Two mouse retinal degenerations caused by missense mutations in the beta-subunit of rod cGMP phosphodiesterase gene

We report the chromosomal localization, mutant gene identification, ophthalmic appearance, histology, and functional analysis of two new hereditary mouse models of retinal degeneration not having the Pde6brd1("r", "rd", or "rodless") mutation. One strain harbors an autosomal recessive mutation that maps to mouse chromosome 5. Sequence analysis showed that the retinal degeneration is caused by a missense point mutation in exon 13 of the beta-subunit of the rod cGMP phosphodiesterase (beta-PDE) gene (Pde6b). The gene symbol for this strain was set as Pde6brd10, abbreviated rd10 hereafter. Mice homozygous for the rd10 mutation showed histological changes at postnatal day 16 (P16) of age and sclerotic retinal vessels at four weeks of age, consistent with retinal degeneration. Retinal sections were highly positive for TUNEL and activated caspase-3 immunoreactivity, specifically in the outer nuclear layer (ONL). ERGs were never normal, but rod and cone ERG a- and b-waves were easily measured at P18 and steadily declined over 90% by two months of age. Protein extracts from rd10 retinas were positive for beta-PDE immunoreactivity starting at about the same time as wild-type (P10), though signal averaged less than 40% of wild-type. Interestingly, rearing rd10 mice in total darkness delayed degeneration for at least a week, after which morphological and functional loss progressed irregularly. With the second strain, a complementation test with rd1 mice revealed that the retinal degeneration phenotype observed represents a possible new allele of Pde6b. Sequencing demonstrated a missense point mutation in exon 16 of the beta-subunit of rod phosphodiesterase gene, different from the point mutations in rd1 and rd10. The gene symbol for this strain was set as Pde6bnmf137, abbreviated nmf137 hereafter. Mice homozygous for this mutation showed retinal degeneration with a mottled retina and white retinal vessels at three weeks of age. The exon 13 missense mutation (rd10) is the first known occurrence of a second mutant allele spontaneously arising in the Pde6b gene in mice and may provide a model for studying the pathogenesis of autosomal recessive retinitis pigmentosa (arRP) in humans. It may also provide a better model for experimental pharmaceutical-based therapy for RP because of its later onset and milder retinal degeneration than rd1 and nmf137.

Ocular complications of autoimmune polyendocrinopathy syndrome type 1

PURPOSE

To report the ocular complications in a series of patients with autoimmune polyendocrinopathy syndrome, type 1 (APS1).

METHODS

A retrospective study of 17 patients with APS1 syndrome treated at the department of ophthalmology, Our Lady's Hospital for Sick Children in Crumlin, Dublin, Ireland. All patients had clinical manifestations of the disease in keeping with the diagnostic criteria of APS1. Each patient had a comprehensive ophthalmic history taken and examination, including ocular symptoms, best-corrected visual acuity, slit-lamp biomicroscopy, tear film evaluation, and dilated ophthalmoscopic examination.

RESULTS

Six of 17 patients (35%) had corneal changes. Two patients (12%) had severe keratoconjunctivitis requiring hospitalization and intensive topical steroids and lubricants. The inflammation resulted in visual acuity reduction in one patient secondary to central corneal scarring. Other ocular findings included reduced tear production, as tested with Schirmers tear strips (63%), lens opacities (18%), hypotrichosis (12%), hypertrichosis (5.9%), anisometropic amblyopia (5.9%), and myopia (5.9%).

CONCLUSIONS

The most common and clinically important ocular manifestation of APS1 was keratoconjunctivitis associated with dry eye. This can result in progressive corneal scarring and vision loss.

Cortical visual function in the rd12 mouse model of Leber Congenital Amarousis (LCA) after gene replacement therapy to restore retinal function

One eye of rd12 mice received a sub-retinal injection of a vector carrying normal human RPE65 cDNA at post-natal day 18, and at 6- and 13-months of age. Electroretinograms (ERGs) and visual-evoked potentials (VEPs) were recorded to luminance, and to spatially and temporally modulated stimuli to assess the consequences of delayed treatment on visual pathway function. Early treatment resulted in better overall retinal rescue and better rescue of cone-mediated function. VEPs to low temporal frequency luminance modulation were well preserved at all but the oldest treatment age and corresponded to predictions based on the amount of retinal rescue. In contrast, VEPs to high frequency spatially and temporally modulated stimuli were impaired even at the earliest age. These results provide further support that early treatment in human LCA will have the most hope for optimal visual performance.

Brachial artery aneurysms in Menkes disease

Generalized vascular tortuosity caused by deficiency of the copper enzyme lysyl oxidase is frequently noted in Menkes disease, but reported examples of peripheral aneurysms are rare. We describe bilateral brachial artery aneurysms in a 10-month-old infant with classical Menkes disease.

Congenital infantile fibrosarcoma: a masquerader of ulcerated hemangioma

Congenital infantile fibrosarcoma, a rare malignant tumor of childhood, may present as a highly vascularized mass that is clinically difficult to distinguish from a hemangioma. When ulcerated, significant hemorrhage, anemia, and thrombocytopenia may occur in children with these lesions. This report describes three infants with ulcerated congenital infantile fibrosarcomas of the hand. As appropriate medical and surgical management hinges on timely and appropriate diagnosis, we review the clinical manifestations of these lesions.

"Cryoanalgesic preparation" before local anaesthetic injection for lid surgery

INTRODUCTION

Lid surgery under local anaesthetic is commonplace in ophthalmic practise. The most distressing part of the surgery for the patient is often the injection of local anaesthetic into the sensitive lid skin. Various methods like pre-injection warming of the anaesthetic agent, buffering pH levels, varying agents used, and using thinner gauge needles have been tried to reduce pain levels. Cooling of tissue is known to have anaesthetic properties and has been proposed as a substitute to injection of local anaesthetic in certain surgical procedures. In this study we use the anaesthetic property of cooling, as a pre local anaesthetic injection procedure ("Cryo-preparation"). The anaesthetic injection induced discomfort with and without "cryo-preparation" was then assessed.

METHODS

Thirty-nine patients aged 13-85 years (mean = 50, s.d. = 19) were randomly allocated and assessed. Twenty-two patients underwent local lid anaesthetic infiltration with "cryo-preparation," and 17 without. Pain monitoring was performed subjectively and objectively by scoring systems. Results were analysed using unpaired two tailed t-test on Microsoft Excel.

RESULTS

Significant reduction in injection pain with cryo-preparation (24.6% reduction in score) was achieved (statistically significant p = 0.039). Surgical anaesthesia was complete in all cases.

CONCLUSION

The study shows that "cryopreparation" by local ice application immediately prior to local anaesthetic injection reduces the sensitivity to the injection by a significant 24.6%. Thus while all the advantages of good analgesia are obtained from the injection, the distressing discomfort is reduced. This study serves as a pilot, in demonstrating a novel method of pain control for lid surgery.

Maternal cigarette smoking during pregnancy increases the risk of having a child with a congenital digital anomaly

BACKGROUND

The U.S. Natality database from 2001 and 2002 was used to investigate the relationship between maternal cigarette smoking during pregnancy and the risk of having a child with polydactyly, syndactyly, or adactyly.

METHODS

The records of 6,839,854 live births were examined to identify 5171 newborns with isolated polydactyly, syndactyly, or adactyly and 10,342 controls with no congenital anomalies.

RESULTS

Maternal cigarette use during pregnancy was associated with a significantly elevated risk of having a child with a congenital digital anomaly (unadjusted odds ratio, 1.33; 95 percent confidence interval, 1.21 to 1.47; p < 0.0001). Univariate analysis indicated that maternal marital status and medical risk factors (anemia, cardiac disease, lung disease, diabetes, hydramnios/oligohydramnios, pregnancy-associated hypertension, incompetent cervix, previous preterm or small-for-gestational-age infant, and rhesus factor sensitization) were potential confounding factors. After adjustment for these variables, the odds ratio remained significant (adjusted odds ratio, 1.31; 95 percent confidence interval, 1.18 to 1.45; p < 0.0001). Cigarette consumption per day was divided into four groups: no smoking, 1 to 10 cigarettes per day, 11 to 20 cigarettes per day, and 21 or more cigarettes per day. A statistically significant dose-response relationship was found when comparing each smoking category with the no-smoking reference group: 1.29 (95 percent confidence interval, 1.15 to 1.46), 1.38 (95 percent confidence interval, 1.12 to 1.71), and 1.78 (95 percent confidence interval, 0.97 to 3.26), respectively. Increased cigarette smoking during pregnancy resulted in an elevated risk of having a child with polydactyly, syndactyly, or adactyly.

CONCLUSIONS

This is the largest study to date to investigate specifically the association between maternal cigarette smoking and the risk of having a newborn with a congenital digital anomaly. The elevated odds ratio for tobacco use and the significant trend in the dose-response relationship suggests smoking during pregnancy may be an important preventable risk factor for these common congenital differences.

Nerve palsies related to pediatric upper extremity fractures

In every child who has a fracture, neurologic examination is essential at initial assessment so that early diagnosis of nerve injury can be made. Electrodiagnostic studies may be helpful in diagnosis when the examination is equivocal and in follow-up to look for signs of recovery. In a patient who has neurologic deficits associated with a fracture, nerve exploration should be considered for open fractures, fractures that require open reduction, and palsies that develop after fracture reduction. For closed fractures associated with nerve palsy at the time of initial injury, observation and serial examination after reduction is recommended. If there is no return of nerve function on examination or electrodiagnostic testing by 4 months, operative exploration is indicated.

Mouse models of ocular diseases

The Jackson Laboratory, having the world's largest collection of mouse mutant stocks and genetically diverse inbred strains, is an ideal place to discover genetically determined eye variations and disorders. In this paper, we list and describe mouse models for ocular research available from Mouse Eye Mutant Resource at The Jackson Laboratory. While screening mouse strains and stocks at The Jackson Laboratory (TJL) for genetic mouse models of human ocular disorders, we have identified numerous spontaneous or naturally occurring mutants. We characterized these mutants using serial indirect ophthalmoscopy, fundus photography, electroretinography (ERG) and histology, and performed genetic analysis including linkage studies and gene identification. Utilizing ophthalmoscopy, electroretinography, and histology, to date we have discovered 109 new disorders affecting all aspects of the eye including the lid, cornea, iris, lens, and retina, resulting in corneal disorders, glaucoma, cataracts, and retinal degenerations. The number of known serious or disabling eye diseases in humans is large and affects millions of people each year. Yet research on these diseases frequently is limited by the obvious restrictions on studying pathophysiologic processes in the human eye. Likewise, many human ocular diseases are genetic in origin, but appropriate families often are not readily available for genetic studies. Mouse models of inherited ocular disease provide powerful tools for rapid genetic analysis, characterization, and gene identification. Because of the great similarity among mammalian genomes, these findings in mice have direct relevance to the homologous human conditions.

Hypoxia reduces adenoviral replication in cancer cells by downregulation of viral protein expression

Successful cancer therapy using replicating viral vectors relies on the spread of virus from infected to uninfected cells. To date, there has been limited clinical success in the use of replicating adenoviruses. In animal models, established xenograft tumors are rarely eliminated despite the persistence of high viral titers within the tumor. Hypoxia is a prevalent characteristic of solid tumors, whereas adenovirus naturally infects tissues exposed to ambient oxygen concentrations. Here, we report that hypoxia (1% oxygen) reduces adenoviral replication in H1299 and A549 lung cancer cells, BxPC-3 pancreatic cancer cells, LNCaP prostate cancer cells and HCT116 colon cancer cells. However, hypoxia does not reduce cell viability or restrict S-phase entry. Importantly, the production of E1a and fiber proteins under hypoxic conditions was substantially decreased at 24 and 48 h compared to room air controls. In contrast, Northern analysis showed similar levels of E1a mRNA in room air and hypoxic conditions. In conclusion, a level of hypoxia similar to that found within solid tumors reduces the replication of adenoviral vectors by reduction of viral protein expression without a reduction in mRNA levels. To further improve oncolytic therapy using a replicating adenovirus, it is important to understand the mechanism through which hypoxia and the virus interact to control expression of viral and cellular proteins, and consequently to develop means to overcome decreased viral production in hypoxic conditions.

Interleukin-1 receptor antagonist haplotype associated with prostate cancer risk

IL1-RN is an important anti-inflammatory cytokine that modulate the inflammation response by binding to IL1 receptors, and as a consequence inhibits the action of proinflammatory cytokines IL1alpha and IL1beta. In this study, we hypothesise that sequence variants in the IL1-RN gene are associated with prostate cancer risk. The study population, a population-based case-control study in Sweden, consisted of 1383 prostate cancer case patients and 779 control subjects. We first selected 18 sequence variants covering the IL1-RN gene and genotyped these single-nucleotide polymorphisms (SNPs) in 96 control subjects. Gene-specific haplotypes of IL1-RN were constructed and four haplotype-tagging single-nucleotide polymorphisms (htSNPs) were identified (rs878972, rs315934, rs3087263 and rs315951) that could uniquely describe >95% of the haplotypes. All study subjects were genotyped for the four htSNPs. No significant difference in genotype frequencies between cases and controls were observed for any of the four SNPs based on a multiplicative genetic model. Overall there was no significant difference in haplotype frequencies between cases and controls; however, the prevalence of the most common haplotype (ATGC) was significantly higher among cases (38.7%) compared to controls (33.5%) (haplotype-specific P = 0.009). Evaluation of the prostate cancer risk associated with carrying the 'ATGC' haplotype revealed that homozygous carriers were at significantly increased risk (odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.2-2.2), compared to noncarriers, while no significant association was found among subjects heterozygous for the haplotype (OR = 1.0, 95% CI = 0.8-1.2). Restricting analyses to advanced prostate cancer strengthened the association between the 'ATGC' haplotype and disease risk (OR for homozygous carriers vs noncarriers 1.8, 95% CI = 1.3-2.5). In conclusion, the results from this study support the hypothesis that inflammation has a role of in the development of prostate cancer, but further studies are needed to identify the causal variants in this region and to elucidate the biological mechanism for this association.

Neuroblastoma with orbital metastasis: ophthalmic presentation and role of ophthalmologists

INTRODUCTION

Neuroblastoma is predominantly a tumour of early childhood, which metastasises to the orbits. In such cases, ophthalmologists are involved in the multidisciplinary management. This unique series from a tertiary referral centre is used to elaborate the ophthalmic associations and the ophthalmologist's role in this rare condition.

METHODS

A review of case notes was performed on six patients who presented to the paediatric ophthalmology - oncology liaison service at the Leeds teaching hospitals between 1998 and 2003. The ophthalmic outcome and role of the ophthalmologist were assessed.

RESULTS

Average age of presentation was 29.8 months (range 15-69 months). Average duration of follow-up was 19.5 months (range 2-58 months). One child died during treatment. Two have completed treatment and are under follow-up. Presenting features of the six children were proptosis in four, periorbital ecchymosis in two, ocular motility restriction in two, and subconjunctival haemorrhage in one. Only one case developed blindness.

CONCLUSIONS

The role of the ophthalmologist in patients with metastatic orbital neuroblastoma can vary from a supportive role to one of active intervention and management of ophthalmic complications. The ophthalmologist is involved in diagnosis and staging as well as monitoring response to treatment of both the primary disease and secondary ophthalmic complications.

A case series on chronic canaliculitis

INTRODUCTION

Primary chronic canaliculitis is an uncommon disease, which is often misdiagnosed and insufficiently treated. We present two cases of canaliculitis caused by two different organisms, Actinomycetes spp. and Arcanobacterium haemolyticum. To the best of our knowledge, canaliculitis due to Arcanobacterium haemolyticum has not been reported before.

PATIENTS AND METHODS

The two cases described in this series show typical clinical features of canaliculitis with an inflamed upper canaliculus, not responsive to topical antibiotics. Appropriate treatment was delayed as they were initially treated for conjunctivitis. Both patients were treated with a canaliculotomy, with curettage and subsequent treatment with topical and systemic penicillin. The contents were sent for microbiological examination.

RESULTS

There was complete resolution following treatment. Actinomyces spp. was grown from one patient as expected. However, in the second patient, Arcanobacterium haemolyticum was isolated. Although this organism was not expected, the patient did respond to similar, conventional treatment.

DISCUSSION

Actinomyces spp. is a cast-forming Gram-positive anaerobe. They are difficult to isolate and identify and can cause infections of hollow spaces with formation of canaliculiths. Arcanobacterium (Corynebacterium) haemolyticum closely resembles Actinomyces (Corynebacterium) pyogenes. Ocular infections reported with this organism include orbital cellulitis and subperiosteal abscesses. The difficulty encountered in the isolation and identification of these organisms is discussed and the need for thorough curettage in the treatment of persistent or recurrent canaliculitis is emphasised.

CONCLUSION

Chronic canaliculitis should be considered in any patient who presents with chronic or recurrent conjunctivitis. Definitive cure will not be affected until all concretions are removed, either at surgery or by mechanical expression.

A Simple Method of Designing a Bilobed Flap Using a Triangle Template

BACKGROUND

The bilobed flap is useful for the reconstruction of skin defects in which the primary closure is difficult. Proper design is paramount to achieve excellent cosmetic results, but flap design often appears unnecessarily complex and difficult.

OBJECTIVE

The objective was to discuss the geometry of the bilobed flap and describe a simple and practical method for constructing such flaps using a triangle template with emphasis on the pivot point.

METHODS

A detailed description with diagrams and an illustrative case are presented to demonstrate the technique.

RESULTS

A patient with a scalp defect was reconstructed with a triangle-template-designed bilobed flap with excellent postoperative results.

CONCLUSION

This new method using a triangle template ensures proper placement of the pivot point and will enable practitioners to achieve superior outcomes.

Percutaneous technique for reduction of complex metacarpophalangeal dislocations

Historically, complex metacarpophalangeal (MCP) joint dislocations have necessitated open surgical management by either a volar or dorsal approach. The authors describe a relatively simple and reliable percutaneous technique to treat these complex MCP dislocations, with results comparable with open surgical reduction. This minimally invasive technique can be performed in the emergency room setting, thereby avoiding the cost and morbidity associated with an open procedure in the operating room. From 1996 to 2003, the percutaneous technique was performed on 4 patients with complex MCP joint dislocations. Three patients underwent percutaneous reduction in an operating room whereas the fourth patient was reduced in the emergency room. Successful reduction was attained on the first attempt in all 4 patients without complications. All dislocations were stable after reduction. Near full, painless range of motion was achieved in all 4 patients and there were no cases of recurrent instability. All patients were satisfied with their results.

A Rare Brachial Artery Pseudoaneurysm 13 Years After Excision of a Humeral Osteochondroma

Pseudoaneurysms resulting from vascular impingement by osteochondromas are extremely rare. The authors detail the case of a 19-year-old man who represents the third known report in the English literature of a brachial artery pseudoaneurysm associated with a humeral osteochondroma. In patients presenting with a painful upper arm mass and a history of multiple hereditary exostoses, one must have a high index of suspicion for pseudoaneurysm.

Hereditary prostate cancer in African American families: linkage analysis using markers that map to five candidate susceptibility loci

African American men have the highest incidence of prostate cancer in the world. Despite this statistic, linkage studies designed to localise prostate cancer susceptibility alleles have included primarily men of Caucasian descent. In this report, we performed a linkage analysis using 33 African American prostate cancer families from two independent research groups. In total, 126 individuals (including 89 men with prostate cancer) were genotyped using markers that map to five prostate cancer susceptibility loci, namely HPC1 at 1q24–25, PCAP at 1q42.2–43, CAPB at 1p36, HPC20 on chromosome 20, and HPCX at Xq27–28. Multipoint mode-of-inheritance-free linkage analyses were performed using the GENEHUNTER software. Some evidence of prostate cancer was detected to HPC1 using all families with a maximum NPL Z score of 1.12 near marker D1S413 (P=0.13). Increased evidence of linkage was observed in the 24 families with prostate cancer diagnosis prior to age 65 years and in the 20 families with male-to-male transmission. Some evidence of prostate cancer linkage was also detected at markers mapping to PCAP, HPC20, and HPCX. Continued collection and analysis of African American prostate cancer families will lead to an improved understanding of inherited susceptibility in this high-risk group.

Electronic transport in a controllably grown carbon nanotube-silicon heterojunction array

A uniform array of a new type of heterojunction formed between carbon nanotubes and silicon is studied. The heterojunction array was controllably grown with parallel and uniform nanotubes vertically aligned to the silicon substrate using a self-organized nanopore array template. The pronounced rectifying characteristics of the heterojunction were measured with an on/off ratio as high as 10(5) at 4 V. The analysis shows a large and type-I band offset at the heterojunction. The charge transport in the nanotubes is found to be strongly coupled to and limited by the dielectric charging and polarization in the hosting alumina matrix surrounding the nanotubes.

Vascular malformation within the flexor tendon sheath

We report an unusual location of a capillary vascular malformation found entirely within the flexor tendon sheath of an 8-year-old girl. Vascular malformations have been found in many locations throughout the hand but have, to our knowledge, not been reported to involve the vinculum of the flexor tendon sheath. The vascular malformation was contained completely within the sheath. Therapeutic management involved surgical excision of the vascular malformation.

[Application of immunochromatographic test for diagnosis and surveillance of bancroftian filariasis]

AIM

To evaluate the usefulness of immunochromatographic test (ICT) for rapid diagnosis and surveillance of Wuchereria bancrofti infection.

METHODS

The monoclonal antibody based-ICT assay was used to detect filarial antigens in the sera from bancroftian filariasis patients.

RESULTS

111 out of 116 bancroftian microfilaria cases showed positive ICT reaction, giving a positive rate of 95.7%. Serum samples from 12 malayian microfilaremia cases, 33 ascariasis cases, 20 schistosomiasis japonica cases and 6 trichinellosis cases were all found negative in ICT, demonstrating a specificity of 100%. In 73 chronic filariasis cases with elephantiasis, hydrocoele, and chyluria cases, 18 showed ICT positive, among whom 16 revealed microfilaremia, suggesting that the ICT positive cases were with active infections. Of the 30 microfilaremia cases before single dose ivermectin treatment, 29 were ICT positive (96.7%). A negative conversion of microfilaremia was observed in all cases 8-14 days post-treatment. Upon following up to 6 and 12 months, microfilaremia reappeared in 5 and 7 cases, respectively. 5 out of 13 ICT positive cases were found microfilaremic at 6 month post-treatment, while among the rest of 8, 5 were found microfilaremic at 12 month post-treatment. Parallel use of ICT with routine blood film examination in Houda village, Zhecheng County, Henan Province for a post-control surveillance survey in 132 local individuals revealed 9 microfilaremia cases were also ICT positive. Of the 123 persons with negative blood examination, only 1 was ICT positive.

CONCLUSION

ICT is a rapid and simple method with high sensitivity and specificity, and might be used for the diagnosis, efficacy evaluation as well as a tool for post-control surveillance of bancroftian filarasis.

Pulsed irrigation of extremity wounds: a simple technique for splashback reduction

Although blood and body fluid exposures are daily events often assumed to be unavoidable by operating room personnel, the potentially lethal consequences of blood-borne pathogen transmission demand preventive measures to minimize contamination risk. The authors outline a simple technique of extremity irrigation that uses a clear plastic isolation drape, pulsed lavage equipment, and surgical suction. They have found that this technique allows for thorough irrigation of wounds while providing optimal barrier protection.

Evidence for shared genetic programs from cluster analysis of hippocampal gene expression dynamics in development and response to injury

Cluster analysis is a computational method that groups together similarly-shaped patterns. It may be applied to large-scale gene expression data to form new hypotheses regarding gene function. In the present study, we clustered the temporal expression patterns of genes expressed in the rat hippocampus during normal development and after a kainate-induced seizure injury at postnatal day 25. We found that two different methods, Euclidean hierarchical and K-means clustering, produced slightly different results, and concluded that different clustering methods may he used to complement one another. We also found that certain genes cluster together both during development and after seizure injury, consistent with the idea of sets of genes that act in concert under various conditions.

Retinal degeneration mutants in the mouse

The Jackson Laboratory, having the world's largest collection of mouse mutant stocks and genetically diverse inbred strains, is an ideal place to look for genetically determined eye variations and disorders. Through ophthalmoscopy, electroretinography and histology, we have discovered disorders affecting all aspects of the eye including the lid, cornea, iris, lens and retina, resulting in corneal disorders, cataracts, glaucoma and retinal degenerations. Mouse models of retinal degeneration have been investigated for many years in the hope of understanding the causes of photoreceptor cell death. Sixteen naturally occurring mouse mutants that manifest degeneration of photoreceptors in the retina with preservation of all other retinal cell types have been found: retinal degeneration (formerly rd, identical with rodless retina, r, now Pde6b(rd1)); Purkinje cell degeneration (pcd); nervous (nr); retinal degeneration slow (rds, now Prph(Rd2)); retinal degeneration 3 (rd3); motor neuron degeneration (mnd); retinal degeneration 4 (Rd4); retinal degeneration 5 (rd5, now tub); vitiligo (vit, now Mitf(mi-vit)); retinal degeneration 6 (rd6); retinal degeneration 7 (rd7, now Nr2e3(rd7)); neuronal ceroid lipofuscinosis (nclf); retinal degeneration 8 (rd8); retinal degeneration 9 (Rd9); retinal degeneration 10 (rd10, now Pde6b(rd10)); and cone photoreceptor function loss (cpfl1). In this report, we first review the genotypes and phenotypes of these mutants and second, list the mouse strains that carry each mutation. We will also provide detailed information about the cpfl1 mutation. The phenotypic characteristics of cpfl1 mice are similar to those observed in patients with complete achromatopsia (ACHM2, OMIM 216900) and the cpfl1 mutation is the first naturally-arising mutation in mice to cause cone-specific photoreceptor function loss. cpfl1 mice may provide a model for congenital achromatopsia in humans.

A functional role for intra-axonal protein synthesis during axonal regeneration from adult sensory neurons

Although intradendritic protein synthesis has been documented in adult neurons, the question of whether axons actively synthesize proteins remains controversial. Adult sensory neurons that are conditioned by axonal crush can rapidly extend processes in vitro by regulating the translation of existing mRNAs (Twiss et al., 2000). These regenerating processes contain axonal but not dendritic proteins. Here we show that these axonal processes of adult sensory neurons cultured after conditioning injury contain ribosomal proteins, translational initiation factors, and rRNA. Pure preparations of regenerating axons separated from the DRG cell bodies can actively synthesize proteins in vitro and contain ribosome-bound beta-actin and neurofilament mRNAs. Blocking protein synthesis in these regenerating sensory axons causes a rapid retraction of their growth cones when communication with the cell body is blocked by axotomy or colchicine treatment. These findings indicate that axons of adult mammalian neurons can synthesize proteins and suggest that, under some circumstances, intra-axonal translation contributes to structural integrity of the growth cone in regenerating axons. By immunofluorescence, translation factors, ribosomal proteins, and rRNA were also detected in motor axons of ventral spinal roots analyzed after 7 d in vivo after a peripheral axonal crush injury. Thus, adult motor neurons are also likely capable of intra-axonal protein synthesis in vivo after axonal injury.

Linkage and association of CYP17 gene in hereditary and sporadic prostate cancer

Androgens are essential for prostate development, growth and maintenance and the association between androgen levels and prostate cancer is well established. Since the CYP17 gene encodes the enzyme cytochrome P450c17alpha, which mediates 17alpha-hydroxylase and 17,20-lyase activities in the androgen biosynthesis pathway, sequence variations in the gene and association with increased risk to prostate cancer has been studied. In particular, several groups have studied the association between a polymorphism in the 5' promoter region and prostate cancer using a population-based association approach. However, the results from these studies were inconclusive. To further study this polymorphism and its possible role in hereditary prostate cancer (HPC), we performed a genetic linkage analysis and family-based association analysis in 159 families, each of which contains at least 3 first-degree relatives with prostate cancer. In addition, we performed a population-based association analysis to compare the risk of this polymorphism to hereditary and sporadic prostate cancer in 159 HPC probands, 249 sporadic prostate cancer patients and 211 unaffected control subjects. Evidence for linkage at the CYP17 gene region was found in the total 159 HPC families (LOD = 1.3, p = 0.01, at marker D10S222). However, family-based association tests did not provide evidence for overtransmission of either allele of the CYP17 polymorphism to affected individuals in the HPC families. The allele and genotype frequencies of the polymorphism were not statistically different among the HPC probands, sporadic cases and unaffected control subjects. In conclusion, our results suggest that the CYP17 gene or other genes in the region may increase the susceptibility to prostate cancer in men; however, the polymorphism in the 5' promoter region has a minor role if any in increasing prostate cancer susceptibility in our study sample.

Frequency of anovulation and early menopause among women enrolled in selected adult AIDS clinical trials group studies

To obtain information on the prevalence of anovulation and early menopause and on pituitary-gonadal function among human immunodeficiency virus type 1-infected women, a study was undertaken that used stored serum samples from women aged 20-42 years who participated in selected Adult AIDS Clinical Trials Group protocols. Defined progesterone and follicle-stimulating hormone (FSH) levels were considered presumptive evidence of ovulation and of menopause, respectively. Anovulation occurred in 16 (48%) of 33 women for whom progesterone levels were tested; early menopause occurred in 2 (8%) of 24 women for whom FSH levels were tested. No statistically significant differences were seen in the demographic and clinical characteristics of anovulatory and ovulatory women, although women who ovulated had higher CD4 T cell counts and were less likely to have reported a recent change in menstrual periods. These data support the findings of prior studies of increased frequency of amenorrhea and/or irregular menstrual cycles, particularly among women with lower CD4 T cell counts.

Underappreciation of sleep disorders as a cause of motor vehicle crashes

Despite an increased risk of motor vehicle crashes (MVC) in patients with obstructive sleep apnea (OSA), we hypothesized that OSA was not considered in drivers admitted to trauma centers after an injury-producing MVC. A retrospective study on drivers involved in MVCs admitted to a level 1 trauma center was performed, with crash cause determined and the frequency of sleep studies recorded. A questionnaire was also mailed to 240 trauma centers seeking information on evaluation of patients with unexplained causes for MVCs, including screening for OSA. There were 122 drivers of MVCs admitted to our hospital, 60/122 (49%) had unexplained crashes and no sleep studies were performed. There were 70 survey respondents (30% return rate), 35/70 (50%) centers routinely screened for syncope after unexplained MVC, however, no center screened for OSA. US trauma centers do not screen for sleep disorders despite the associated increased crash risk and the high prevalence of crashes that can not be explained by other causes. We believe this reflects a lack of awareness of sleep disorders by health care professionals caring for trauma victims and education is of utmost importance.

The evolution of acetyl-CoA synthase

Acetyl-coenzyme A synthases (ACS) are Ni-Fe-S containing enzymes found in archaea and bacteria. They are divisible into 4 classes. Class I ACS's catalyze the synthesis of acetyl-CoA from CO2 + 2e-, CoA, and a methyl group, and contain 5 types of subunits (alpha, beta, gamma, delta, and epsilon). Class II enzymes catalyze essentially the reverse reaction and have similar subunit composition. Class III ACS's catalyze the same reaction as Class I enzymes, but use pyruvate as a source of CO2 and 2e-, and are composed of 2 autonomous proteins, an alpha 2 beta 2 tetramer and a gamma delta heterodimer. Class IV enzymes catabolize CO to CO2 and are alpha-subunit monomers. Phylogenetic analyses were performed on all five subunits. ACS alpha sequences divided into 2 major groups, including Class I/II sequences and Class III/IV-like sequences. Conserved residues that may function as ligands to the B- and C-clusters were identified. Other residues exclusively conserved in Class I/II sequences may be ligands to additional metal centers in Class I and II enzymes. ACS beta sequences also separated into two groups, but they were less divergent than the alpha's, and the separation was not as distinct. Class III-like beta sequences contained approximately 300 residues at their N-termini absent in Class I/II sequences. Conserved residues identified in beta sequences may function as ligands to active site residues used for acetyl-CoA synthesis. ACS gamma-sequences separated into 3 groups (Classes I, II, and III), while delta-sequences separated into 2 groups (Class I/II and III). These groups are less divergent than those of alpha sequences. ACS epsilon-sequence topology showed greater divergence and less consistency vis-à-vis the other subunits, possibly reflecting reduced evolutionary constraints due to the absence of metal centers. The alpha subunit phylogeny may best reflect the functional diversity of ACS enzymes. Scenarios of how ACS and ACS-containing organisms may have evolved are discussed.

Intraocular pressure and pulsatile ocular blood flow after retrobulbar and peribulbar anaesthesia

AIMS

This study investigated the effect of peribulbar and retrobulbar local anaesthesia on intraocular pressure (IOP) and pulsatile ocular blood flow (POBF), as such anaesthetic techniques may adversely affect these parameters.

METHODS

20 eyes of 20 patients who were to undergo phacoemulsification cataract surgery were prospectively randomised to receive peribulbar or retrobulbar anaesthesia. The OBF tonometer (OBF Labs, Wiltshire, UK) was used to simultaneously measure IOP and POBF before anaesthesia and 1 minute and 10 minutes after anaesthesia. Between group comparisons of age, baseline IOP, and baseline POBF were performed using the non-parametric Mann-Whitney test. Within group comparisons of IOP and POBF measured preanaesthesia and post-anaesthesia were performed using the non-parametric Wilcoxon signed ranks test for both groups.

RESULTS

There was no statistically significant IOP increase post-anaesthesia in either group. In the group receiving peribulbar anaesthesia, there was a significant reduction in POBF initially post-anaesthesia which recovered after 10 minutes. In the group receiving retrobulbar anaesthesia, there was a persistent statistically significant reduction in POBF.

CONCLUSIONS

Retrobulbar and peribulbar injections have little effect on IOP. Ocular compression is not needed for IOP reduction when using local anaesthesia for cataract surgery. Conversely, POBF falls, at least for a short time, when anaesthesia for ophthalmic surgery is administered via a retrobulbar route or a peribulbar route. This reduction may be mediated by pharmacologically altered orbital vascular tone. It may be safer to use other anaesthetic techniques in patients with ocular vascular compromise.

Treadmill injuries to the upper extremity in pediatric patients

Injury is the leading cause of preventable death and disability in childhood and early adulthood. Approximately 25,000 children are injured on exercise equipment each year. Although hand injuries sustained on stationary bicycles in the home have been well documented, little has been reported on home treadmill injuries. Between September 1996 and March 2000, the authors treated 12 children at The Children's Hospital of Philadelphia for injuries to the upper extremity sustained on a treadmill. The age at the time of injury ranged from 14 months to 7 years, with a median age of 2.4 years. Average length of follow-up was 11.4 months. Ten of the 12 children sustained partial- or full-thickness burns to the volar aspect of the hand and digits. Overall, 6 patients required surgical repair. A total of 25% of the volar flexion creases involved required surgery. All patients had good functional results. The authors discuss the mechanism of injury, management, and measures to prevent treadmill injuries to children. To their knowledge, this is the first report of such injuries resulting from the use of a treadmill.

Evidence for a prostate cancer linkage to chromosome 20 in 159 hereditary prostate cancer families

Prostate cancer is the most common malignancy diagnosed in men in the US. Genetic susceptibility to prostate cancer has been well documented. A region at chromosome 20q13 (HPC20) has been reported to be linked to a prostate cancer susceptibility gene. To confirm this finding, we genotyped 16 markers spanning approximately 95 cM on chromosome 20 in 159 hereditary prostate cancer (HPC) families. Positive (but not statistically significant) linkage scores were observed from 20pter to 20q11, with the highest non-parametric linkage (NPL) score for the complete dataset of 1.02 (P=0.15) being observed at D20S195 at 20q11. Evidence for linkage from parametric analyses with a dominant or a recessive model was weak. Interestingly, consistent with the original findings of linkage to 20 g higher linkage scores were observed in the subsets of families with a later age at diagnosis (> or =65 years; n=80, NPL=1.94, P=0.029 at D20S186), fewer than five affected family members (n=69, NPL=1.74, P=0.037 at D20S889), or without male-to-male disease transmission (n=60, NPL=1.01, P=0.15 at D20S117). The region with positive linkage scores spanned approximately 60 cM from 20pter to 20q11 in these subsets of families. Our results are consistent with a prostate cancer susceptibility locus on chromosome 20.

Ultraviolet-Assisted Punch Biopsy Mapping for Lentigo Maligna Melanoma

Lentigo maligna melanoma (LMM) accounts for a substantial incidence of all locally recurrent melanoma. In addition, the head and neck area accounts for 60% to 90% of all LMMs, which has important functional and cosmetic implications. The difficulty in the identification of the true borders of LMM may account for the high incidence of local recurrence. The purpose of this study was to evaluate the efficacy of ultraviolet-assisted punch biopsy mapping to identify clear margins using identified, 2-mm circumferentially arranged punch biopsies at the junction of the pigmented and nonpigmented borders. A retrospective chart review of 20 patients with biopsy-confirmed LMM of the head and neck was performed. Using ultraviolet identification, 2-mm circumferentially arranged biopsy specimens were obtained and sent for formal pathological review, including immunohistochemical staining. The average time for completion of pathological review was 5 to 7 days. If the punch biopsies were positive for lentigo maligna or LMM, punch biopsies were obtained more peripherally. Once clear, margins were obtained and definitive resection was performed. Twenty patients with biopsy-proved LMM were evaluated. Follow-up ranged from 6 months to 3 years (mean follow-up, 1 year). Fourteen patients were cleared after their first series of biopsies, 3 patients required a second series of biopsies, 2 patients required a third session, and 1 patient required a fourth biopsy session. To date, there has been no evidence of recurrence. No patients required reexcision for positive surgical margins. One complication has been local cellulitis of a punch biopsy site requiring a short course of antibiotics. Ultraviolet-assisted punch biopsy mapping of LMM is a safe, well-tolerated, and accurate technique for identifying the true histological margin of LMM. The procedure reduces the need for repeat surgical excisions to obtain clear margins and may decrease the risk for recurrence by mapping accurately the true histological margin.

Primary retroperitoneal seminoma with utrasonically abnormal testes

Primary retroperitoneal seminomas account for approximately 2% of all seminomas. Differentiating the primary retroperitoneal tumor from a metastatic tumor with an occult testicular primary remains difficult despite the availability of ultrasonic examination. We present a case of primary retroperitoneal seminoma with ultrasonically demonstrated abnormalities in both testes. The patient underwent a unilateral orchiectomy and ultrasound-guided biopsy of the opposite testis. All surgical specimens were negative for testis cancer. Controversial issues in the diagnosis and treatment of primary retroperitoneal germ cell tumors are discussed.

Laparoscopic orchidopexy: a review of a large clinical series

OBJECTIVE

To report the overall success rate of a laparoscopic orchidopexy (LO) series over 5 years including over 100 procedures.

PATIENTS AND METHODS

The records were reviewed of children who underwent laparoscopic procedures for an impalpable testis at our institutions. The laparoscopic procedures included the standard LO and one-stage and staged Fowler-Stephens (F-S) LOs. The success of orchidopexy was defined as a testis in the scrotum with no atrophy after surgery.

RESULTS

From 1994, 80 children (101 impalpable testes) were treated using LO. Of these patients, 20 (25%) had impalpable testes on the right, 39 (50%) were on the left and 21 (25%) were bilateral. The testicular location was identified during laparoscopy as: intra-abdominal in 46, iliac in 14, in the internal ring in 22, 'peeping' in 12, behind the bladder in three and intracanulicular in four. Standard LO was used in 72 testes, a one-stage F-S in 20 and a two-stage F-S in nine (first stage two, second stage seven). The median (range) age of the patients was 18 months (0.5-12 years); the mean (range) follow-up was 5 (1-36) months. After orchidopexy the testis was scrotal in 90 (low 78, mid four and high eight), at the pubis in one and not stated in seven (no follow-up available). Four patients (4%) had testicular atrophy from failed F-S orchidopexies, two of whom had undergone previous testicular surgery and one caused by additional dissection around the vas. The overall success rate, including only those with follow-up, was 96% (90 of 94). Of the 20 one-stage F-S orchidopexies, 17 testes were successfully placed in the scrotum with no atrophy. The overall success rate for all F-S procedures was 85% (23 of 27). However, excluding patients who had previous testicular surgery or who required extensive dissection near the vas, 96% (23 of 24) of the testes were successfully placed into the scrotum with no atrophy.

CONCLUSION

The high overall success rate in placing the testis into the scrotum through laparoscopic procedures is considerably better than reported in other series to date. LO is an effective method for managing intra-abdominal testes in children. Patients who had undergone previous surgery had a higher risk of developing testicular atrophy. The additional dissection around the vas almost inevitably leads to testicular atrophy.

Linkage of prostate cancer susceptibility loci to chromosome 1

Three prostate cancer susceptibility genes have been reported to be linked to different regions on chromosome 1: HPC1 at 1q24-25, PCAP at 1q42-43, and CAPB at 1p36. Replication studies analyzing each of these regions have yielded inconsistent results. To evaluate linkage across this chromosome systematically, we performed multipoint linkage analyses with 50 microsatellite markers spanning chromosome 1 in 159 hereditary prostate cancer families (HPC), including 79 families analyzed in the original report describing HPC1 linkage. The highest lod scores for the complete dataset of 159 families were observed at 1q24-25 at which the parametric lod score assuming heterogeneity (hlod) was 2.54 (P=0.0006) with an allele sharing lod of 2.34 (P=0.001) at marker D1S413, although only weak evidence was observed in the 80 families not previously analyzed for this region (hlod=0.44, P=0.14, and allele sharing lod=0.67, P=0.08). In the complete data set, the evidence for linkage across this region was very broad, with allele sharing lod scores greater than 0.5 extending approximately 100 cM from 1p13 to 1q32, possibly indicating the presence of multiple susceptibility genes. Elsewhere on chromosome 1, some evidence of linkage was observed at 1q42-43, with a peak allele sharing lod of 0.56 (P=0.11) and hlod of 0.24 (P=0.25) at D1S235. For analysis of the CAPB locus at 1p36, we focused on six HPC families in our collection with a history of primary brain cancer; four of these families had positive linkage results at 1p36, with a peak allele sharing lod of 0.61 (P=0.09) and hlod of 0.39 (P=0.16) at D1S407 in all six families. These results are consistent with the heterogeneous nature of hereditary prostate cancer, and the existence of multiple loci on chromosome 1 for this disease.

Penetrating esophageal injuries: multicenter study of the American Association for the Surgery of Trauma

OBJECTIVE

The purpose of this study was to define the period of time after which delays in management incurred by investigations cause increased morbidity and mortality. The outcome study is intended to correlate time with death from esophageal causes, overall complications, esophageal related complications, and surgical intensive care unit length of stay.

METHODS

This was a retrospective multicenter study involving 34 trauma centers in the United States, under the auspices of the American Association for the Surgery of Trauma Multi-institutional Trials Committee over a span of 10.5 years. Patients surviving to reach the operating room (OR) were divided into two groups: those that underwent diagnostic studies to identify their injuries (preoperative evaluation group) and those that went immediately to the OR (no preoperative evaluation group). Statistical methods included Fisher's exact test, Student's T test, and logistic regression analysis.

RESULTS

The study involved 405 patients: 355 male patients (86.5%) and 50 female patients (13.5%). The mean Revised Trauma Score was 6.3, the mean Injury Severity Score was 28, and the mean time interval to the OR was 6.5 hours. There were associated injuries in 356 patients (88%), and an overall complication rate of 53.5%. Overall mortality was 78 of 405 (19%). Three hundred forty-six patients survived to reach the OR: 171 in the preoperative evaluation group and 175 in the no preoperative evaluation group. No statistically significant differences were noted in the two groups in the following parameters: number of patients, age, Injury Severity Score, admission blood pressure, anatomic location of injury (cervical or thoracic), surgical management (primary repair, resection and anastomosis, resection and diversion, flaps), number of associated injuries, and mortality. Average length of time to the OR was 13 hours in the preoperative evaluation group versus 1 hour in the no preoperative evaluation group (p < 0.001). Overall complications occurred in 134 in the preoperative evaluation group versus 87 in the no preoperative evaluation group (p < 0.001), and 74 (41%) esophageal related complications occurred in the preoperative evaluation group versus 32 (19%) in the no preoperative evaluation group (p = 0.003). Mean surgical intensive care unit length of stay was 11 days in the preoperative evaluation group versus 7 days in the no preoperative evaluation group (p = 0.012). Logistic regression analysis identified as independent risk factors for the development of esophageal related complications included time delays in preoperative evaluation (odds ratio, 3.13), American Association for the Surgery of Trauma Organ Injury Scale grade >2 (odds ratio, 2.62), and resection and diversion (odds ratio, 4.47).

CONCLUSION

Esophageal injuries carry a high morbidity and mortality. Increased esophageal related morbidity occurs with the diagnostic workup and its inherent delay in operative repair of these injuries. For centers practicing selective management of penetrating neck injuries and transmediastinal gunshot wounds, rapid diagnosis and definitive repair should be made a high priority.

Depression in sarcoidosis

Sarcoidosis, a chronic, multisystem disease, impacts quality of life and may increase depression risk. No previous study has reported the depression prevalence among U.S. sarcoid patients. This cross-sectional study examined sociodemographic and disease morbidity factors associated with depression. Patients diagnosed for > or = 1 yr and treated at one of six centers were eligible (n = 176); 154 completed a questionnaire of demographics, treatment, access to medical care, and a short-form Center for Epidemiologic Studies- Depression Scale (CES-D). The primary outcome variable was a CES-D score of > or = 9, indicating clinical depression. The prevalence of depression was 60%. Gender, income, access to medical care, dyspnea on exertion, and number of systems involved were associated with depression. Female sex, decreased access to medical care, and increased dyspnea predicted depression (odds ratio [OR] = 3.33, 11.64, and 2.78, respectively) after adjusting for race, income, and steroid therapy. Despite tertiary care access, patients reported medical care limitation. Health care providers must be sensitive to multiple barriers faced by chronic sarcoid patients; acknowledging depression risk and improving access to medical care will promote better overall health among sarcoid patients. Future studies of sarcoidosis will need to address depression diagnosis and treatment.