The formation of ubiquitin rich condensates triggers recruitment of the ATG9A lipid transfer complex to initiate basal autophagy

Autophagy is an essential cellular recycling process that maintains protein and organelle homeostasis. ATG9A vesicle recruitment is a critical early step in autophagy to initiate autophagosome biogenesis. The mechanisms of ATG9A vesicle recruitment are best understood in the context of starvation-induced non-selective autophagy, whereas less is known about the signals driving ATG9A vesicle recruitment to autophagy initiation sites in the absence of nutrient stress. Here we demonstrate that loss of ATG9A or the lipid transfer protein ATG2 leads to the accumulation of phosphorylated p62 aggregates in the context of basal autophagy. Furthermore, we show that p62 degradation requires the lipid scramblase activity of ATG9A. Lastly, we present evidence that poly-ubiquitin is an essential signal that recruits ATG9A and mediates autophagy foci assembly in nutrient replete cells. Together, our data support a ubiquitin-driven model of ATG9A recruitment and autophagosome formation during basal autophagy.

Effect of Vasopressin and Methylprednisolone vs. Placebo on Long-Term Outcomes in Patients with In-Hospital Cardiac Arrest A Randomized Clinical Trial

OBJECTIVE

The primary results from the Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrest (VAM-IHCA) trial have previously been reported. The objective of the current manuscript is to report long-term outcomes.

METHODS

The VAM-IHCA trial was a multicenter, randomized, double-blind, placebo-controlled trial conducted at ten hospitals in Denmark. Adult patients (age ≥ 18 years) were eligible for the trial if they had an in-hospital cardiac arrest and received at least one dose of epinephrine during resuscitation. The trial drugs consisted of 40 mg methylprednisolone (Solu-Medrol®, Pfizer) and 20 IU of vasopressin (Empressin®, Amomed Pharma GmbH) given as soon as possible after the first dose of epinephrine. This manuscript report outcomes at 6 months and 1 year including survival, survival with favorable neurological outcome, and health-related quality of life.

RESULTS

501 patients were included in the analysis. At 1 year, 15 patients (6.3%) in the intervention group and 22 patients (8.3%) in the placebo group were alive corresponding to a risk ratio of 0.76 (95% CI, 0.41-1.41). A favorable neurologic outcome at 1 year, based on the Cerebral Performance Category score, was observed in 14 patients (5.9%) in the intervention group and 20 patients (7.6%) in the placebo group (risk ratio, 0.78 [95% CI, 0.41-1.49]. No differences existed between groups for favorable neurological outcome and health-related quality of life at either 6 months or 1 year.

CONCLUSIONS

Administration of vasopressin and methylprednisolone, compared with placebo, in patients with in-hospital cardiac arrest did not improve long-term outcomes in this trial.

Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest: A Randomized Clinical Trial

IMPORTANCE

Previous trials have suggested that vasopressin and methylprednisolone administered during in-hospital cardiac arrest might improve outcomes.

OBJECTIVE

To determine whether the combination of vasopressin and methylprednisolone administered during in-hospital cardiac arrest improves return of spontaneous circulation.

DESIGN, SETTING, AND PARTICIPANTS

Multicenter, randomized, double-blind, placebo-controlled trial conducted at 10 hospitals in Denmark. A total of 512 adult patients with in-hospital cardiac arrest were included between October 15, 2018, and January 21, 2021. The last 90-day follow-up was on April 21, 2021.

INTERVENTION

Patients were randomized to receive a combination of vasopressin and methylprednisolone (n = 245) or placebo (n = 267). The first dose of vasopressin (20 IU) and methylprednisolone (40 mg), or corresponding placebo, was administered after the first dose of epinephrine. Additional doses of vasopressin or corresponding placebo were administered after each additional dose of epinephrine for a maximum of 4 doses.

MAIN OUTCOMES AND MEASURES

The primary outcome was return of spontaneous circulation. Secondary outcomes included survival and favorable neurologic outcome at 30 days (Cerebral Performance Category score of 1 or 2).

RESULTS

Among 512 patients who were randomized, 501 met all inclusion and no exclusion criteria and were included in the analysis (mean [SD] age, 71 [13] years; 322 men [64%]). One hundred of 237 patients (42%) in the vasopressin and methylprednisolone group and 86 of 264 patients (33%) in the placebo group achieved return of spontaneous circulation (risk ratio, 1.30 [95% CI, 1.03-1.63]; risk difference, 9.6% [95% CI, 1.1%-18.0%]; P = .03). At 30 days, 23 patients (9.7%) in the intervention group and 31 patients (12%) in the placebo group were alive (risk ratio, 0.83 [95% CI, 0.50-1.37]; risk difference: -2.0% [95% CI, -7.5% to 3.5%]; P = .48). A favorable neurologic outcome was observed in 18 patients (7.6%) in the intervention group and 20 patients (7.6%) in the placebo group at 30 days (risk ratio, 1.00 [95% CI, 0.55-1.83]; risk difference, 0.0% [95% CI, -4.7% to 4.9%]; P > .99). In patients with return of spontaneous circulation, hyperglycemia occurred in 77 (77%) in the intervention group and 63 (73%) in the placebo group. Hypernatremia occurred in 28 (28%) and 27 (31%), in the intervention and placebo groups, respectively.

CONCLUSIONS AND RELEVANCE

Among patients with in-hospital cardiac arrest, administration of vasopressin and methylprednisolone, compared with placebo, significantly increased the likelihood of return of spontaneous circulation. However, there is uncertainty whether this treatment results in benefit or harm for long-term survival.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03640949.

Lidocaine-Assisted Xylocaine Jelly Anesthesia versus one Quadrant Sub-Tenon Infiltration for Self-Sealing Sclerocorneal Incision Routine Phacoemulsification

Purpose

To compare the effect of Xylocaine jelly and intracameral lidocaine with one quadrant instant sub-Tenon infiltration for self-sealing sclerocorneal phacoemulsification.

METHODS

One hundred patients were enrolled into a prospective randomized study, receiving either a combination of topical 2% Xylocaine jelly and 0.5 ml of intracameral 1% lidocaine or sub-Tenon infiltration with 2 ml of 2% Xylocaine on the operating table. All patients underwent a standard divide and conquer phacoemulsification procedure through a superior sclerocorneal frown incision followed by implantation of a polymethylmethacrylate intraocular lens. Intraoperative pain was indicated by the patient by squeezing the bedside nurse's hand, who allocated it to particular stages of surgery on a chart. After surgery, patients assessed the pain experienced using a 10-unit visual analogue scale.

Results

Pain was indicated on 31 occasions during the operation in the sub-Tenon group (mainly the injection itself) and 67 times in the topical group. The median overall subjective pain score was 3 in the jelly group and 0 in the sub-Tenon. Five eyes (10%) had to be converted to sub-Tenon during the surgery because of intolerable pain.

CONCLUSIONS

Whereas lidocaine supported Xylocaine jelly anesthesia provided acceptable analgesia for 90% of patients operated, sub-Tenon anesthesia proved to deliver better intraoperative comfort in all patients receiving sclerocorneal incision cataract surgery.

Glaukomdrainagesystem nach Molteno bei therapieresistentem Glaukom - eine zweizeitige Operationstechnik zur Vermeidung einer postoperativen Hypotonie

BACKGROUND

The treatment of therapy-resistant secondary glaucoma with cyclodestructive approaches may give rise to unsatisfactory intraocular pressure results, leading to phthisis. A final option may be the implantation of an external glaucoma drainage system (GDS). A consecutive positioning of the drainage system under the conjunctiva and implantation of the drainage tube into the anterior chamber, may result in an uncontrolled reduced of intraocular pressure leading to intraocular haemorrhages into the anterior chamber or vitreous cavity. In particular, expulsive haemorrhages are feared as deleterious complication.

PATIENTS AND METHODS

15 patients (15 eyes) with secondary glaucoma received a GDS. All patients were previously unsuccessfully treated by numerous approaches (mean 2.7 times). The mean preoperative intraocular pressure was 37 mmHg (range: 22 to 55 mmHg). We performed a sequential approach: during the first operation we implanted and fixed the resorption site of a Molteno GDS onto the sclera close to the equator in the superotemporal quadrant. After an inflammation-free interval of 2 - 3 weeks we placed the drainage tube into the anterior chamber. The average postoperative follow-up period was 20.5 months (range: 3 to 62 months).

RESULTS

The implantation of the GDS using a sequential approach was well tolerated by all patients. While 14 out of 15 eyes achieved an IOP of 15 mmHg (range: 12 to 18 mmHg), 2 of them still required additional topical glaucoma treatment. An unsatisfactory IOP regulation was observed in only one eye although a revision surgery was performed postoperatively. Four eyes developed a light anterior chamber haemorrhage that resorbed without serious complications within 3 weeks. A choroidal effusion in one eye was treated by an anterior chamber injection of a viscoelastic gel.

CONCLUSION

The potential disadvantage of the GDS can be almost completely avoided using a sequential approach. The implant heals well in the subtenon space during the first postoperative week, thus preventing an overfiltration of anterior chamber fluid. Our positive results show that the GDS is an important treatment option in selected patients.

Pars-plana-Vitrektomie mit Infusionszugang über eine korneale Parazentese bei pseudophaken Augen

BACKGROUND

More than 50% of vitrectomies are performed in pseudophakic eyes. There is free communication between the anterior segment of the eye and the vitreous cavity through the zonular fibres of the lens. This means it is possible to use a primary anterior chamber infusion for pars-plana vitrectomy.

METHODS

For some years, therefore, we have used an anterior chamber approach for the infusion cannula when carrying out such simple vitreo-retinal procedures as silicone oil removal or macular pucker peeling in pseudophakic eyes.

RESULTS

In all eyes the anterior chamber access was placed via a corneal paracenthesis and during all vitrectomies it was held in place by corneal tissue tone with no need for suturing. Secure wound closure was also achieved without suturing by simply swelling the paracentesis. Conventional sclerotomies were closed with absorbable sutures. During vitrectomy the infusional flow was sufficient to ensure adequate intraocular pressure regardless of intraocular lens type and diameter.

CONCLUSIONS

In pseudophakic eyes the anterior chamber infusion approach by way of a paracentesis is a safe way of reducing surgical trauma during vitrectomy. It must, however, be borne in mind that when an endotamponade is applied it is necessary to switch the infusion to one of the sclerotomies.

Complete resorption of retinal hemorrhages in idiopathic thrombocytopenic purpura

PURPOSE

Idiopathic thrombocytopenic purpura (ITP) is characterized by refractory thrombocytopenia, production of autoantibodies, and persistent predisposition to bleeding affecting virtually all mucocutaneous tissues and various organs.

METHODS

A 50-year-old man with chronic ITP and diabetic maculopathy developed massive preretinal, intraretinal, and numerous subretinal hemorrhages accompanied by impaired vision to 20/400. His platelet count was 1100/microL, hemoglobin concentration was 4.6 mg/dL, however his blood clotting and activated partial thromboplastin time (APTT) maintained a normal 26 sec.

RESULTS

After a splenectomy the patient was placed on high-dose oral corticosteroids (40 mg/day), immunoglobulin, and CellCept. The platelet count was restored to 25,000/microL within months. Four months later the unaffected retina received a panretinal photocoagulation and intravitreal triamcinolone injection (25 mg). Two years after the thrombolytic event the hemorrhages resolved completely and the patient's vision recovered to 20/100.

CONCLUSIONS

Repetitive treatments with immunoglobulins and high-dose corticosteroids may increase the platelet count, inducing a complete resorption of the retinal hemorrhages and visual recovery during a long-term follow-up.

High incidence of vitreomacular traction in recurrent choroidal neovascularisation after repeated photodynamic therapy

BACKGROUND

The causes of recurrent choroidal neovascularisation (CNV) after photodynamic therapy (PDT) remain controversial. Subretinal surgery was carried out after unsuccessful PDT.

AIMS

To determine intraoperatively the status of the posterior vitreous interface.

DESIGN

Interventional case series.

METHODS

Conventional three-port vitrectomy was carried out in 10 eyes with CNV that had undergone 1-4 PDT sessions. The vitreous cutter was held close to the edge of the optic nerve to evaluate the status of the posterior vitreous.

RESULTS

Lesion size showed an increase from 1.5 (standard deviation (SD) 0.53) to 2.3 (SD 0.83) macular photocoagulation study disc diameters, between the first and the last PDT. Intraoperative findings during vitrectomy showed little liquefaction of the vitreous gel and an incomplete posterior-vitreous detachment, with remarkably firm attachments at the macula in all cases (10/10).

CONCLUSION

We determined an abnormally high incidence of vitreous attachments in eyes with recurrent CNV. Vitreomacular attachments may trigger the progression or recurrence of CNV.

[Massive subretinal hemorrhages. A challenge for vitreous body surgeons]

BACKGROUND

In patients with advanced age-related macular degeneration (AMD), massive subretinal hemorrhage may sometimes be the reason for a loss of peripheral vision, leading to a significantly reduced quality of life.

PATIENTS AND METHODS

During the years 1995-2001 we operated five eyes (five consecutive patients) with acute massive subretinal hemorrhage extending into all four quadrants and profoundly reduced vision in the fellow eye due to a Junius-Kuhnt macular scar. Within an interval of 1-2 weeks after the bleeding, pars plana vitrectomy with peripheral retinotomy was performed. After the retina was turned upside down and the partially liquified blood was removed, the underlying subfoveal CNV membrane was removed with a vitrectome. Three phakic eyes required additional cataract surgery and IOL implantation. The retina reattached under PFCL and a silicone oil tamponade applied for 3-6 months.

RESULTS

The removal of the subretinal hemorrhage was without complications. The size of the subretinal membrane was between 4 and 6 PD with partially fibrovascular tissue. After the membrane was removed, a large central pigment epithelium defect made a macular rotation impossible. Visual acuity of hand motion improved from preoperatively 0.05 to postoperatively 1/35 to 0.1 after a follow-up of 3-6 months.

CONCLUSION

In patients with such an extremely reduced visual acuity and visual field, subretinal surgery with removal of the subretinal blood may achieve sufficient vision for the patients' orientation.

Primary vitrectomy in complicated rhegmatogenous retinal detachment--a survey of 205 eyes

INTRODUCTION

In a few types of rhegmatogenous retinal detachment (RRD), scleral buckling (SB) has a lower success, and, here, pars plana vitrectomy (PPV) is a good alternative option. This survey reviews the indications and the surgical outcome of primary PPV with internal tamponade.

PATIENTS AND METHODS

We reviewed 205 eyes operated by primary PPV for RRD at the Department of Ophthalmology of the Philipps University Marburg between the years 1990 and 1997. The indications of PPV were: holes greater than 90 degrees; holes posterior to the equator; proliferative vitreoretinopathy grade C; pseudophakic status.

RESULTS

A complete reattachment of the retina after absorption of the gas or after silicone oil removal was achieved by 1 operation in 146 eyes (71.2%) and in 195 eyes (95.2%) by a second intervention.

CONCLUSION

Although SB is the standard procedure for the treatment of RRD, complicated cases can be treated successfully with primary PPV.

Vermessung der skotopischen Pupille

PURPOSE

The aim of the study was to compare the accuracy and the reproducibility of scotopic pupil measurements using two different methods.

PATIENTS AND METHODS

We developed a simple test to measure scotopic pupil diameters using a narrow slit of light through a green filter of the Haag-Streit slitlamp. A total of 100 eyes from 50 refractive surgery candidates were prospectively examined by 2 independent investigators using both the Colvard pupilometer (Oasis/USA) and Sekundo's slitlamp green light test. Results were compared using all pairwise multiple comparison procedures (Student-Newman-Keuls method, SigmaStat/Jandel Scientific). The mean age of the patients was 36.3 years with a male:female ratio of 16:34. The colour of the iris was considered blue for 36 individuals and brown for the remainder.

RESULTS

Reproducibility: the right eye mean pupil diameter using Sekundo's method was 6.4 mm (+/-0.9) measured by both the first (Slit 1R) and the second (Slit 2R) investigator. The left eye mean pupil diameter was 6.5 mm (+/-1) (Slit 1L) and 6.35 mm (+/-1) (Slit 2L), respectively. The following measurements were obtained with the Colvard pupillometer: (Colv1R)=6.25+/-0.85 mm, (Colv2R)=5.99+/-1 mm, (Colv1L)=6.15+/-0.91 mm, (Colv2L)=6.05+/-0.9 mm. There were no statistically significant differences between the two investigators within the same method of examination. Comparability:The data of both investigators were combined to form 4 groups: (Slit R)=6.4+/-0.96 mm, (Slit L)=6.4+/-1 mm, (Colv R)=6.05+/-0.9 mm, (Colv L)=6.1+/-0.93 mm. There was a significant difference ( p=0.024) between the two methods for both right and left eyes. Particularly for large pupils, the slitlamp green light measurements were significantly higher (up to 0.35 mm) than those with Colvard's device.

CONCLUSIONS

The slitlamp green light test provides similar reproducibility for the measurement of the scotopic pupil diameter as the commercially available Colvard pupilometer.

[Therapy of radiation resistant malignant uveal melanoma with endoresection by pars plana vitrectomy in two patients]

BACKGROUND

Since introduction of brachytherapy using (106)ruthenium plaque therapy for treating malignant choroidal melanomas a number of comparative studies have shown that survival rates are equal between patients who underwent radiation or enucleation. When radiation treatment fails, the patient might be determined to choose removal of the tumor by pars plana vitrectomy.

PATIENTS AND METHODS

Between 1995 and 1998 a total number of 48 patients underwent (106)ruthenium plaque irradiation. In 9 patients tumor regression was not sufficient. Two of these nine patients decided explicitly against enucleation and choose to have the tumor removed from within the eye employing pars plana vitrectomy.

RESULTS

Intraoperatively, the previously radiated melanoma was easily removed with the vitrectomy cutter without significant bleeding. Postoperative recovery was without complications. Silicone oil removal was carried out in one patient after one year. Vision 9 months and 2.5 years after surgery was 0.2 and 0.02, respectively. The cosmetic results with parallel axis of the globes were very good and one patient gained binocular vision. No recurrent tumor growth was seen so far. Histologically, no mitotic figures were found.

CONCLUSION

Malignant choroidal melanomas can be safely removed by pars plana vitrectomy with stable intraocular pressure. Previous radiation therapy alters the tumor, inducing fibrous tissue growth and necrosis of tumor cells. These tissue types are not prone to bleed when they are resected by the vitrectomy cutter. Long time studies have to elucidate the difference in survival rates between patients undergoing enucleation of the eye and patients who chose endoresection of the melanoma by pars plana vitrectomy.

Rapid identification of biological warfare agents using an instrument employing a light addressable potentiometric sensor and a flow-through immunofiltration-enzyme assay system

An instrument employing a light addressable potentiometric sensor and a flow-through immunofiltration-enzyme assay system has been developed for the rapid and specific identification of biological warfare (BW) agents. The system has been designed to assay for up to eight agents simultaneously and provides an indication of the absence or presence of a threat within 15 min. Parameters affecting the mixing of the reagents within the instrument's fluidic lines were investigated and optimized. Measurements of blank samples and samples containing Bacillus subtilis spores in the concentration range of 10(4) to 10(6) cfu/ml indicate the limit of detection (LOD) is 3 x 10(3) cfu/ml for B. subtilus. Although the LOD is higher than that of several technologies currently under development, this instrument offers an immediate interim approach for addressing the need to rapidly detect biological warfare agents in the field.

Selenomethionyl dihydrofolate reductase from Escherichia coli. Comparative biochemistry and 77Se nuclear magnetic resonance spectroscopy

The biosynthetic replacement of Met residues by selenomethionine (SeMet) facilitates the determination of three-dimensional structure by multiwavelength anomalous diffraction (Yang, W., Hendrickson, W. A., Crouch, R.J., and Satow, Y. (1990) Science 249, 1398-1405). In an effort to examine any biochemical effects due to the replacement of Met residues by SeMet, we chose to compare the kinetic and binding properties of selenomethionyl dihydrofolate reductase with those of the wt enzyme. There are 5 Met residues in Escherichia coli dihydrofolate reductase with 2 located in the Met-20 loop, which is a sequence of residues forming a lid over the active site. Utilizing plasmid pWT8, which affords 10-15% soluble protein as E. coli dihydrofolate reductase, we readily isolated both the SeMet and wt enzymes from E. coli DL41 utilizing a novel purification protocol. Both enzymes exhibited essentially the same kinetic and binding properties, including specific activities (45 mumol/min/mg), Km (7,8-dihydrofolate = 0.39 microM; NADPH = 2.0 microM), kcat (13.5/s), and 1:1 noncovalent inhibitory binding ratios with methotrexate. The inhibitory effects of divalent and monovalent cations on activity were also assessed, with the SeMet-containing enzyme exhibiting a uniformly greater sensitivity than the wt enzyme. We conclude that the biochemical properties of dihydrofolate reductase are virtually unperturbed by SeMet inclusion. Analysis of SeMet dihydrofolate reductase by 77Se nuclear magnetic resonance spectroscopy revealed five distinct resonances, thus indicating the potential value of this technique in employing selenium as a nonperturbing NMR probe of protein structure and function.

Vital bleach of hemorrhagic discoloration

An unusual case is presented of a maxillary central incisor with hemorrhagic discoloration that was successfully treated with the thermocatalytic vital bleach technique. This case emphasizes the need for a thorough radiographic and clinical examination to include vitality tests when a patient presents with a discolored tooth.

Prolonged mechanical ventilation for respiratory failure: a cost-benefit analysis

To define the costs and benefits associated with prolonged mechanical ventilation, we studied retrospectively the records of 137 consecutive patients who required at least 48 h of ventilator support. The patients were physiologically unstable and required intensive care. Causes of respiratory failure included pulmonary diseases, post-operative complications, neuromuscular diseases, cardiac dysfunction, and GI disease. Forty-nine (36%) patients survived the hospitalization, and 38 (28%) patients were alive 3 yr after receiving prolonged mechanical ventilation. The mean total hospital cost was +16,930/patient (U.S. dollars, 1976-1977). The cost-benefit averaged +1826/yr of extended life. These costs varied from +460/yr of extended life for patients with respiratory failure complicating asthma to +8026/yr for patients with cardiac dysfunction. The cost-benefit ratio increased sharply for men older than 56 yr and for women older than 75 yr. These data document the importance of the basic disease process and the patient's age in the cost-benefit relationship.

Effect of tetraethyl lead and restricted food intake on locomotor activity in the rat

The effect of tetraethyl lead (TEL) and restricted food intake on spontaneous locomotor activity in male albino rats was investigated. Forty animals were injected intraperitoneally with 4, 7, 10 or 13 mg/kg body weight of TEL in peanut oil, or a peanut oil placebo. Forty additional animals were food yoked to lead treated animals as a control procedure to hold food intake constant between lead treated and lead free animals. A comparison of pre- and posttreatment measures revealed significant decreases in food intake and increases in activity levels at dosages of 7, 10 and 13 mg/kg of TEL. In addition, food intake and activity were significantly correlated in both lead treated and yoked groups. The issue of factors associated with reduced food intake playing a role in observed activity level increases was raised.

Effect of tetraethyl lead on food and water intake in the rat

The effect of tetraethyl lead (TEL) on food and water intake in adult male albino rats was studied. Animals received 1, 4, 7, 10, or 13 mg/kg body weight of TELin peanut oil, or a peanut oil placebo, via either intragastric (IG) intubation or intraperitoneal (IP) injection. For food intake, route of administration was a significant factor and, compared to baseline levels, food intake was significantly depressed at dosage levels of 7, 10, and 13 mg/kg for both IP and IG administration. Further, the time course of food intake differed significantly across route of administration. Water intake was also significantly depressed at 7, 10, and 13 mg/kg, but route of administration was not a critical factor. Results were discussed in relation to clinical and experimental data on lead intoxication, and were viewed as severely limiting the utility of employing food and/or water as motivational variables in assessment of behavioral effects linked to TEL poisoning.