Long-chain omega-3 polyunsaturated fatty acids are reduced in neonates with substantial brain injury undergoing therapeutic hypothermia after hypoxic-ischemic encephalopathy

Hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal morbidity and mortality. Although therapeutic hypothermia is an effective treatment, substantial chronic neurological impairment often persists. The long-chain omega-3 polyunsaturated fatty acids (PUFAs), docosahexaenoic (DHA) and eicosapentaenoic (EPA) acids, offer therapeutic potential in the post-acute phase. To understand how PUFAs are affected by HIE and therapeutic hypothermia we quantified for the first time the effects of HIE and therapeutic hypothermia on blood PUFA levels and lipid peroxidation. In a cross-sectional approach, blood samples from newborns with moderate to severe HIE, who underwent therapeutic hypothermia (sHIE group) were compared to samples from newborns with mild HIE, who did not receive therapeutic hypothermia, and controls. The sHIE group was stratified into cerebral MRI predictive of good (n = 10), or poor outcomes (n = 10; nine developed cerebral palsy). Cell pellets were analyzed for fatty acid content, and plasma for lipid peroxidation products, thiobarbituric acid reactive substances and 4-hydroxy-2-nonenal. Omega-3 Index (% DHA + EPA) was similar between control and HIE groups; however, with therapeutic hypothermia there were significantly lower levels in poor vs. good prognosis sHIE groups. Estimated Δ-6 desaturase activity was significantly lower in sHIE compared to mild HIE and control groups, and linoleic acid significantly increased in the sHIE group with good prognosis. Reduced long-chain omega-3 PUFAs was associated with poor outcome after HIE and therapeutic hypothermia, potentially due to decreased biosynthesis and tissue incorporation. We speculate a potential role for long-chain omega-3 PUFA interventions in addition to existing treatments to improve neurologic outcomes in sHIE.

Static ocular counterroll reflex in skew deviation

OBJECTIVE

The static ocular counterroll (OCR) reflex generates partially compensatory torsional eye movements during head roll. It is mediated by the utricle in the inner ear. Skew deviation is a vertical strabismus thought to be caused by imbalance in the utriculo-ocular pathway. We hypothesized that if skew deviation is indeed caused by damage to this reflex pathway, patients with skew deviation would show abnormal OCR.

METHODS

Eighteen patients with skew deviation caused by brainstem or cerebellar lesions and 18 normal participants viewed a target at 1 m. Ocular responses to static passive head roll-tilts of approximately 20° were recorded using search coils. Static OCR gain was calculated as the change in torsional eye position divided by the change in head position during sustained head roll. Perception of the subjective visual vertical (SVV) was also measured.

RESULTS

Group mean OCR gain was reduced by 45% in patients. At an individual level, OCR gains were asymmetric between eyes and between torsional directions in 90% of patients. In addition, the hypotropic eye incyclotorting gain was lower than the hypertropic eye excyclotorting gain during head roll toward the hypotropic eye in 94% of patients. No consistent pattern of gain asymmetry was found during head roll toward the hypertropic eye. The SVV was tilted toward the hypotropic eye.

CONCLUSION

Static OCR gain is significantly reduced in skew deviation. Interocular and directional gain asymmetries are also prevalent. The asymmetries provide further evidence that disruption of the utriculo-ocular pathway is a mechanism for skew deviation.

Patterns of ocular oscillation in oculopalatal tremor: Imaging correlations

OBJECTIVE

To determine patterns of nystagmus in oculopalatal tremor (OPT, also designated oculopalatal myoclonus) and correlate them with MRI changes in the inferior olivary nuclei (ION). Mixed torsional-vertical pendular nystagmus (PN) in OPT has been considered to signify unilateral brainstem damage and symmetric vertical nystagmus considered to indicate bilateral disease.

METHODS

Ocular oscillations were analyzed in 22 patients with OPT, 20 from focal brainstem lesions, with or without cerebellar lesions, and two from the progressive ataxia and palatal tremor syndrome. MRI was performed in all patients.

RESULTS

Patients had mainly vertical oscillations with varied combinations of torsional and horizontal components. Fourteen patients had binocular symmetry of PN and eight showed dissociated PN. MRI demonstrated ION signal change, unilateral in 14 and bilateral in eight. Unilateral olivary changes were associated with symmetric PN in six and with dissociated nystagmus in eight patients. Bilateral olivary changes were visible in eight patients with symmetric nystagmus. Dissociated PN was associated with MR pseudohypertrophy of ION on the side of the eye with greater vertical amplitude of oscillation. Notably, four patients never developed palatal tremor despite ION signal change. OPT resolved in one patient after 20 years and was markedly reduced in another patients after 6 years.

CONCLUSIONS

Dissociated pendular nystagmus predicted asymmetric (unilateral) inferior olivary pseudohypertrophy on MRI with accuracy, but symmetric pendular nystagmus was associated with either unilateral or bilateral signal changes in the inferior olivary nucleus. Instability of eye velocity to position integration from damage to the paramedian tract projections and denervation of the dorsal cap of the inferior olive are proposed mechanisms of the pendular nystagmus.

Saccades in children with spina bifida and Chiari type II malformation

BACKGROUND

Saccades are essential for optimal visual function. Chiari type II malformation (CII) is a congenital anomaly of the cerebellum and brainstem, associated with spina bifida.

OBJECTIVE

To investigate the effects of CII on saccades and correlate saccadic parameters with brain MRI measurements.

METHODS

Saccades were recorded in 21 participants with CII, aged 8 to 19, using an infrared eye tracker. Thirty-nine typically developing children served as controls. Participants made saccades to horizontal and vertical target steps. Nineteen participants with CII had MRI. Regression analyses were used to investigate the effects of spinal lesion level, number of shunt revisions, presence of nystagmus, and midsagittal MRI measurements on saccades.

RESULTS

Saccadic amplitude gains, asymptotic peak velocities, and latencies did not differ between the control and CII groups (p > 0.01). No significant differences were found between saccadic gains, asymptotic peak velocities or latencies, and spinal lesion level, number of shunt revisions, presence of nystagmus, or MRI measurements.

CONCLUSIONS

Saccades were normal in most participants with Chiari II malformation (CII). Neural coding of saccades is robust and is typically not affected by the anatomic deformity of CII.

Expression of lux genes in a clinical isolate of Streptococcus pneumoniae: using bioluminescence to monitor gemifloxacin activity

A clinical isolate of Streptococcus pneumoniae was transformed with a plasmid containing the lux operon of Photorhabdus luminescens that had been modified to function in gram-positive bacteria. Cells containing this plasmid produced light stably and constitutively, without compromising the growth rate. Light output was correlated with measurements of optical density and viable counts during exponential growth and provided a sensitive, real-time measure of the pharmacodynamics of the fluoroquinolone gemifloxacin.

The vertical vestibulo-ocular reflex, and its interaction with vision during active head motion: effects of aging

The effects of aging on the vertical vestibulo-ocular reflex (VOR), and its interactions with vision during active head motion had not been investigated. We measured smooth pursuit, combined eye-head tracking, the VOR, and its visual enhancement and cancellation during active head motion in pitch using a magnetic search coil technique in 21 younger (age < 65) and 10 elderly (age > or = 65) subjects. With the head immobile, subjects pursued a target moving sinusoidally with a frequency range of 0.125 to 2.0 Hz, and with peak target accelerations (PTAs) ranging from 12 to 789 degrees /s(2). Combined eye-head tracking, the VOR in darkness, and its visual enhancement during fixation of an earth-fixed target (VVOR) were measured during active sinusoidal head motion with a peak-to-peak amplitude of 20 degrees at frequencies of 0.25, 0.5, 1.0 and 2.0 Hz. The efficacy of VOR cancellation was determined from VOR gains during combined eye-head tracking. VOR and VVOR gains were symmetrical in both directions and did not change with aging, except for reduced gains of the downward VOR and VVOR at low frequency (0.25 Hz). However, in the elderly, smooth pursuit, and combined eye-head tracking gains and the efficacy of cancellation of the VOR were significantly lower than in younger subjects. In both the young and elderly groups, VOR gain in darkness did not vary with the frequency of active head motion while the gains of smooth pursuit, combined eye-head tracking, and VVOR declined with increasing target frequency. VOR and VVOR performance in the elderly implicates relative preservation of neural structures subserving vertical vestibular smooth eye motion in senescence.

Opsoclonus in three dimensions: oculographic, neuropathologic and modelling correlates

Opsoclonus is a dyskinesia consisting of involuntary, arrhythmic, chaotic, multidirectional saccades, without intersaccadic intervals. We used a magnetic scleral search coil technique to study opsoclonus in two patients with paraneoplastic complications of lung carcinoma. Eye movement recordings provided evidence that opsoclonus is a three-dimensional oscillation, consisting of torsional, horizontal, and vertical components. Torsional nystagmus was also present in one patient. Antineuronal antibody study revealed the presence of anti-Ta (Ma2 onco-neuronal antigen) antibodies in one patient, which had previously been associated only with paraneoplastic limbic encephalitis and brainstem dysfunction, but not opsoclonus, and only in patients with testicular or breast cancer. Neuropathologic examination revealed mild paraneoplastic encephalitis. Normal neurons identified in the nucleus raphe interpositus (rip) do not support postulated dysfunction of omnipause cells in the pathogenesis of opsoclonus. Computer simulation of a model of the saccadic system indicated that disinhibition of the oculomotor region of the fastigial nucleus (FOR) in the cerebellum can generate opsoclonus. Histopathological examination revealed inflammation and gliosis in the fastigial nucleus. This morphological finding is consistent with, but not necessary to confirm, damage to afferent projections to the FOR, as determined by the model. Malfunction of Purkinje cells in the dorsal vermis, which inhibit the FOR, may cause opsoclonus by disinhibiting it.

Use of green fluorescent protein in visualisation of pneumococcal invasion of broncho-epithelial cells in vivo

The pneumococcus is the principle cause of bacterial pneumonia and also a major cause of bacterial meningitis. The mechanisms and sites of pneumococcal adherence and invasion of the respiratory tract in vivo are not clear however. We have made pneumococci expressing green fluorescent protein (GFP) and used it to trace pneumococcal adherence and invasion in vivo. By using GFP pneumococci we have shown bacterial adherence and invasion of broncho-epithelial cells in vivo by 4 h post-infection, with increases in pneumococcal invasiveness by 24 h. Using confocal image analysis we have shown varying levels of pneumococcal penetration and internalisation into host cells, as well as translocation through epithelial layers. To our knowledge this is the first report of pneumococcal invasion and cellular translocation in vivo.

Central nystagmus induced by deep-brain stimulation for epilepsy

PURPOSE

The goal of the present study was to describe the localization of central nystagmus induced as a side effect of electrical deep-brain stimulation for epilepsy.

METHODS

Bilateral deep-brain stimulating electrodes were inserted in the centromedian nucleus of the thalamus to control seizures in a patient with intractable epilepsy.

RESULTS

Cathodal high-frequency stimulation through the deepest contact of each electrode elicited cycles of slow ipsiversive conjugate eye deviations, each followed by rapid contralateral jerks. The involved electrode contacts were situated at the mesodiencephalic junction just inferior to the centromedian nucleus of the thalamus and rostral to the superior colliculus. Right-sided stimulation evoked left beating nystagmus and left-sided stimulation evoked right beating nystagmus. Stimulation through other electrode contacts did not induce nystagmus. Electronystagmography showed the nystagmus to have constant velocity slow phases.

CONCLUSIONS

A central nystagmogenic area exists in humans that appears to be homologous to the nucleus of the optic tract, a region described in nonhuman primates to play a role in the generation of optokinetic nystagmus.

A human PKD1 transgene generates functional polycystin-1 in mice and is associated with a cystic phenotype

Three founder transgenic mice were generated with a 108 kb human genomic fragment containing the entire autosomal dominant polycystic kidney disease (ADPKD) gene, PKD1, plus the tuberous sclerosis gene, TSC2. Two lines were established (TPK1 and TPK3) each with approximately 30 copies of the transgene. Both lines produced full-length PKD1 mRNA and polycystin-1 protein that was developmentally regulated, similar to the endogenous pattern, with expression during renal embryogenesis and neonatal life, markedly reduced at the conclusion of renal development. Tuberin expression was limited to the brain. Transgenic animals from both lines (and the TPK2 founder animal) often displayed a renal cystic phenotype, typically consisting of multiple microcysts, mainly of glomerular origin. Hepatic cysts and bile duct proliferation, characteristic of ADPKD, were also seen. All animals with two copies of the transgenic chromosome developed cysts and, in total, 48 of the 100 transgenic animals displayed a cystic phenotype. To test the functionality of the transgene, animals were bred with the Pkd1(del34) knockout mouse. Both transgenic lines rescued the embryonically lethal Pkd1(del34/del34) phenotype, demonstrating that human polycystin-1 can complement for loss of the endogenous protein. The rescued animals were viable into adulthood, although more than half developed hepatic cystic disease in later life, similar to the phenotype of older Pkd1(del34/+) animals. The TPK mice have defined a minimal area that appropriately expresses human PKD1. Furthermore, this model indicates that over-expression of normal PKD1 can elicit a disease phenotype, suggesting that the level of polycystin-1 expression may be relevant in the human disease.

alpha-thalassemia resulting from a negative chromosomal position effect

To date, all of the chromosomal deletions that cause alpha-thalassemia remove the structural alpha genes and/or their regulatory element (HS -40). A unique deletion occurs in a single family that juxtaposes a region that normally lies approximately 18-kilobase downstream of the human alpha cluster, next to a structurally normal alpha-globin gene, and silences its expression. During development, the CpG island associated with the alpha-globin promoter in the rearranged chromosome becomes densely methylated and insensitive to endonucleases, demonstrating that the normal chromatin structure around the alpha-globin gene is perturbed by this mutation and that the gene is inactivated by a negative chromosomal position effect. These findings highlight the importance of the chromosomal environment in regulating globin gene expression.

A comparison of tangent screen, goldmann, and humphrey perimetry in the detection and localization of occipital lesions

OBJECTIVE

To compare manual kinetic perimetry with tangent screen and Goldmann techniques and automated static perimetry with the Humphrey Field Analyzer in the detection and localization of occipital lobe lesions.

DESIGN

Prospective consecutive comparative case series.

PARTICIPANTS

Twelve patients with well-defined occipital lobe infarcts on magnetic resonance (MR) imaging were studied.

MAIN OUTCOME MEASURES

The patients were tested by tangent screen, Goldmann, and Humphrey perimetry (central 30-2 threshold program). The three visual fields were compared and correlated with MR images.

RESULTS

All three perimetric techniques detected the presence of postchiasmal lesions. However, localization of lesions differed with perimetric technique. Visual fields obtained from tangent screen and Goldmann perimetry were similar and corresponded well with the location of lesions on MR images in all 12 patients. Humphrey perimetry inaccurately localized the lesion to the proximal part of the postchiasmal pathway by revealing incongruous fields in two patients, failed to detect sparing of the posterior occipital cortex or occipital pole in four patients, and estimated a larger extent of damage in one patient when compared with MR images and manual perimetry.

CONCLUSIONS

All three perimetric techniques are satisfactory screening tests to detect occipital lesions. However, tangent screen and Goldmann perimetry provide information about the location and extent of lesions that is more consistent with prevailing knowledge of the effects of the lesion in the postgeniculate visual pathway.

Representation of the visual field in the human occipital cortex: a magnetic resonance imaging and perimetric correlation

OBJECTIVES

To evaluate the retinotopic map of the human occipital cortex by correlating magnetic resonance imaging (MRI) findings with visual field defects in patients with occipital lobe infarcts and to assess the compatibility between our cliniconeuroimaging findings and the location of lesions predicted by the classic Holmes map and a revised map.

METHODS

Magnetic resonance images were obtained in 14 patients with occipital lobe infarcts. Visual field analysis was performed with tangent screen, the Goldmann perimeter, and the Humphrey Field Analyzer. Based on the pattern of visual field deficit, the location of the lesion in the mesial occipital lobe in each patient was predicted using the Holmes map and other retinotopic maps of the occipital cortex. The predicted location of the lesion was then compared with its actual location shown on MRI to assess the compatibility between our data and the other maps. These maps determine retinotopic correlates of the medial occipital lobe, but they cannot establish correlates of the striate cortex (V1). The medial occipital representation of central vision was evaluated by regression analysis.

RESULTS

The MRI correlations in this study confirmed gross estimates of the retinotopic organization of the occipital cortex. However, our findings did not correlate exactly with the Holmes map. We determined that the central 15 degrees of vision occupies 37% of the total surface area of the human medial occipital lobe. Based on our data, a refined retinotopic map is presented.

CONCLUSIONS

The resolution of conventional MRI testifies to its considerable value in localizing occipital lobe lesions. Our findings support, and refine, the Holmes map of the human occipital cortex.

Ocular tracking of step-ramp targets by patients with unilateral cerebral lesions

The relationship of sinusoidal smooth pursuit defects to pursuit defects with step-ramp targets in patients with cerebral lesions is unclear. We examined pursuit and saccades to both step-ramp and sinusoidal targets in 17 patients with unilateral cerebral lesions. Two types of pursuit defects were found. One group of three patients had ipsi-directional sinusoidal pursuit defects from lesions to the posterior internal capsule. Their chief abnormality with step-ramp targets was increased contra-directional pursuit. Their ipsi-directional step-ramp pursuit was often normal and disproportionately better than their ipsi-directional sinusoidal pursuit. Another patient with a parietal lesion had a second type of pursuit defect. He had low-normal sinusoidal pursuit bilaterally, but decreased ipsi- and contra-directional step-ramp pursuit. Also, he had an abnormal contra-directional drift after saccades to stationary targets. Despite these pursuit defects, saccadic accuracy did not show poor compensation for target motion in either patient type. The patient with the parietal lesion also had increased latencies for contralateral saccades. Recovery of pursuit was studied in one patient with an infarct of the posterior internal capsule. Initially he had a contra-directional bias that caused decreased ipsi-directional pursuit, increased contra-directional pursuit, and a contra-directional drift after saccades to stationary targets. Four months later, ipsi-directional pursuit and the post-saccadic drift to stationary targets had recovered, but contra-directional pursuit remained abnormally high. We conclude that lesions of descending pursuit tracts in the internal capsule are characterized by a contra-directional bias which recovers partly through a direction-specific adaptation. Lesions that affect the human homologue of posterior parietal cortex cause asymmetric bi-directional defects in pursuit initiation and increased contralateral saccadic latencies.

Understanding alpha globin gene expression: a step towards effective gene therapy

During the past 20 years developments in molecular and cellular biology have kindled the hope that one might eventually ameliorate or even cure some serious genetic diseases by repairing or replacing the defective gene. Other articles deal with the formidable problems of isolating pluripotent hematopoietic stem cells; efficiently, safely, and stably transfecting them, and developing transplantation protocols to ensure that the corrected cells supplant the patient's abnormal stem cells after transplantation. Assuming that these hurdles can be overcome, it will also be important to establish the ideal segment of DNA to introduce into stem cells to ensure that, regardless of its position of integration in the genome, the gene in question will be appropriately regulated. In the case of the globin genes this is a particularly difficult task because in order to correct disorders of globin synthesis we need to obtain high levels of stable, tissue- and developmental-stage specific expression. Issues relevant to this problem arising from the analysis of the human beta globin cluster are discussed in the article in this issue by Grosveld. In this article we review our current understanding of how eukaryotic genes might be expressed from their normal chromosomal environment, using the human alpha globin cluster as a specific example. We also discuss how this information might be used in the development of strategies for gene therapy.

Cortical control of eye movements

Event related cortical potentials and imaging provide information about roles of the cerebral hemispheres in generating voluntary and reflexive saccades. This review also discusses relationships between smooth pursuit and visual discrimination of motion direction and the phenomenon of blindsight. Cortical effects of strabismus on motion processing and smooth pursuit are reviewed.

Vestibulo-ocular reflex deficits to rapid head turns following intratympanic gentamicin instillation

The response of the vestibulo-ocular reflex following unilateral vestibular deafferentation by gentamicin ablation was studied using transient stimuli. The response to these rapid passive head turns showed a strong asymmetry with permanent, reduced gains toward the side of lesion. These gain reductions have large variation (gains of 0.26 to 0.83), which may result from preferential sparing of regularly firing afferent fibers following gentamicin ablation. Based on the size and nature of the nonlinearity, an explanation based on Ewald's second law was discounted.

Smooth pursuit and saccades to moving targets in blind hemifields. A comparison of medial occipital, lateral occipital and optic radiation lesions

We tested smooth pursuit and saccades to targets within the contralateral homonymous visual field defects of 10 patients with unilateral cerebral hemispheric lesions. Four patients had medial occipital lesions that spared the putative motion area in lateral occipitotemporal cortex and the optic radiations proximal to this site. The other six had lesions involving this area or the proximal optic radiations. From current hypotheses, that surviving extra-striate cortex is responsible for 'blindsight', we expected that the patients with lesions restricted to medial occipital cortex would be more likely to have residual ocular motor responses to moving targets. We found, however, that these patients with sparing of the lateral motion area did not show significantly better correlations of either post-saccadic eye velocity with target velocity or initial saccadic amplitude with the position of the moving target, compared with the other six patients. With increased target velocities against a background of darkness, two patients had weakly positive ocular motor correlations. However, in one patient this finding was replicated by a normal control stimulating the patient's scotoma and, in the other patient, the correlation disappeared when the eye with a residual monocular temporal crescents was occluded. These features indicate an artifact from light scatter. Only one other patient demonstrated a consistent, but weak, correlation of ocular tracking with target motion in the blind region; paradoxically, this patient had a lateral occipitotemporal lesion. We conclude that sparing of the lateral motion area is not sufficient condition for residual tracking of moving targets in homonymous visual field defects, and may not even be necessary.

Motion direction discrimination in blind hemifields

We tested motion direction discrimination with random dot cinematograms (RDCs) projected into the contralateral homonymous visual field defects of 10 patients with unilateral cerebral hemispheric lesions. Five patients had medial occipital lesions that spared the putative motion area in lateral occipitotemporal cortex and the optic radiations and other white matter tracts proximal to this site. The other 5 had lesions involving this area or the proximal optic radiations. Eye position was monitored to ensure fixation. No patient in either group discriminated motion direction in signal/noise RDCs at a level better than chance, and the performance of those with lesions restricted to medial occipital lobe did not differ from those with lateral occipital or optic radiation lesions. A subgroup of patients with medial occipital lesions also performed a "frequency of discrimination" experiment, using 100% coherent dot motion with stimulus velocities ranging as high as 79.4 degrees/sec. Their results on these tests were also no better than chance. Sparing of the putative motion area in lateral occipitotemporal cortex and its input fibers is not a sufficient condition for residual direction discrimination (blindsight) with RDCs in homonymous visual field defects.

Globin gene switching in transgenic mice carrying HS2-globin gene constructs

We have examined the pattern of human globin gene switching in transgenic mice containing three different gamma and beta gene constructs (HS2G gamma A gamma delta beta, HS2A gamma beta neo, and HS2A gamma en beta) and compared the results with previously described transgenics (HS2A gamma beta, HS2G gamma A gamma-117 delta beta, and LCR epsilon G gamma A gamma delta beta). Developmental regulation was observed in all cases with identical patterns in lines bearing the same construct. Three different patterns of switching were observed: LCR epsilon G gamma A gamma delta beta and HS2A gamma beta neo mice switched rapidly, HS2G gamma A gamma delta beta and HS2G gamma A gamma-117 delta beta at an intermediate rate, and HS2A gamma beta and HS2A gamma en beta mice showed delayed switching, with a plateau in late fetal-early neonatal life and readily detectable levels of gamma mRNA in adults. No difference was observed in the time of switching of the HS2G gamma A gamma delta beta mice compared with those with the A gamma-117 hereditary persistence of fetal hemoglobin mutation, but adult levels of gamma mRNA were significantly higher (approximately 5%) in lines carrying the mutation than in those without (approximately 1%). Reversion to the rapid switch of the LCR epsilon G gamma A gamma delta beta mice was observed in three lines with the HS2A gamma beta neo construct in which expression of the tk-neo gene was approximately equal to that of the globin genes. The inclusion of the A gamma enhancer in HS2A gamma beta mice did not alter the pattern of switching, or reduce the relatively high levels of gamma mRNA in these lines. However, unlike other HS2 mice, the combination of HS2 and the A gamma enhancer resulted in copy number-dependent expression in HS2A gamma en beta lines, with intrauterine death at approximately 12.5 days gestation at high copy numbers. These results demonstrate that numerous elements throughout the beta globin gene cluster interact to produce the correct pattern of developmental regulation of these genes. Furthermore, extinction of gamma gene expression in adult life is not completely autonomous and is incomplete when HS2 is the only LCR element present.

Proximal promoter elements of the human zeta-globin gene confer embryonic-specific expression on a linked reporter gene in transgenic mice

We have investigated the transcriptional regulation of the human embryonic zeta-globin gene promoter. First, we examined the effect that deletion of sequences 5' to zeta-globin's CCAAT box have on zeta-promoter activity in erythroid cell lines. Deletions of sequences between -116 and -556 (cap = 0) had little effect while further deletion to -84 reduced zeta-promoter activity by only 2-3-fold in both transiently and stably transfected erythroid cells. Constructs containing 67, 84 and 556 bp of zeta-globin 5' flanking region linked to a beta-galactosidase reporter gene (lacZ) and hypersensitive site -40 (HS-40) of the human alpha-globin gene cluster were then employed for the generation of transgenic mice. LacZ expression from all constructs, including a 67 bp zeta-globin promoter, was erythroid-specific and most active between 8.5 and 10.5 days post-fertilisation. By 16.5 days gestation, lacZ expression dropped 40-100-fold. These results suggest that embryonic-specific activation of the human zeta-globin promoter is conferred by a 67 bp zeta-promoter fragment containing only a CCAAT and TATA box.

Directional defects in pursuit and motion perception in humans with unilateral cerebral lesions

We tested motion perception and smooth pursuit in 26 patients with unilateral cerebral hemispheric lesions. We used random dot cinematograms to test motion direction discrimination. We measured pursuit gain as they followed a predictable sinusoidal target moving horizontally at three different frequencies, and an unpredictable horizontal step-ramp target in the ipsilateral hemi-field. Six patients had defects in motion perception when the targets were moving towards the side of the lesions ('ipsi-directional' defects) and two had bi-directional defects. Motion perception defects occurred with lesions of the junction of Brodmann areas 19 and 37, a putative human homologue of the monkey V5 complex. Seven patients had ipsi-directional pursuit defects, five of whom had damage to the posterior limb of the internal capsule. Only two patients had ipsi-directional defects of both motion perception and sinusoidal smooth pursuit. Four patients had ipsi-directional defects of motion perception alone, and five patients had ipsi-directional pursuit defects alone. The two patients with bi-directional defects in motion perception had normal sinusoidal smooth pursuit. Patients with lesions at the 19/37 junction and defects of motion perception alone had normal pursuit of unpredictable step-ramp targets in the ipsilateral hemi-field. In contrast, patients with ipsi-directional sinusoidal pursuit defects had decreased ipsi-directional and increased contra-directional velocities with step-ramp targets. No patient group had a motion-specific directional defect in saccadic accuracy. We conclude that neither predictable nor unpredictable pursuit is necessarily impaired by lesions of the 19/37 junction that cause ipsi-directional defects of motion perception. These dissociations between smooth pursuit and motion perception provide evidence that the pursuit system operates as an interconnected network with parallel pathways, rather than as a simple sequential hierarchy of cortical areas.

Gene expression in somatic cell hybrids derived from embryonic mice transgenic for human globin genes

Somatic cell hybrids have been used previously to investigate the developmental regulation of globin gene expression. When a chromosome containing an active human fetal gamma gene is transferred to mouse erythroleukaemia (MEL) cells by cell fusion, there is persistent expression of this gene through multiple hybrid-cell divisions despite the 'adult' trans-acting factor environment of the MEL cell. We analysed hybrids formed between embryonic erythroblasts and MEL cells to determine whether the embryonic globin genes would be similarly regulated. Surprisingly, there was no detectable expression of either the endogenous (epsilon, beta h 1) or the transgenic (human epsilon) embryonic beta-like genes in a large number of hybrid pools and clones, even though these genes were expressed in the donor cells at the time of fusion. In contrast, the human gamma gene, which is also expressed as an embryonic gene in transgenic mice, continued to be expressed in these hybrids. This lack of embryonic gene expression in hybrids also applied to the alpha gene cluster; no mouse or human zeta mRNA was detectable in embryonic cell hybrids from mice transgenic for the human alphaglobin genes. Hybrids generated from embryonic non-erythroid cells resulted in expression that was largely restricted to the adult beta gene. It has previously been suggested that epigenetic modifications to the beta-globin gene cluster during normal development are responsible for the perpetuation of gamma and beta gene expression in this hybrid cell system. The results presented here suggest that no such stable modifications occur around the embryonic genes and therefore that the regulatory mechanisms determining embryonic globin gene transcription differ from those responsible for the expression of gamma and beta genes in this system.

Acquired esotropia due to Arnold-Chiari I malformation

OBJECTIVE

Diplopia is not frequently associated with Arnold-Chiari I malformation. We reviewed our cases of Arnold-Chiari I malformation in which acquired esotropia with diplopia was the main neuro-ophthalmologic finding early in the clinical course.

MATERIALS AND METHODS

Five patients were studied, all female, ranging in age from 17 to 36 years, who were treated by the neuro-ophthalmology service of urban teaching hospitals. Eye movement recordings using magnetic search coil technique were performed in two patients.

RESULTS

All patients reported onset of horizontal diplopia due to acquired esotropia as an initial manifestation of the Arnold-Chiari I malformation. All had full abduction of each eye. In addition, all five had gaze-evoked nystagmus, two skew deviations, and one bilateral internuclear ophthalmoparesis. Oculography in two patients showed normal abducting saccadic peak velocities. This supports divergence palsy as a mechanism of acquired esotropia and provides evidence against subtle sixth nerve palsy in these patients. Four patients underwent neurosurgical decompression of their Chiari malformations, and neuro-ophthalmologic signs and symptoms improved in all.

CONCLUSIONS

Acquired esotropia, often in association with other eye movement abnormalities, may be an early sign of Arnold-Chiari I malformation. This quantitative study indicates that divergence palsy is the cause of esotropia in some patients. Neurosurgical suboccipital and upper cervical decompression may lead to improvement or resolution of diplopia.

Saccadic duration and intrasaccadic fatigue in myasthenic and nonmyasthenic ocular palsies

We measured the duration and amplitude of saccades in three normal subjects, eight patients with myasthenia gravis, and eight patients with nonmyasthenic ocular palsies. Saccades were examined at the start of a repetitive saccade task, after 3 minutes of activity, and 1 minute after administration of edrophonium. The duration of saccades was prolonged initially in both myasthenic and nonmyasthenic palsies. Activity did not produce significant differences among the three groups in either the slope of the duration-amplitude relationship or the predicted durations of saccades of 5 degrees, 10 degrees, or 15 degrees. However, durations decreased in myasthenia but increased in nonmyasthenic palsies after edrophonium. Much of this decrease in myasthenic saccadic duration was due to reduction in deceleration time, indicating resolution of intrasaccadic fatigue after edrophonium administration. However, the relation of deceleration fraction (deceleration time divided by total duration) to total duration remained constant in all subject groups. Analysis of saccadic duration is a useful means of interpreting responses to edrophonium because it incorporates data from saccades of a wide range of amplitudes into a linear relation between duration and amplitude.

Established epigenetic modifications determine the expression of developmentally regulated globin genes in somatic cell hybrids

Somatic cell hybrids generated from transgenic mouse cells have been used to examine the developmental regulation of human gamma-to-beta-globin gene switching. In hybrids between mouse erythroleukemia (MEL) cells and transgenic erythroblasts taken at various stages of development, there was regulated expression of the human fetal gamma and adult beta genes, reproducing the in vivo pattern prior to fusion. Hybrids formed from embryonic blood cells produced predominantly gamma mRNA, whereas beta gene expression was observed in adult hybrids and a complete range of intermediate patterns was found in fetal liver hybrids. The adult environment of the MEL cells, therefore, did not appear to influence selective transcription from this gene complex. Irradiation of the embryonic erythroid cells prior to fusion resulted in hybrids containing only small fragments of donor chromosomes, but the pattern of gene expression did not differ from that of unirradiated hybrids. This finding suggests that continued expression of trans-acting factors from the donor erythroblasts is not necessary for continued expression of the human gamma gene in MEL cells. These results contrast with the lack of developmental regulation of the cluster after transfection of naked DNA into MEL cells and suggest that epigenetic processes established during normal development result in the gene cluster adopting a developmental stage-specific, stable conformation which is maintained through multiple rounds of replication and transcription in the MEL cell hybrids. On prolonged culture, hybrids that initially expressed only the gamma transgene switched to beta gene expression. The time period of switching, from approximately 10 to > 40 weeks, was similar to that seen previously in human fetal erythroblast x MEL cell hybrids but in this case bore no relationship to the time of in vivo switching. It seems unlikely, therefore, that switching in these hybrids is regulated by a developmental clock.

The mouse alpha-globin locus regulatory element

We have identified and cloned the major alpha globin locus regulatory element in the mouse (m alpha RE). This element shows a high level of sequence homology to its human counterpart (HS -40) and lies between the same two exons of an upstream, widely expressed gene in both species. Footprinting and band shift studies of the core element show conservation of many (but not all) of the protein binding sites identified as functionally important in HS -40. The functional equivalence of the mouse element was shown by attaching it to a human alpha globin gene and examining expression in transgenic mice. Readily detectable levels of human alpha mRNA were produced in these mice but they were lower than the endogenous gene expression and did not show copy number dependence. These results suggest that sequences additional to this major regulatory element may be necessary to obtain complete regulation of the alpha globin genes in both species.

'Saccadic jitter' is a quantitative ocular sign in myasthenia gravis

PURPOSE

To examine the variability of saccadic peak-velocity amplitude relationships in myasthenic and nonmyasthenic ocular palsies.

METHODS

The authors measured centrifugal saccades in nine patients with myasthenia gravis, nine patients with proven nonmyasthenic ocular palsies, and three normal subjects. Patients made repetitive saccades for 8 minutes. Saccades were analyzed at the start of the task, after 3 minutes of the task (fatigue), and at 1 minute after edrophonium. The authors fitted an exponential function to individual data and averages for amplitude bins and calculated the root mean square error of the curves. They then subtracted the root mean square error of curves fitted to bin averages from that of curves fitted to individual saccades: The result was an index of the variability of saccadic peak velocity, which they called saccadic jitter.

RESULTS

Compared to those without myasthenia, the saccades of patients with myasthenia showed more variability in the initial and the fatigue periods. The change induced by edrophonium did not distinguish between the groups.

CONCLUSIONS

Signal detection analysis indicated that saccadic jitter has little value as a screening tool but is a useful diagnostic sign in 42% of myasthenic saccadic analyses.

Retinotopic and directional defects in motion discrimination in humans with cerebral lesions

We investigated the discrimination of motion direction in peripheral and central vision in 23 patients with unilateral cerebral hemispheric lesions on computed tomography or magnetic resonance imaging. We used random dot cinematograms that determined a percent coherence motion threshold for 16 points in the peripheral field and for four directions separately in central vision. We measured asymmetry of right- versus left-field peripheral discrimination (retinotopic defects) and asymmetry of central discrimination for rightward versus leftward motion (directional defects), compared with normal subjects. Five patients had directional asymmetries of foveal motion perception, all worse for motion toward the side of their lesions. One patient had a bidirectional defect for the perception of horizontal motion. For 3 of these 6, the average of all horizontal and vertical motion discrimination thresholds was also elevated. Two had contralateral retinotopic defects. One of these also had an ipsidirectional foveal defect, but the other did not. The remaining 5 patients with ipsidirectional foveal defects had hemianopias that precluded testing for coexistent retinotopic defects. The lesions of the 6 patients with ipsidirectional defects overlapped in white matter underlying the lateral temporo-occipital cortex, at the junction of Brodmann areas 19 and 37. In contrast, lesions of patients without directional defects spared this region.

Contrasting effects of alpha and beta globin regulatory elements on chromatin structure may be related to their different chromosomal environments

Expression of the human alpha and beta globin gene clusters is regulated by remote sequences, referred to as HS -40 and the beta-locus control region (beta-LCR) that lie 5-40 kb upstream of the genes they activate. Because of their common ancestry, similar organization and coordinate expression it has often been assumed that regulation of the globin gene clusters by HS -40 and the beta-LCR occurs via similar mechanisms. Using interspecific hybrids containing chromosomes with naturally occurring deletions of HS -40 we have shown that, in contrast to the beta-LCR, this element exerts no discernible effect on long-range chromatin structure and in addition does not influence formation of DNase I hypersensitive sites at the alpha globin promoters. These differences in the behaviour of HS -40 and the beta-LCR may reflect their contrasting influence on gene expression in transgenic mice and may result from the differing requirements of these elements in their radically different, natural chromosomal environments; the alpha cluster lying within a region of constitutively 'open' chromatin and the beta cluster in a segment of chromatin which opens in a tissue-specific manner. Differences in the hierarchical control of the alpha and beta globin clusters may exemplify more general differences in the regulation of eukaryotic genes which lie in similar open or closed chromosomal regions.

Deficits of smooth-pursuit eye movement after unilateral frontal lobe lesions

We recorded horizontal smooth-pursuit responses to sinusoidal and step-ramp stimuli in 7 patients with unilateral frontal lobe lesions. Five patients had directional smooth-pursuit deficits, all with impairment toward the side of cerebral damage. Ipsidirectional pursuit defects involved pursuit maintenance to sinusoidal targets, pursuit initiation to step-ramp targets, or both. No patient had asymmetry of smooth pursuit according to the retinal hemifield of target appearance. Smooth-pursuit velocities were subnormal in both horizontal directions in 4 patients. The human frontal lobes participate in the initiation and maintenance of smooth pursuit in both directions, with a greater ipsilateral contribution. Of 5 patients with ipsilateral pursuit impairment, 3 had cerebral lesions in the area of the frontal eye field (FEF). These 3 patients also made inaccurate saccades to targets moving away from the side of the lesion, implying that the FEF transmits motion information to the saccadic system. Two patients with ipsidirectional smooth-pursuit defects had cerebral damage that spared the FEF, indicating that other frontal regions also contribute to smooth pursuit.

Analysis of a 70 kb segment of DNA containing the human zeta and alpha-globin genes linked to their regulatory element (HS-40) in transgenic mice

We have ligated two cosmids through an oligonucleotide linker to produce a single fragment spanning 70 kb of the human alpha-globin cluster, in which the alpha-like globin genes (zeta 2, alpha 2 and alpha 1), their regulatory element (HS-40) and erythroid-specific DNase I hypersensitive sites accurately retain their normal genomic organization. The zeta (embryonic) and alpha (embryonic, fetal and adult) globin genes were expressed in all 17 transgenic embryos. Similarly, all fetal and adult mice from seven transgenic lines that contained one or more copies of the fragment, produced up to 66% of the level of endogenous mouse alpha-globin mRNA. However, as for smaller constructs containing these elements, human alpha-globin expression was not copy number dependent and decreased by 1.5-9.0 fold during development. These findings suggest that either it is not possible to obtain full regulation of human alpha-globin expression in transgenic mice or, more likely, that additional alpha-globin regulatory elements lie beyond the 70 kb segment of DNA analysed.

Effects of edrophonium on saccadic velocity in normal subjects and myasthenic and nonmyasthenic ocular palsies

We measured saccadic peak velocities in 8 patients with myasthenia gravis, 9 patients with proven nonmyasthenic ocular palsies, and 3 controls. Patients followed a target moving to and from primary position at 1-second intervals for 8 minutes. We measured the amplitudes and velocities of centrifugal saccades at the start of the task, after 3 minutes of the task (fatigue) and 1 minute after receiving IV edrophonium. The effects of fatigue, though prominent in some myasthenic patients, did not distinguish between the groups. However, edrophonium increased saccadic peak velocities in myasthenic patients but decreased them in both controls and nonmyasthenic patients. Analysis of saccades by amplitude bins showed that these changes in peak velocity reflected shifts in the velocity-amplitude relationship.

Usefulness of single fiber EMG for distinguishing neuromuscular from other causes of ocular muscle weakness

Consecutive patients (n = 114), who had single fiber electromyography of the frontalis muscles for symptoms suggestive of ocular myasthenia gravis, were followed up for a mean of 14 months (3-64 mos). At follow up, based on strict criteria, 23 patients were classified as having ocular myasthenia gravis, 8 patients were diagnosed as having mitochondrial myopathy or oculopharyngeal dystrophy, 18 patients were found to have other diseases and 65 patients remained without a definite diagnosis. The single fiber electromyography data of these patients were then reviewed. The patients with ocular myasthenia gravis had, on average, more than 7/20 single fiber pairs with jitter > 45 microseconds and mean jitter of 56 microseconds. The 8 patients with mitochondrial myopathy or oculopharyngeal dystrophy had an average of 5/20 single fiber pairs with jitter > 45 microseconds and a mean jitter of 52 microseconds and could not be separated from the group with ocular myasthenia gravis on the basis of the single fiber electromyography results. The 18 patients with definite other diagnosis had an average of less than 1/20 single fiber pair with jitter > 45 microseconds and a mean jitter of 25 microseconds. This group could be clearly separated from the group with ocular myasthenia gravis. We conclude that single fiber electromyelography is useful in the separation of ocular myasthenia gravis from other causes of oculomotor weakness except mitochondrial myopathy and oculopharyngeal dystrophy.

The initial vestibulo-ocular reflex and its visual enhancement and cancellation in humans

The gain (ratio of eye velocity to head velocity) of the initial horizontal vestibulo-ocular reflex (VOR) was calculated in 12 normal subjects over 350 ms during impulsive, unpredictable whole body rotation under three conditions: (1) darkness; (2) visual enhancement of the VOR, while the subjects fixated a stationary target; and (3) visual cancellation of the reflex, while subjects fixated a target that rotated with the head. The gain of the initial 80 ms of compensatory eye movement increased significantly during visual fixation in 5 subjects and decreased during attempted VOR cancellation in 3 subjects, when compared with VOR gain in darkness. Compensatory vestibular smooth eye movements were slowed, becoming curved at the onset of VOR cancellation, at mean latencies ranging from 78 to 149 ms in individual subjects (group mean 128 ms). At about 190 ms, quick phases moved the eyes in the same direction as head and target motion. The subsequent vestibular eye movements were about 50% slower than the initial smooth eye movements, indicating more effective cancellation. Visual enhancement of the VOR can occur prior to the onset of pursuit, providing evidence that fixation and smooth pursuit are distinct ocular motor systems. Visual cancellation of the VOR also begins prior to smooth pursuit initiation and becomes more effective after the latency of smooth pursuit.

Muscarinic antagonists in the treatment of acquired pendular and downbeat nystagmus: a double-blind, randomized trial of three intravenous drugs

We performed a double-blind, randomized trial of intravenous scopolamine, benztropine, and glycopyrrolate in 7 patients with acquired nystagmus and oscillopsia. Five patients had pendular nystagmus and 2, downbeat nystagmus. We recorded eye movements with a magnetic search coil technique and tested visual acuity and motion perception before and after administration of each drug. Scopolamine reduced nystagmus in all patients. Benztropine was moderately effective and glycopyrrolate had a negligible impact. Visual acuity improved only with scopolamine; motion discrimination and oscillopsia improved significantly with scopolamine and benztropine. Pendular and downbeat nystagmus respond to intravenous antagonists of central muscarinic receptors.

Analysis of the human alpha-globin gene cluster in transgenic mice

A 350-bp segment of DNA associated with an erythroid-specific DNase I-hypersensitive site (HS-40), upstream of the alpha-globin gene cluster, has been identified as the major tissue-specific regulator of the alpha-globin genes. However, this element does not direct copy number-dependent or developmentally stable expression of the human genes in transgenic mice. To determine whether additional upstream hypersensitive sites could provide more complete regulation of alpha gene expression we have studied 17 lines of transgenic mice bearing various DNA fragments containing HSs -33, -10, -8, and -4, in addition to HS -40. Position-independent, high-level expression of the human zeta- and alpha-globin genes was consistently observed in embryonic erythroid cells. However, the additional HSs did not confer copy-number dependence, alter the level of expression, or prevent the variable down-regulation of expression in adults. These results suggest that the region upstream of the human alpha-globin genes is not equivalent to that upstream of the beta locus and that although the two clusters are coordinately expressed, there may be differences in their regulation.

Oblique misdirection and slowing of vertical saccades after unilateral lesions of the pontine tegmentum

Three patients with unilateral lesions of the pontine tegmentum, identified by CT and MRI, had abnormal vertical saccades and slowed ipsilateral horizontal saccades. Attempted vertical saccades were misdirected obliquely, away from the side of the lesion, and their vertical components were prolonged. Oblique saccades had curved trajectories and prolonged durations of their vertical components. Unilateral damage to excitatory burst neurons and pause cells in the medial part of the caudal paramedian pontine reticular formation may cause these abnormal vertical and oblique saccades. Misdirection and slowing of vertical saccades can accompany the paralysis or slowing of ipsilateral horizontal saccades caused by pontine damage.

Role of upstream DNase I hypersensitive sites in the regulation of human alpha globin gene expression

Erythroid-specific DNase 1 hypersensitive sites have been identified at the promoters of the human alpha-like genes and within the region from 4 to 40 kb upstream of the gene cluster. One of these sites, HS-40, has been shown previously to be the major regulator of tissue-specific alpha-globin gene expression. We have now examined the function of other hypersensitive sites by studying the expression in mouse erythroleukemia (MEL) cells of various fragments containing these sites attached to HS-40 and an alpha-globin gene. High level expression of the alpha gene was observed in all cases. When clones of MEL cells bearing a single copy of the alpha-globin gene fragments were examined, expression levels were similar to those of the endogenous mouse alpha genes and similar to MEL cells bearing beta gene constructs under the control of the beta-globin locus control region. However, there was no evidence that the additional hypersensitive sites increased the level of expression or conferred copy number dependence on the expression of a linked alpha gene in MEL cells.

The effects of head and trunk position on torsional vestibular and optokinetic eye movements in humans

We measured torsional vestibular and optokinetic eye movements in human subjects with the head and trunk erect, with the head supine and the trunk erect, and with the head and trunk supine, in order to quantify the effects of otolithic and proprioceptive modulation. During active head movements, the torsional vestibulo-ocular reflex (VOR) had significantly higher gain with the head upright than with the head supine, indicating that dynamic otolithic inputs can supplement the semicircular canal-ocular reflex. During passive earth-vertical axis rotation, torsional VOR gain was similar with the head and trunk supine and with the head supine and the trunk erect. This finding implies that static proprioceptive information from the neck and trunk has little effect upon the torsional VOR. VOR gain with the head supine was not increased by active, self-generated head movement compared with passive, whole body rotation, indicating that the torsional VOR is not augmented by dynamic proprioceptive inputs or by an efference copy of a command for head movement. Viewing earth-fixed surroundings enhanced the torsional VOR, while fixating a chair-fixed target suppressed the VOR, especially at low frequencies. Torsional optokinetic nystagmus (OKN) evoked by a full-field stimulus had a mean slow-phase gain of 0.22 for 10 degrees/s drum rotation, but gain fell to 0.06 for 80 degrees/s stimuli. Despite this fall in gain, mean OKN slow-phase velocities increased with drum speed, reaching maxima of 2.5 degrees/s-8.0 degrees/s in our subjects. Optokinetic after nystagmus (OKAN) was typically absent.(ABSTRACT TRUNCATED AT 250 WORDS)

Monocular temporal hemianopia

Monocular temporal hemianopia was identified in 24 patients. The field of the fellow eye was normal. Computed tomography or magnetic resonance imaging showed juxta-sellar lesions in 19 patients. Fifteen had pituitary adenomas, two had tuberculum sella meningiomas, one a craniopharyngioma, and one an astrocytoma. One patient had optic neuritis. A relative afferent pupillary defect (RAPD) was detected in most patients. Field loss was functional in two. Two had congenital optic disc dysversion with hemianopia which did not respect the vertical meridian. Monocular temporal hemianopia is attributed to involvement of the ipsilateral optic nerve close enough to the chiasm to selectively impair conduction in crossing nasal retinal fibres from the ipsilateral eye, but too anterior to affect crossing nasal retinal fibres from the contralateral eye. The combination of an RAPD, with or without optic disc pallor, on the side of monocular temporal field loss implicates compression of the optic nerve at its junction with the chiasm.

Vertical saccades in senescence

PURPOSE

To determine the metrics of vertical saccades in elderly subjects for comparison in neurologic disease.

METHODS

Sixteen elderly subjects, ten middle-aged subjects, and thirteen young subjects were examined using a magnetic search coil technique. Saccades were measured to predictable vertical target steps and maximal saccadic excursion was measured from primary position.

RESULTS

Maximal upward voluntary excursion was reduced in the elderly (mean 32.9 degrees) compared to young subjects (mean 43.1 degrees). Maximal downward voluntary excursion was also reduced in the elderly (mean 32.8 degrees), compared to young subjects (mean 46.8 degrees). The limited ocular motor range of the elderly was not increased by oculocephalic maneuvers. Individual young subjects had significantly larger downward than upward excursions, but elderly subjects generally had symmetrical upward and downward excursions. Asymptotic peak velocities were not significantly slower in the elderly. Individual young subjects made faster upward than downward saccades. Vertical saccade latencies were significantly prolonged and saccadic accuracy was reduced in the elderly compared to the young subjects.

CONCLUSIONS

The range and accuracy of upward and downward saccades decrease, and their latency increases in senescence. This quantitative study provides norms for the detection of brain or orbital disease in young, middle-aged, and elderly subjects.

Oscillopsia and horizontal nystagmus with accelerating slow phases following lumbar puncture in the Arnold-Chiari malformation

Oscillopsia and nystagmus began in a woman 2 weeks after an inadvertent lumbar puncture during anesthesia for childbirth. Examination showed horizontal-torsional jerk nystagmus in all positions of gaze. Magnetic-search-coil oculography revealed accelerating slow phases, with an increase in nystagmus amplitude in darkness. Magnetic resonance images showed type 1 Arnold-Chiari malformation. Three months after occipital decompressive surgery, nystagmus had almost disappeared. Accelerating slow phases should not be considered diagnostic of congenital nystagmus, especially with an onset of oscillopsia in adult life; imaging should be considered to exclude treatable hindbrain anomalies. Lumbar puncture in patients with the Arnold-Chiari malformation may accentuate craniospinal pressure dissociation and precipitate neurological signs.

Retinotopic and directional deficits of smooth pursuit initiation after posterior cerebral hemispheric lesions

We investigated the initiation of ocular smooth pursuit with horizontal ramp targets in 16 patients with unilateral posterior cerebral lesions. Four of the 16 patients had directional pursuit asymmetry, in which smooth eye movement velocities were reduced toward the lesion, independent of target location on the retina. Of seven patients with normal visual fields for the target, two had a retinotopic eye movement deficit consisting of impaired smooth pursuit of targets moving in both horizontal directions in the hemifield contralateral to their lesion. Patients with retinotopic deficits and normal visual fields, and those with directional deficits, had impairment of smooth pursuit similar to that caused by unilateral lesions of cortical areas MT (middle temporal) and MST (medial superior temporal) in monkeys. All but one patient with either of these defects had a lesion near the junction of Brodmann's areas 19, 37, and 39, providing evidence that this region includes the human homologues of monkey areas MT and MST. One patient with a retinotopic pursuit defect and normal visual fields had a lesion of the rostral superior temporal sulcus, which may have included the homologue of the superior temporal polysensory area of monkeys.

Structure, evolution and expression of the mitochondrial ADP/ATP translocator gene from Chlamydomonas reinhardtii

The first AUG in the Chlamydomonas reinhardtii ADP/ATP translocator (CRANT) mRNA initiates an open reading frame (ORF) which is very similar (51-79% amino acid identity) to other ANT proteins. In contrast to higher plants, no evidence for a long amino-terminal extension was obtained. The 5' non-transcribed region of the single-copy CRANT gene contains sequence motifs present in other C. reinhardtii nuclear genes. Four introns, whose positions are not conserved in other ANT genes, interrupt the protein coding region. A short heat shock specifically reduces CRANT mRNA levels. CRANT mRNA levels were unaffected by a mutation in photosynthesis. In a dark/light regime CRANT mRNA levels are high in the dark phase and low in the early light phase. Data on translation initiation sites, splice junctions and the codon preferences of C. reinhardtii nuclear genes were compiled. With the exception of two rare codons, ACA and GGA, the CRANT gene exhibits the biased codon usage of C. reinhardtii nuclear genes that are highly expressed during normal vegetative growth.

Smooth pursuit initiation in young and elderly subjects

Smooth pursuit initiation to step-ramp stimuli was investigated in normal subjects, young and elderly. Older subjects had significant reductions in initial pursuit acceleration before saccades, and in post-saccadic and peak pursuit velocities. Aging impairs the open-loop performance of the pursuit system, possibly by decreasing sensitivity to retinal image motion or by limiting the conversion of visual motion signals into commands for smooth pursuit. Lower open-loop pursuit gain degrades steady-state, closed-loop smooth pursuit in senescence. Our elderly subjects also made less accurate saccades to moving targets, implying defective use of visual motion information by the saccadic system.

Analysis of the human alpha globin upstream regulatory element (HS-40) in transgenic mice

We have analysed the effect of a 1.4 kb segment of DNA containing the upstream alpha globin regulatory element (HS-40) on human alpha globin gene expression in fetal mice and lines of transgenic mice. High levels of tissue-specific, human alpha mRNA expression were seen in all transgenic animals and in this sense expression was position independent. However, the level of human alpha mRNA expression per integrated gene copy decreased during development and was inversely related to copy number. The limitation in expression with increasing gene copy number was shown to be in cis since homozygotes for the transgene produced twice as much human alpha mRNA as hemizygotes. In many respects HS -40 appears similar to single elements within the previously described beta globin locus control region and in cross breeding experiments we have shown that HS -40 behaves in a similar manner to such elements in transgenic mice.

Regulation of human embryonic globin genes zeta 2 and epsilon in stably transformed mouse erythroleukemia cells

Previous work has suggested that the promoter regions of the human embryonic zeta 2 and epsilon globin genes contain negative regulatory regions that could play a role in the repression of these genes in postembryonic erythroblasts. We have examined this possibility by studying the expression of these genes in mouse erythroleukemia cells, an adult erythroid cell line that might be expected to contain repressor molecules that would bind to the putative negative regulatory regions. When attached to appropriate upstream regulatory elements (alpha HS-40 and beta HS1,2) both the zeta and epsilon genes were expressed in these cells at a low level, but no increase in expression was observed when similar constructs lacking the proposed negative regulatory sequences were introduced into these cells. These results cast doubt on the possibility that these sequences play a major role in the developmental repression of the embryonic globin genes, unless they function only in a normal chromosomal organization.

Motion-defined letter detection and recognition in patients with multiple sclerosis

Two important distinctions in visual perception are (1) between the detection and recognition of shape (e.g., letters), and (2) between the recognition of shapes defined by a difference in brightness and the recognition of shapes defined by a difference in motion. We report that 6 of 10 patients with multiple sclerosis showed impaired recognition for motion-defined (MD) letters, although the detection of MD letters was normal as were both detection and recognition of luminance-defined letters. We have shown that this was not a function of acuity loss or the loss of ability to detect motion or a general failure of recognition per se, but was confined to a loss of ability to recognize MD letters. The neurological implications of these findings are discussed, and it is suggested that the MD letter test be used by others interested in the central pathology of visual disorders.