relatively thick edge, there was often abrupt termination of cells at the peripheral edge of the optic. The posterior capsule subtending the entire optic zone was therefore relatively or totally cell free.

CONCLUSIONS

The barrier effect of the IOL optic appears to be of critical importance in retarding ingrowth of cells, functioning as a second line of defense when cortical cleanup is incomplete. Analysis of PC IOLs obtained postmortem showed that a square, truncated optic edge seemed to provide the maximum impediment to cell growth behind the IOL optic.

Ginkgo biloba inhibits hydrogen peroxide-induced activation of nuclear factor kappa B in vascular endothelial cells

The present study determined the effects of Ginkgo biloba extract (GBE) on the activation of nuclear factor kappa B (NF-kappaB) and the level of hydrogen peroxide (H2O2) in bovine pulmonary artery endothelial cells (PAEC). H2O2 showed a concentration-dependent activation of NF-kappaB. GBE demonstrated a concentration-dependent suppression of NF-kappaB activated by H2O2. GBE directly scavenged H2O2 in a cell-free system; it also decreased H2O2 levels in PAEC. These results suggest that the inhibitory effect of GBE on H2O2-induced NF-kappaB activation may be caused by its scavenging and suppression of H2O2. Our experiments demonstrate that GBE can inhibit NF-kappaB activation induced by H2O2 and may thus be effective for the prevention or treatment of atherosclerosis and other disorders related to NF-kappaB activation.

[Antihypertensive study of xingnao qingxuan recipe]

OBJECTIVE

To observe the effect of decreasing blood pressure of Xingnao Qingxuan Casuples.

METHOD

The blood pressure in normal and anesthetised cats was examined with direct method, the blood pressure in the conscious SHR was obtained by indirect method.

RESULTS

Duodenuos administration(id) of XQC of 2.8 g/kg produced a decrease of blood pressure in normal cats; XQC of 1.4, 2.8 and 5.6 g/kg once a day for 14 days produced a dose-dependent reduction of blood pressure in SHR, 3-4 days after administration the blood pressure returned to the level before but the change was not significant. With gastric administration of XQC of 2.8 and 5.6 g/kg for 3 times, the incubation period of eyeball tremor induced by chloroform by dropping into the ear was prolonged by 14.4% and 13.0%, and the keeping time shortened by about 33.3% and 23.3% respectively. Brain basic arterial spasm induced by KCl or 5-HT in dog was relaxed obviously by XQC in vitro experiment.

CONCLUSION

XQC has the effect of reducing blood pressure resisting dizziness, which is related to the diastole of brain blood vessel.

[Transplantation of neural retina after photic injury of retina in mice]

OBJECTIVE

To examine the possibility of retinal photoreceptors rescued after photic injury by allogeneic neural retinal transplantation.

METHODS

The retinal photic injury model was established by a light-damage trunk designed by ourselves. After photo-illumination, 60 mice were divided into two groups: Group I (n = 20) was the photic injury group and group II (n = 40), the retinal transplantation group; then group II was subdivided into II(A) (n = 20) and II(B) (n = 20) subgroups. External approach for neural retinal transplantation was performed at 24hr (group II(A)) and day 7 (group II(B)) after photic injury respectively. The recipients were sacrificed at day 6, day 12, day 18 and day 30 post-operatively to examine whether the graft could rescue the injured retinal photoreceptors.

RESULTS

In group I, the inner and outer segment showed edema, disorganization and vesiculation, the outer nuclear layer became very thin and disorganized, and the cell nuclear chromatin showed pyknosis and margination. In group II, the graft survival rate in group II(A) was 50% (10/20) and in group II(B) was 80% (16/20), the difference being significant (chi(2) = 3.956, P < 0.05). Among the graft survival samples, we compared the rescue rate of photoreceptors between group II(A) 40% (4/10) and group II(B) 50% (8/16), the difference being not significant (P = 0.702).

CONCLUSION

The retinal photic injury may result in photoreceptor degeneration that can be rescued by retinal transplantation, and the successful rate of the transplantation performed at day 7 is higher than that at 24-hr after injury.

Update on fixation of rigid and foldable posterior chamber intraocular lenses. Part II: Choosing the correct haptic fixation and intraocular lens design to help eradicate posterior capsule opacification

PURPOSE

Posterior capsule opacification (PCO) is one of the most common complications of cataract surgery, and there is an urgent need to reduce its incidence. Its main treatment, neodymium:YAG (Nd:YAG) laser posterior capsulotomy, may be associated with significant morbidity and is expensive. In this study, the authors ascertain the effect of posterior chamber intraocular lens (PC-IOL) fixation and various IOL designs (rigid polymethyl methacrylate [PMMA] optic and small-incision foldable designs) on the pathogenesis of PCO.

DESIGN

Prospective analysis of pseudophakic eyes obtained postmortem.

PARTICIPANTS

A total of 3493 eyes with PC-IOLs obtained postmortem and received between 1984 and 1998.

METHODS

Miyake-Apple posterior photographic technique.

MAIN OUTCOME MEASURES

Peripheral Soemmering's ring, central PCO in the visual axis, and eyes that have had Nd:YAG laser posterior capsulotomy were analyzed and scored, and these findings were correlated with the type of fixation and IOL design.

RESULTS

The degree of formation of peripheral Soemmering's ring was not influenced by IOL fixation. The acrylic design revealed relatively low Soemmering's ring scores. In contrast, central PCO and Nd:YAG laser capsulotomy scores were consistently influenced by fixation. The scores were significantly lower in eyes with in-the-bag fixation. The bag-bag fixated acrylic-PMMA design and the three modern silicone IOL designs analyzed in this study had less central PCO and lower posterior capsulotomy scores than did the PMMA IOLs.

CONCLUSIONS

The formation of peripheral PCO (the Soemmering's ring), the precursor of clinically significant, vision-threatening PCO, is not significantly influenced by the haptic fixation pattern. It is much more dependent on the quality and thoroughness of surgical cortical cleanup. Reduction of Soemmering's ring is an important goal because the retained regenerative cortical cells within this lesion are the cells of origin of PCO. The acrylic IOL design was associated with a lessor amount of peripheral Soemmering's ring as compared with all other designs. In sharp contrast to peripheral PCO, fixation of the IOL was a highly significant factor affecting the formation and quantity of central PCO-the clinically significant opacity behind the IOL optic, measured in this series either by scoring an intact retro-optical membrane or by documenting the presence of a Nd:YAG laser posterior capsulotomy orifice. The quantity of central PCO was consistently much lower in eyes with in-the-bag fixated IOLs compared with lenses with one or both haptics out of the bag. This is best explained by the fact that secure in-the-bag fixation positions the IOL optic in the best possible position to create a barrier effect. The lowest PCO rates were generally noted with the acrylic and modern silicone IOL designs.

Update on fixation of rigid and foldable posterior chamber intraocular lenses. Part I: Elimination of fixation-induced decentration to achieve precise optical correction and visual rehabilitation

PURPOSE

Realizing that precise posterior chamber intraocular lens (PC-IOL) centration is needed to consistently achieve good optical results and visual rehabilitation after modern cataract surgery, the authors assessed the status and success rate of lens haptic fixation and its correlation with lens optic centration-decentration in a large series of eyes with PC-IOLs obtained postmortem.

DESIGN

Prospective analysis of pseudophakic eyes obtained postmortem.

PARTICIPANTS

A total of 3493 human eyes obtained postmortem, the largest database of such specimens available to date.

METHODS

Miyake-Apple posterior photographic technique.

MAIN OUTCOME MEASURES

The amount of decentration of rigid PC-IOLs and small-incision foldable PC-IOLs was analyzed, and the results were correlated with the type of fixation that had been achieved in each case.

RESULTS

Determination of mean values revealed that capsular bag fixation was achieved in 52.05% of eyes, asymmetric bag-sulcus fixation in 34.21 % of eyes, and sulcus-sulcus fixation in 13.74% of eyes. Asymmetrically fixed lenses consistently showed significant decentration. During the past 5 years (1993-98), the overall rate of in-the-bag fixation increased to 59.2%; by 1998 it had increased to 64%. Most significantly, success in achieving bag-bag fixation of foldable IOLs implanted in association with modern capsular surgery with small incisions has surged to 90% over the past 4 years.

CONCLUSIONS

The authors found a direct correlation of decentration in eyes with asymmetric fixation, and the results underscore the need for careful in-the-bag haptic placement. Although few surgeons today would dispute the goal to implanting haptics in the capsular bag, these findings show that the overall success rate over the years has, while improving, remained surprisingly low. The overall success rate of about 60% seen with all lens designs is probably as good as can be expected with classic large-incision extracapsular techniques. However, and most important and encouraging, the success rate of haptic fixation in cases with foldable lenses has improved dramatically during the past 4 years (up to the 90% range). This coincides with the present emphasis on modern capsular surgery and small-incision techniques used to insert these lenses.

[p16 gene suppresses growth of human esophageal carcinoma cells]

OBJECTIVE

To explore the effect of p16 gene on the growth inhibition of esophageal carcinoma cell line NEC.

METHODS

The full length of wild-type p16 cDNA was transfected into the esophageal carcinoma cell line of human fetus induced by N-methyl-N-benzylnitrosamine (NMBzA). In these esophageal carcinoma cell, p16 gene was homozygously deleted.

RESULTS

Expression of exogenous p16 gene in NEC cells was identified by dot blot and Western blot analyses. The growth rate of NEC transfected with p16 gene (NEC-p16) was markedly suppressed. Colony formation in soft agar was also decreased significantly. Cell cycle analysis by flow cytometry showed that the number of cells in G1-G0 phase of NEC-p16 cells was significantly increased while cells in S and G2 + M phase was decreased compared to that of the control NEC cells.

CONCLUSION

Transduction of wild type p16 gene into p16 gene-depleted esophageal cancer cells can restore its suppressive effect on cell growth by arrest of cell cycle at G1 phase.

[Synthetic assessment of health impact of cerebrovascular diseases on potential health days of life lost]

OBJECTIVE

To assess synthetically the impact on population health caused by cerebrovascular diseases.

METHODS

Incidence, duration of disease, disabilities and deaths of cerebrovascular diseases were analyzed with potential health days of life lost (PHDLL) as an indicator in urban areas of Changsha, Hunan Province.

RESULTS

The PHDLL caused by cerebrovascular disease totaled 2 624.94 days per thousand of population, 33.01% of them attributed to deaths and 53.44% to chronic disability.

CONCLUSION

Hemorrhagic cerebrovascular disease mainly lead to death and ischemic one caused chronic disability.

Pathological examination of an explanted phakic posterior chamber intraocular lens

PURPOSE

To report the clinicopathological correlation of an explanted phakic posterior chamber intraocular lens (PPC IOL) and to study the conformation of this lens implanted into human eyes obtained postmortem.

SETTING

Center for Research on Ocular Therapeutics and Biodevices, Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.

METHODS

Three silicone PPC IOLs were explanted. One lens, explanted from a 38-year-old woman with complicated cataract, was submitted for pathological analysis. In addition to gross and scanning electron microscopy (SEM), the lens was studied after experimental implantation in human eyes obtained postmortem using frontal, posterior, and side-view techniques.

RESULTS

Although gross and SEM showed that the IOL was well polished, examination of the lens in human cadaver eyes showed it was oversized and poorly fixated. It was relatively bulky in its anterior-posterior dimension and revealed evidence of significant contact with the iris and crystalline lens.

CONCLUSIONS

This study illustrates many pitfalls to be avoided in the design of a plate PPC IOL. The lens in this report was too large, and instead of ciliary sulcus fixation, it showed poor fixation through the zonules onto the posterior face of the pars plicata. Present and future PPC IOLs should be submitted for similar preclinical studies to clarify the type and site of fixation.

Different apoptotic pathways are induced from various intracellular sites by tetraphenylporphyrins and light

The induction of apoptosis from different intracellular sites was studied by exposing V79 Chinese hamster fibroblasts to photodynamic therapy (PDT) with various porphyrins and light. The effects of two lipophilic, intracellular membrane-localized porphyrins, tetra(3-hydroxyphenyl)porphyrin (3THPP) and Photofrin, were compared with that of two sulphonated meso-tetraphenylporphines (TPPS2a and TPPS4), which are taken up into lysosomes by endocytosis. Apoptotic fractions induced by the various dyes and light were quantified by flow cytometry using the terminal deoxynucleotidyl transferase (TdT) assay. Cell fragmentation was measured in parallel, while the nuclear morphology of apoptotic cells was studied by fluorescence microscopy. Different kinetics were found for the induction of DNA strand breaks characteristic of apoptotic cells. PDT-induced damage to membranes resulted in an increasing number of apoptotic cells for about 12 h after PDT After damage to lysosomes, apoptotic cells were not detected until more than 12 h after PDT. Furthermore, apoptotic bodies were not observed after PDT-induced damage to intracellular membranes, whereas apoptosis induced from lysosomal sites was characterized by extensive cell fragmentation. Cell fragmentation occurred in combination with or in the absence of nuclear fragmentation. The results support the idea that the degradation phase of apoptosis can consist of a sequence of independent steps rather than a common final pathway.

Fructus corni attenuates oxidative stress in macrophages and endothelial cells

The antioxidant effect of a Chinese medicinal herb, Fructus corni extract (FCE), was investigated using models of oxidative stress in macrophages and vascular endothelial cells. Murine macrophages (J774) were incubated with FCE at 37 degrees C and 5% CO2 for 1 hr. Oxidative burst was triggered by zymosan and measured with a fluorescent probe. FCE exhibited a concentration- dependent suppression of oxidative burst. Confluent monolayers of bovine pulmonary artery endothelial cells (PAEC) were preincubated with FCE for 20 hrs, washed, and then exposed to an organic oxidant t-butyl hydroperoxide (tBHP) for 2 hrs. Cell viability was assessed by methylthiazol tetrazolium (MTT) assay, and cell injury by the release of intracellular lactate dehydrogenase (LDH). Lipid peroxidation products of PAEC were determined by measuring thiobarbituric acid-reactive substances (TBARS). Exposure of PAEC to tBHP resulted in decreased cell viability, increased LDH release, and elevated TBARS. Preincubation of PAEC with FCE significantly reversed these changes. Our results demonstrated that FCE can protect vascular endothelial cells from oxidant injury. The data thus suggest that Fructus corni may be useful for the prevention and/or treatment of disorders associated with oxidative damage.

Production of protoporphyrin IX induced by 5-aminolevulinic acid in transplanted human colon adenocarcinoma of nude mice can be increased by ultrasound

BALB/c nude mice bearing WiDr human colon adenocarcinoma were used to determine the effect of ultrasound on the production of 5-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) both in the tumors and in skin overlying the tumors. Ultrasound (1 MHz) with pulsed irradiation at an average intensity of 3 W/cm2 was given 10 min to the tumor area 10 min after administration of ALA (20% in an oil-in-water emulsion applied topically on the surface of the tumor for 30 min to 3 hr). An approximately 45% increase in the amount of PpIX produced by ALA in the tumors was obtained within 1 to 2 hr following ultrasound treatment. In particular, 1 hr after ultrasound treatment, the amount of PpIX in the tumors was at the same level as that 3 hr after ALA application alone. However, pulsed ultrasound irradiation for 5 min or continuous irradiation for 5 or 10 min had no significant effect on the production of PpIX by the tumor 1 hr after topical ALA application. Furthermore, in most cases, the amount of PpIX in the tumors was significantly decreased when ultrasound was given immediately before ALA application. There was no significant change in the ratio of the amount of PpIX in tumor to that in skin after ultrasound treatment. Most likely, the distribution of PpIX fluorescence in the tumors treated with ultrasound was more homogeneous than that in the tumors given ALA only. Our results provide a theoretical basis for possible clinical use of ultrasound-combined ALA or ALA based photodynamic therapy.

Susceptibility to esophageal cancer and genetic polymorphisms in glutathione S-transferases T1, P1, and M1 and cytochrome P450 2E1

Genetic polymorphisms in enzymes involved in carcinogen metabolism have been shown to influence susceptibility to cancer. Cytochrome P450 2E1 (CYP2E1) is primarily responsible for the bioactivation of many low molecular weight carcinogens, including certain nitrosamines, whereas glutathione S-transferases (GSTs) are involved in detoxifying many other carcinogenic electrophiles. Esophageal cancer, which is prevalent in China, is hypothesized to be related to environmental nitrosamine exposure. Thus, we conducted a pilot case-control study to examine the association between CYP2E1, GSTM1, GSTT1, and GSTP1 genetic polymorphisms and esophageal cancer susceptibility. DNA samples were isolated from surgically removed esophageal tissues or scraped esophageal epithelium from cases with cancer (n = 45), cases with severe epithelial hyperplasia (n = 45), and normal controls (n = 46) from a high-risk area, Linxian County, China. RFLPs in the CYP2E1 and the GSTP1 genes were determined by PCR amplification followed by digestion with RsaI or DraI and Alw26I, respectively. Deletion of the GSTM1 and GSTT1 genes was examined by a multiplex PCR. The CYP2E1 polymorphism detected by RsaI was significantly different between controls (56%) and cases with cancer (20%) or severe epithelial hyperplasia (17%; P < 0.001). Persons without the RsaI variant alleles had more than a 4-6-fold risk of developing severe epithelial hyperplasia (adjusted odds ratio, 6.0; 95% confidence interval, 2.3-16.0) and cancer (adjusted odds ratio, 4.8; 95% confidence interval, 1.8-12.4). Polymorphisms in the GSTs were not associated with increased esophageal cancer risk. These results indicate that CYP2E1 may be a genetic susceptibility factor involved in the early events leading to the development of esophageal cancer.

[FTIR study on the normal and tumor gastrointestinal tissues]

Series of cancer tissues and corresponding normal tissues of gastrointestinal tract (stomach, colon, esophagus) were studied by FTIR technique and the results showed the analogy of the spectra for the cancer tissues, while the spectra of normal tissues can be classified into three kinds. The secondary structures of protein were obtained by using deconvolution and curve-fitting techniques with Amide I bands and the results showed that the contents of alpha -helix and beta-sheet are different between the normal and cancer tissues.

Fructus corni enhances endothelial cell antioxidant defenses

1. The present study determined the effects of Fructus corni extract (FCE) on the levels of hydrogen peroxide (H2O2) and superoxide anion (O2-), on the glutathione (GSH) redox cycle and on the activities of antioxidant enzymes in bovine pulmonary artery endothelial cells (PAECs). 2. Confluent monolayers of PAECs were incubated with FCE, and oxidative stress was triggered by hypoxanthine and xanthine oxidase (to induce H2O2) or H2O2 (to induce O2-). 3. FCE exhibited a concentration-dependent suppression of H2O2 and O2-. 4. It modulated the GSH redox cycle by increasing the intracellular GSH content, the activities of GSH peroxidase and GSH disulfide reductase, and by decreasing the intracellular level of GSH disulfide. 5. It also increased the activities of superoxide dismutase and catalase. 6. These results demonstrate that FCE can promote a protective antioxidant defense state by affecting some important enzymatic and nonenzymatic oxidant-scavenging systems and may thus be useful for the prevention or treatment of disorders associated with oxidative damage.

Posterior capsular plaque: a common feature of cataract surgery in the developing world

PURPOSE

To study the histopathologic findings of posterior capsular plaque, a lesion that is discovered frequently in eyes undergoing cataract surgery in the developing world.

METHODS

Two hundred human crystalline lenses removed from 200 eyes of 200 patients who underwent intracapsular cataract extraction at Sagarmatha Choudhary Eye Hospital in Nepal were analyzed histopathologically.

RESULTS

Forty-nine lenses (24.5%) had a posterior capsular plaque. We confirm that the posterior plaques are composed of collagen that stains positively for Masson trichrome stain and that forms after pseudofibrous metaplasia of lens cells along the posterior capsule. The plaques form in a fashion analogous to a healing process.

CONCLUSIONS

We postulate that posterior capsular plaques result from posterior migration of epithelium and pseudofibrous metaplasia of lens epithelium. Most of the posterior capsular plaques are minute and not likely to affect vision. However, a small percentage of plaques are thicker and are likely to impair vision after extracapsular cataract surgery.

Mini-haptics to improve capsular fixation of plate-haptic silicone intraocular lenses

PURPOSE

To evaluate the effects of a new mini-haptic design on the strength and stability of capsular bag fixation of plate-haptic silicone intraocular lenses (IOLs) and determine whether this design encourages the growth of regenerating lens material or fibrous tissue around the haptic biomaterial and thus improves lens fixation in the capsular bag.

SETTING

Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Department of Ophthalmology, Charleston, South Carolina, USA.

METHODS

Six rabbits had bilateral continuous curvilinear capsulorhexis, phacoemulsification, and plate-haptic silicone IOL implantation. Each rabbit had a small-hole plate IOL (Chiron C10UB) implanted in the right eye and a mini-haptic plate IOL (Chiron C40UB) in the left eye. All rabbits were killed at 2 months. The force required to extract one haptic from the capsular bag was measured with a digital force gauge. Histopathologic analysis was performed on all specimens.

RESULTS

The mini-haptic style IOLs required significantly more extraction force than the small-hole design (P = .011). Histopathologically, proliferating lens epithelial cells were observed growing circumferentially around the mini-haptics, causing a 360 degree synechia formation. This formation did not occur with the conventional small-hole plate IOLs used as the control.

CONCLUSIONS

Lens epithelial cell proliferation around the mini-haptics significantly improved capsular bag fixation of the plate-haptic silicone IOL. This should decrease the incidence of clinical decentration and dislocation.

Fixation elements on plate intraocular lens: large positioning holes to improve security of capsular fixation

OBJECTIVE

This study aimed to evaluate in rabbit eyes the effects of large positioning holes in one-piece silicone plate-haptic intraocular lenses (IOLs) with respect to security of capsular bag fixation. Mechanical strength of capsular fixation is correlated with the histologic findings of regenerating lens material and fibrous tissue ingrowth through the positioning holes on silicone plate IOLs, comparing capsules implanted with large-hole style plate IOLs to fellow capsules implanted with small-hole style plate IOLs.

DESIGN

The study design was a prospective, randomized, experimental study.

PARTICIPANTS

A total of 40 fellow capsular bags from 20 New Zealand white rabbits were examined. Capsules implanted with conventional small-hole silicone plate IOLs were used as the control in all pairs of fellow capsules.

INTERVENTION

Phacoemulsification and implantation of a silicone plate IOL with small positioning holes in one eye and implantation of a silicone plate IOL with large positioning holes in the fellow eye were measured. All rabbits were killed at 2 months. The force required to extract the IOLs from the capsular bag was measured. All capsular bags underwent histopathologic analysis.

MAIN OUTCOME MEASURES

Extraction force measurements and histopathologic examination, comparing capsules implanted with small-hole plate IOLs with fellow capsules implanted with large-hole plate IOLs, were measured.

RESULTS

The large-hole style IOL required significantly more force to extract from the capsular bag compared to the conventional small-hole style (P = 0.003). Histologically, proliferating lens epithelial material and fibrous tissue were observed growing through all of the large positioning holes (synechia formation) but not through any of the small positioning holes.

CONCLUSIONS

Silicone plate IOLs with large positioning holes become affixed more firmly within the capsular bag compared to conventional small-hole plate IOLs. These findings suggest that large holes in silicone plate IOLs allow for superior capsular bag fixation. This should reduce the rates of decentration and dislocation.

[Use of 5-aminolevulinic acid in photochemotherapy and fluorescence diagnostics]

5-aminolevulinic acid is an early intermediate product in the synthesis of heme. Some of the enzymes in the heme synthesis chain have altered activities in tumor tissue, so that application of 5-aminolevulinic acid leads to an accumulation of protoporphyrin IX in tumors. This molecule absorbs light and acts as a potent photosensitizer; tumors containing the compound can therefore be destroyed by light. 5-aminolevulinic acid based photochemotherapy is presently being employed in the treatment of thin basal cell carcinomas in many countries. The cosmetic result of this treatment is excellent. Furthermore, it is a simple and inexpensive form of treatment with curative rates comparable to those of established therapy modalities. Experimentally, a number of other malignant lesions reachable by light via optical fibers are being treated. Since protoporphyrin IX has a characteristic red fluorescence, 5-aminolevulinic acid can also be applied for diagnostic purposes.

Apoptosis induction by different pathways with methylene blue derivative and light from mitochondrial sites in V79 cells

The importance of mitochondria for the induction of apoptosis by photodynamic therapy (PDT) was studied with a new photosensitizing dye, methylene blue derivative (MBD), and light. By using fluorescence microscopy and by measuring the MBD-PDT-induced inhibition of specifically subcellularly localized marker enzymes, we show that MBD is localized in mitochondria and not in lysosomes, endoplasmic reticulum or Golgi apparatus of V79 Chinese hamster fibroblasts. Cellular uptake kinetics and fluorescence properties of the dye in cells were characterized. Cell death was studied by a cell survival assay and by flow cytometry of cells stained using the terminal deoxynucleotidyl transferase (TdT) assay. MBD with light induced cell death by apoptosis via 2 different pathways, one rapid and one delayed, depending on the amount of dye in the cells. Cells treated with an MBD concentration higher than 0.05 microg/ml died by apoptosis within 3 hr after light exposure. At a concentration of 0.05 microg/ml MBD, cell death was induced slowly, and apoptotic cells appeared increasingly from the second day after PDT. Combination studies with 2-deoxyglucose (2-DOG) and carbonylcyanide-m-chlorophenylhydrazone (CCCP), inhibitors of glycolysis and oxidative phosphorylation, respectively, indicated that MBD and light inhibited mitochondrial oxidative phosphorylation. Abolishment of both energy sources led to cell death by necrosis within 6 hr. Inhibition of glycolysis alone induced apoptosis between 3 and 6 hr, while inhibition of mitochondrial oxidative phosphorylation alone led to delayed apoptosis within days.

[Genetic polymorphisms of cytochrome P450 2E1 and glutathione S-transferase P1 and susceptibility to esophageal cancer]

OBJECTIVES

To study the association between genetic polymorphisms of cytochrome P4502E1 (CYP2E1) and/or glutathione S-transferase P1 (GSTP1) and susceptibility to esophageal cancer.

METHODS

Genotyping of CYP2E1 and GSTP1 was performed using PCR-based RFLP analysis on DNA isolated from surgically removed esophageal tissues or scraped esophageal epithelium from cancer cases (n = 45), severe epithelial hyperplasia cases (n = 45), and normal controls (n = 45).

RESULTS

The variant genotypes (c1/c2 and c2/c2) detected by RsaI digestion was found in 17% of epithelial hyperplasia cases, 20.0% of esophageal cancer cases and 55.6% of controls, with the differences being statistically significant (P < 0.001). Subjects carrying wild-type genotype of CYP2E1 had more than 5-fold risk for developing severe epithelial hyperplasia (odds ratio, OR = 5.78; 95% confidence interval, CI = 2.2-15.2) and esophageal cancer (OR = 5.00; 95% CI = 2.0-12.8). No association with the risk of severe epithelial hyperplasia and esophageal cancer was observed for the DraI polymorphism of CYP2E1 or for the Awl26I polymorphism of GSTP1.

CONCLUSION

CYP2E1 is a genetic susceptibility factor involved in the early events for esophageal carcinogenesis.

[Deletion of MTS1/p16 gene in human esophageal carcinoma]

OBJECTIVE

To investigate the alteration of MTS1/p16 gene in human esophageal carcinoma.

METHODS

A total of 60 human esophageal tissue specimens, comprising 30 squamous-cell carcinomas and 30 tumor-adjacent tissue specimens, were examined for homozygous deletion of p16 gene by using Southern blot hybridization and PCR method.

RESULTS

The results showed that no deletions were detected in 30 tumor-adjacent tissue samples. However, of 30 esophageal carcinoma specimens, 7 were found negative for p16 gene in Southern blot assay, and the deletion of the p16 gene in 5 samples were confirmed by PCR with a 16.7% p16 gene deletion rate.

CONCLUSION

These data suggest that MTS1/p16 gene alterations may play a role in the progression of human esophageal carcinoma.

Potent induction of a neutrophil and eosinophil-rich infiltrate in vivo by human mast cell tryptase: selective enhancement of eosinophil recruitment by histamine

Tryptase is the most abundant protein constituent of the secretory granules of human mast cells, but little is known of the contribution of this serine proteinase in acute allergic reactions. We have purified tryptase from human lung tissue by immunoaffinity procedures, and have investigated its potential to provoke an inflammatory infiltrate in vivo. Within 6 h of injection into the skin of guinea pigs, the accumulation of large numbers of neutrophils and eosinophils was observed, and those eosinophils closest to the injection site were partially degranulated. Similarly, injection of tryptase into the peritoneum of mice, even in quantities as low as 5 ng, stimulated the ingress of neutrophils. The response was dose dependent at 3, 6, and 16 h, with increases in median numbers of up to 400-fold. At the later time points eosinophil numbers were increased by up to 10-fold, and there were elevations also in the numbers of lymphocytes and macrophages. In both models, the actions of tryptase appeared to be dependent on an intact catalytic site. Coinjection of heparin with tryptase had relatively little effect on tryptase-induced responses. On the other hand, although histamine did not itself stimulate cell accumulation, over a range of concentrations it altered the cellular composition of the infiltrate induced by tryptase. Addition of histamine to tryptase provoked selective increases in eosinophil numbers of up to fivefold in the mouse peritoneum. Tryptase may provide an important stimulus for granulocyte recruitment in allergic disease.

Potent induction of a neutrophil and eosinophil-rich infiltrate in vivo by human mast cell tryptase: selective enhancement of eosinophil recruitment by histamine

Tryptase is the most abundant protein constituent of the secretory granules of human mast cells, but little is known of the contribution of this serine proteinase in acute allergic reactions. We have purified tryptase from human lung tissue by immunoaffinity procedures, and have investigated its potential to provoke an inflammatory infiltrate in vivo. Within 6 h of injection into the skin of guinea pigs, the accumulation of large numbers of neutrophils and eosinophils was observed, and those eosinophils closest to the injection site were partially degranulated. Similarly, injection of tryptase into the peritoneum of mice, even in quantities as low as 5 ng, stimulated the ingress of neutrophils. The response was dose dependent at 3, 6, and 16 h, with increases in median numbers of up to 400-fold. At the later time points eosinophil numbers were increased by up to 10-fold, and there were elevations also in the numbers of lymphocytes and macrophages. In both models, the actions of tryptase appeared to be dependent on an intact catalytic site. Coinjection of heparin with tryptase had relatively little effect on tryptase-induced responses. On the other hand, although histamine did not itself stimulate cell accumulation, over a range of concentrations it altered the cellular composition of the infiltrate induced by tryptase. Addition of histamine to tryptase provoked selective increases in eosinophil numbers of up to fivefold in the mouse peritoneum. Tryptase may provide an important stimulus for granulocyte recruitment in allergic disease.

[Penetration of ciprofloxacin and cefoperazone into human pancreas]

Major pancreatic infection is responsible for more than 80% of deaths in patients with acute pancreatitis. Therefore, the role of antimicrobial drugs in the prevention and treatment of secondary parcreatic infection is very important. The choice of antimicrobial drugs must be based upon the ability of the drug to exceed the therapeutic concentration in pancreas for the common pathogens. The penetration of ciprofloxacin and cefoperazone into pancreas was investigated in ten patients who had undergone pancreatoduodenectomy. The pancreatic juice was temporarily diverted to the exterior via a panoreatic duct catheter. The pancreatic tissue was obtained intraoperatively and pancreatic juice was drained postoperatively. The antimicrobial drug concentrations were determined by high-performance liquid chromatography. The concentrations of ciprofloxacin and cefoperazone in pancreatic juice were 44% and 17%, respectively, of those in serum, and exceeded the in vitro concentration (MIC-90) for most bacteria associated with pancreatic infections. The result indicates that ciprofloxacin and cefoprazone appear to be appropriate for both prophylaxis and therapy of secondary pancreatic infections.