Late-Onset Retinal Findings and Complications in Untreated Retinopathy of Prematurity

PURPOSE

To investigate late retinal findings and complications of eyes with a history of retinopathy of prematurity (ROP) that did not meet treatment criteria and did not receive treatment during infancy.

DESIGN

Retrospective, nonconsecutive, noncomparative, multicenter case series.

PARTICIPANTS

Three hundred sixty-three eyes of 186 patients.

METHODS

Data were requested from multiple providers on premature patients with a history of ROP and no treatment during infancy who demonstrated late retinal findings or complications and included age, gender, gestational age and weight, zone and stage at infancy, visual acuity, current retina vascularization status, vitreous character, presence of peripheral retinal findings such as lattice retinal tears and detachments (RDs), retinoschisis, and fluorescein findings.

MAIN OUTCOME MEASURES

Rate of RDs and factors conferring a higher risk of RDs.

RESULTS

The average age was 34.5 years (range, 7-76 years), average gestational age was 26.6 weeks (range, 23-34 weeks), and average birth weight was 875 g (range, 425-1590 g). Findings included lattice in 196 eyes (54.0%), atrophic holes in 126 eyes (34.7%), retinal tears in 111 eyes (30.6%), RDs in 140 eyes (38.6 %), tractional retinoschisis in 44 eyes (11.9%), and visible vitreous condensation ridge-like interface in 112 eyes (30.5%). Fluorescein angiography (FA) was performed in 113 eyes, of which 59 eyes (52.2%) showed leakage and 16 eyes (14.2%) showed neovascularization. Incomplete vascularization posterior to zone 3 was common (71.6% of eyes). Retinal detachments were more likely in patients with a gestational age of 29 weeks or less (P < 0.05) and in eyes with furthest vascularization to posterior zone 2 eyes compared with zone 3 eyes (P = 0.009).

CONCLUSIONS

Eyes with ROP not meeting the treatment threshold during infancy showed various late retinal findings and complications, of which RDs were the most concerning. Complications were seen in all age groups, including patients born after the Early Treatment for Retinopathy of Prematurity Study. Contributing factors to RDs included atrophic holes within peripheral avascular retina, visible vitreous condensation ridge-like interface with residual traction, and premature vitreous syneresis. We recommend regular examinations and consideration of ultra-widefield FA examinations. Prospective studies are needed to explore the frequency of complications and benefit of prophylactic treatment and if eyes treated with anti-vascular endothelial growth factor therapy are at risk of similar findings and complications.

Peripubertal GnRH and testosterone co-treatment leads to increased familiarity preferences in male sheep

Chronic gonadotropin-releasing hormone agonist (GnRHa) treatment is effective for the medical suppression of the hypothalamic-pituitary-gonadal axis in situations like central precocious puberty and gender dysphoria. However, its administration during the peripubertal period could influence normal brain development and function because GnRH receptors are expressed in brain regions that regulate emotions, cognition, motivation and memory. This study used an ovine model to determine whether chronic peripubertal GnRHa-treatment affected the developmental shift from preference of familiarity to novelty. Experimental groups included Controls and GnRHa-treated rams. To differentiate between effects of altered GnRH signaling and those associated with the loss of sex steroids, a group was also included that received testosterone replacement as well as GnRHa (GnRHa + T). Preference for a novel versus familiar object was assessed during 5-min social isolation at 8, 28 and 46 weeks of age. Approach behavior was measured as interactions with and time spent near the objects, whereas avoidance behavior was measured by time spent in the entrance zone and attempts to escape the arena via the entry point. Emotional reactivity was measured by the number of vocalizations, escape attempts and urinations. As Control and GnRHa-treated rams aged, their approach behaviors showed a shift from preference for familiarity (8 weeks) to novelty (46 weeks). In contrast, relative to the Controls the GnRHa + T rams exhibited more approach behaviors towards both objects, at 28 and 46 weeks of age and preferred familiarity at 46 weeks of age. Vocalisation rate was increased in GnRHa treated rams in late puberty (28 weeks) compared to both Control and GnRHa + T rams but this effect was not seen in young adulthood (46 weeks). These results suggest that the specific suppression of testosterone during a developmental window in late puberty may reduce emotional reactivity and hamper learning a flexible adjustment to environmental change. The results also suggest that disruption of either endogenous testosterone signalling or a synergistic action between GnRH and testosterone signalling, may delay maturation of cognitive processes (e.g. information processing) that affects the motivation of rams to approach and avoid objects.

Circadian rhythms of melatonin and behaviour in juvenile sheep in field conditions: Effects of photoperiod, environment and weaning

Entrainment of circadian rhythms (CR) to the light dark cycle has been well described under controlled, experimental conditions. However, studies in rodents have reported that rhythms in the laboratory are not always reproduced under field conditions. The aim of this study was to characterise the CR of sheep maintained under conditions of standard UK farm animal husbandry and to investigate the effects of environmental challenges presented by season, weaning and changes in housing on CR. Male sheep (n = 9) were kept at pasture, or group housed in barns, under natural photoperiod for one year. CR in locomotor activity were monitored using accelerometry, and 24 h patterns in plasma cortisol and melatonin were measured every 4 h by ELISA. CR was measured before and after weaning, in summer and winter, and at pasture and by barn housing. Cosinor analysis revealed high amplitude, diurnal rhythms in locomotor activity that were disrupted by weaning and by barn housing. Rhythms in winter showed an interrupted night time activity pattern, but only when the sheep were kept at pasture. Cortisol and melatonin secretion followed typical circadian patterns in winter and summer. The CR of the sheep under the field conditions of this study were strikingly robust under basal conditions, but easily disrupted by environmental challenges. Interrupted patterns of activity during the long nights of wintertime, not previously reported for sheep kept in experimental conditions were recorded. Based on these findings, we propose that animals require exposure to more complex environments than the laboratory in order to exhibit their true circadian phenotype.

Effects of season on the reproductive organs and steroid hormone profiles in guinea hens (Numida meleagris)

The study documented gross anatomical and histological differences in the reproductive organs of 28 breeding and non-breeding female guinea fowls. Peripheral progesterone and 17β-oestradiol concentrations were also compared in breeding and non-breeding hens. In non-breeding females, all ovarian and oviducal gross anatomical features had significantly regressed. Histologically, some of the changes in a regressing oviduct include systematic changes in height and size of all epithelial cells in all regions of the duct, absence/sparse ciliation of portions of surface epithelium in the magnum, isthmian and uterine regions, general loss of cytoplasmic mass, reduction in size and degeneration of tubular glands. Mucosal folds in all regions of the oviduct except the infundibular lip were higher in breeding females. No difference was found between the two groups in plasma progesterone concentrations. Breeding females, however, had higher peripheral oestradiol concentrations than non-breeding females. About 2 h prior to oviposition, plasma oestradiol concentrations peaked at 2.4-fold (230 pg/ml) compared with baseline concentration and plasma progesterone concentrations by nearly 9-fold (5.29 ng/ml) of baseline. Significant regression and changes in the histological structure of the ovary and oviduct had occurred in non-breeding females, and lower peripheral oestrogen concentrations may be responsible for this phenomenon.

Disrupted seasonal biology impacts health, food security and ecosystems

The rhythm of life on earth is shaped by seasonal changes in the environment. Plants and animals show profound annual cycles in physiology, health, morphology, behaviour and demography in response to environmental cues. Seasonal biology impacts ecosystems and agriculture, with consequences for humans and biodiversity. Human populations show robust annual rhythms in health and well-being, and the birth month can have lasting effects that persist throughout life. This review emphasizes the need for a better understanding of seasonal biology against the backdrop of its rapidly progressing disruption through climate change, human lifestyles and other anthropogenic impact. Climate change is modifying annual rhythms to which numerous organisms have adapted, with potential consequences for industries relating to health, ecosystems and food security. Disconcertingly, human lifestyles under artificial conditions of eternal summer provide the most extreme example for disconnect from natural seasons, making humans vulnerable to increased morbidity and mortality. In this review, we introduce scenarios of seasonal disruption, highlight key aspects of seasonal biology and summarize from biomedical, anthropological, veterinary, agricultural and environmental perspectives the recent evidence for seasonal desynchronization between environmental factors and internal rhythms. Because annual rhythms are pervasive across biological systems, they provide a common framework for trans-disciplinary research.

Epigenetics and developmental programming of welfare and production traits in farm animals

The concept that postnatal health and development can be influenced by events that occur in utero originated from epidemiological studies in humans supported by numerous mechanistic (including epigenetic) studies in a variety of model species. Referred to as the 'developmental origins of health and disease' or 'DOHaD' hypothesis, the primary focus of large-animal studies until quite recently had been biomedical. Attention has since turned towards traits of commercial importance in farm animals. Herein we review the evidence that prenatal risk factors, including suboptimal parental nutrition, gestational stress, exposure to environmental chemicals and advanced breeding technologies, can determine traits such as postnatal growth, feed efficiency, milk yield, carcass composition, animal welfare and reproductive potential. We consider the role of epigenetic and cytoplasmic mechanisms of inheritance, and discuss implications for livestock production and future research endeavours. We conclude that although the concept is proven for several traits, issues relating to effect size, and hence commercial importance, remain. Studies have also invariably been conducted under controlled experimental conditions, frequently assessing single risk factors, thereby limiting their translational value for livestock production. We propose concerted international research efforts that consider multiple, concurrent stressors to better represent effects of contemporary animal production systems.

Reasons for recall following conditional discharge: explanations given by male patients suffering from dual diagnosis in a London Forensic Unit

Patients who have been discharged from forensic services often have conditions they have to abide by as part of their discharge, and failure to do so leads to recall. We interviewed six men who had been conditionally discharged from forensic services and then been recalled into hospital to find out what they thought went wrong. The reasons they gave for why things went wrong included feeling that the system was unfair and made them feel like criminals even though they did not feel they had put anyone at risk. Some of them were not fully aware of the conditions they needed to adhere to, and some of them had breached the conditions but did not take responsibility for what had happened. In addition, supervision was felt to be very controlling and disruptive rather than supportive when patients were often lonely, bored and needing support. Most participants reported that they experienced poor standards of aftercare in hostels they were required to reside in. In the future, care of patients after conditional discharge should include better communication between patients and their supervisory team, recognition of the need for more support and improvements in the standards of care in hostels, as well as a collaborative approach to risk assessment that might reduce the frequency of relapse and readmission. This study explores how male patients suffering from dual diagnosis in a forensic unit perceive being recalled and readmitted following conditional discharge and their views about how services might be improved. A qualitative approach was used drawing on grounded theory techniques. Audiotaped semistructured interviews collected data from a purposefully selected sample of six participants who had been recalled and met the inclusion criteria of the study. Data were analysed using the constant comparative method. Most participants perceived the recall system as unfair, inappropriately criminalized their behaviour and was based on an assessment of risk that they did not understand or accept. Participants were not fully aware of the conditions of their discharge, and most did not accept responsibility for their role in being recalled and blamed the system. Care following discharge was rarely seen as positive, and poor standards in hostels were reported by most participants. Supervision was often seen as disruptive and controlling, and focused more on surveillance rather than support. Better communication might have helped them understand and adhere to the conditions of their discharge. Participants identified the importance of family and friends to their recovery, the importance of having their own accommodation, and the need to be more independent.

Aging causes a slowing in ciliary beat frequency, mediated by PKCε

The elderly are at much higher risk for developing pneumonia than younger individuals. Pneumonia is a leading cause of death and is the third most common reason for hospitalization in the elderly. One reason that elderly people may be more susceptible to pneumonia is a breakdown in the lung's first line of defense, mucociliary clearance. Cilia beat in a coordinated manner to propel out invading microorganisms and particles. Ciliary beat frequency (CBF) is known to slow with aging, however, little is known about the mechanism(s) involved. We compared the CBF in BALB/c and C57BL/6 mice aged 2, 12, and 24 mo and found that CBF diminishes with age. Cilia in the mice at age 12 and 24 mo retained their ability to be stimulated by the β2 agonist procaterol. To help determine the mechanism of ciliary slowing, we measured protein kinase C alpha and epsilon (PKCα and PKCε) activity. There were no activity differences in PKCα between the mice aged 2, 12, or 24 mo. However, we demonstrated a significantly higher PKCε activity in the mice at 12 and 24 mo than the in the mice 2 mo of age. The increase in activity is likely due to a nearly threefold increase in PKCε protein in the lung during aging. To strengthen the connection between activation of PKCε and ciliary slowing, we treated tracheas of mice at 2 mo with the PKCε agonist 8-[2-(2-pentylcyclopropylmethyl)-cyclopropyl]-octanoic acid (DCP-LA). We noted a similar decrease in baseline CBF, and the cilia remained sensitive to stimulation with β2 agonists. The mechanisms for the slowing of baseline CBF have not been previously determined. In this mouse model of aging we were able to show that decreases in CBF are related to an increase in PKCε activity.

Developmental programming: prenatal androgen exposure alters the gonadotroph population of the ovine pituitary gland

In utero exposure of the female foetus to androgens during development disrupts the reproductive axis and results in hypersecretion of luteinising hormone (LH) (but not follicle-stimulating hormone) in postnatal life. Abnormalities in the neural circuits controlling hypothalamic gonadotrophin-releasing hormone have been documented; however, androgens could also programme abnormalities in the pituitary gland. Ovine foetuses were exposed to either testosterone propionate or the non-aromatisable androgen dihydro-testosterone from days 30-90 of gestation (term 147 days) and the effects on the functional morphology of the pituitary were determined. Exogenous testosterone propionate exposure resulted in pituitary glands in adult male and female sheep that were 40% heavier than controls. Because this effect was not observed in the dihydro-testosterone-exposed animals, these actions are mediated via the oestrogen receptor (ER). No significant differences were apparent in 90- or 140-day foetuses. There was no difference between control and androgen-exposed animals in the density of LHβ or ERα immunoreactive cells in the pituitary although the density of follicle-stimulating hormone-β immunoreactive cells was lower in the testosterone-treated animals. The percentage of cells co-localising LHβ and ERα was lower in the testosterone-treated ewes and this may, in part, explain a reduced ability to respond to steroid feedback. Thus, enlargement of the pituitary gland, coupled with a reduced sensitivity to oestrogen negative-feedback, may contribute to the hyper-secretion of LH observed in animals that have been exposed to excess androgens during foetal life.

Masculinization of the distal tubular and external genitalia in female sheep with prenatal androgen exposure

Prenatal exposure to endogenous or exogenous androgens alters the development of the female reproductive tract. Although lesions in ovaries and external genitalia of androgenized female sheep have been reported, lesions of the tubular genitalia have not. Testosterone propionate (TP) or dihydrotestosterone (DHT) was administered by intramuscular injection twice weekly to 32 ewes from 30 to 90 days of pregnancy. The ewes lambed normally. The reproductive tracts from 24 treated and 13 control postpubertal female offspring were examined at 10 months of age. The ovaries, oviducts, and uteri were grossly and histologically normal in both TP- and DHT-exposed sheep. However, in the DHT-treated sheep, the uterus connected to a misshapen, saccular vagina that opened into the urethra; in the TP-treated sheep, it ended in a blind sac. In both TP- and DHT-treated sheep, the urethra was approximately 5 times longer than that of control sheep, and it resembled a male urethra with bilateral male accessory genital glands. The urethra terminated in a fully developed penis in both TP- and DHT-treated sheep, and a scrotal sac was present (without testes). These results show that prenatal exposure of female sheep to exogenous androgens results in masculinization of the tubular and external genitalia.

Distribution of galanin receptor-2 immunoreactive neurones in the ovine hypothalamus: no evidence for involvement in the control of gonadotrophin-releasing hormone secretion

Galanin is a small neuropeptide that mediates its effects via three receptor isoforms: galanin receptor-1, galanin receptor-2 and galanin receptor-3 (Gal-R1, Gal-R2 and Gal-R3). Galanin is thought to be an important intermediate in signalling in the hypothalamic-pituitary-gonadal axis and has been widely detected in the ovine hypothalamus. The expression of galanin and Gal-R1 has been reported to fluctuate during the reproductive cycle. Although the distribution of Gal-R1 has been determined in the ovine hypothalamus, the distribution of Gal-R2 was hitherto unknown. Using immunohistological and immunofluorescence techniques, we have mapped the distribution of Gal-R2 in the ovine hypothalamus, collected during the follicular phase of the oestrous cycle and examined colocalisation of Gal-R2 with oestrogen receptor alpha (ERalpha) and gonadotrophin-releasing hormone (GnRH). Gal-R2 was expressed in several regions of the hypothalamus (supraoptic nucleus, paraventricular nucleus, ventromedial nucleus, arcuate nucleus) but not as widely expressed as Gal-R1. Areas of Gal-R2 expression overlapped with those reported for Gal-R1. We observed that, in certain defined regions of the hypothalamus, up to 50% of neurones that express Gal-R2 also express ERalpha. No neurones coexpressed Gal-R2 and GnRH. Thus, we conclude that, in follicular phase animals, this receptor plays little or no role in direct intermediary signal transmission in GnRH-mediated control of the reproductive cycle.

Impacts of aggregate dredging on sediment composition and associated benthic fauna at an offshore dredge site in the southern North Sea

Dredging and associated screening at a dredge site in the southern North Sea (Area 408) is associated with areas of well-sorted fine sand that extend for up to 3 km to the south-east of the dredged area and overlay sediments with a more variable particle size composition. This well-sorted fine sand may reflect deposition and transport of material mobilised by the dredging and screening processes at the dredge site. Multivariate analysis of the benthic community structure suggests that marine aggregate dredging, at the level of intensity employed in the study area prior to sample collection, has had a limited impact on benthic community composition compared with that reported from studies elsewhere. This is ascribed to the likely rapid rates of recolonisation by the mobile opportunistic polychaetes and crustaceans that dominate the macrofauna of the sandy gravel deposits at this particular dredge site. Analysis of variance showed, however, that significant differences existed between the sample treatments in terms of species evenness (Pielou's J). Dredged samples were found to have the lowest mean species evenness (0.71) when compared to controls (0.77). The present study highlights the inherent difficulties in the application of general impact/recovery predictions to dredged sites with varying environmental characteristics.

Progesterone can block the preovulatory gonadotropin-releasing hormone/luteinising hormone surge in the ewe by a direct inhibitory action on oestradiol-responsive cells within the hypothalamus

Elevated oestradiol concentrations during the follicular phase stimulate a surge in gonadotropin-releasing hormone (GnRH) and luteinising hormone (LH) concentrations, which leads to ovulation. Progesterone can block the oestradiol-induced GnRH/LH surge, but the mechanism that is involved is unclear. We examined the effect of progesterone on oestradiol-induced activation of cells within the ovine hypothalamus/preoptic area (POA) to determine: (i) in which regions progesterone acts to block the GnRH/LH surge and (ii) whether progesterone directly or indirectly prevents activation of oestradiol-responsive cells. Cellular activation was assessed by measuring the number of cells that expressed Fos (an immediate early gene). Exposure to increased oestradiol concentrations in the absence of progesterone (which normally stimulates a LH surge) did not cause any region-specific changes in hypothalamic Fos expression during the activation stage of the LH surge-induction process (Experiment 1). The same treatment significantly increased cellular activation within the POA, lateral septum (LS), and arcuate nucleus at the time of surge onset (Experiment 2). Concurrent exposure to increased oestradiol and progesterone concentrations during the activation stage of the surge-induction process (which normally blocks the LH surge) was associated with significantly reduced cellular activation within the ventromedial hypothalamus and anterior hypothalamic area, relative to the positive controls (oestradiol increment alone) and arcuate nucleus relative to the negative controls (no increment in oestradiol) during the activation stage (Experiment 1). At the time of surge onset (Experiment 2), exposure to progesterone during the activation period prevented the oestradiol-induced increase in cellular activation that occurred in the POA, LS and arcuate nucleus of the positive controls. These results demonstrated that oestradiol and progesterone induced differential region- and time-specific effects on cellular activation within the regions of the ovine brain that generate the preovulatory GnRH/LH surge. Moreover, the lack of cellular activation within the POA, LS and arcuate nucleus at the time of surge onset in animals exposed to progesterone during the activation stage is consistent with the hypothesis that progesterone can block the preovulatory surge by direct inhibition of oestradiol-induced cellular activation in these areas.

Antigenic variations in the CD4 induced sites of the CCR5-tropic, pathogenic SHIVsf162p3 gp120 variants

In vivo passage of non-pathogenic, CCR5-tropic simian/human immunodeficiency virus (SHIV) - SHIVsf162 resulted in a pathogenic isolate, SHIVsf162p3. In an attempt to characterize envelope (Env)-mediated properties that may contribute to its pathogenicity, major (P3 major) and minor (P3 minor) Env gp120 variants were cloned from the plasma of a SHIVsf162p3-infected animal, and expressed in the context of luciferase reporter viruses. Entry mediated by these envelopes and susceptibility to neutralization by CD4 induced-site (CD4i) antibodies (MAbs) was analyzed in comparison to parental SF162. Sequence analysis revealed that the P3 major and minor variant Envs contained 14 and 17 amino acid changes, respectively, compared with SF162. The rank order of entry mediated by the three envelopes was P3 major > SF162 > P3 minor, whereas the reverse order was observed for susceptibility to neutralization by CD4i MAbs. Since CD4i epitopes overlap the coreceptor (CoR) binding site, these findings suggest that the amino acid changes accumulated upon in vivo passage of SHIVsf162 result in Env gp120 structural rearrangements that modulate the exposure and/or conformation of the CoR binding site. This, in turn, led to increased entry and infectivity of the P3 major variant and may be responsible, in part, for the enhanced pathogenicity of SHIVsf162p3.

Neuroendocrine mechanisms underlying the effects of progesterone on the oestradiol-induced GnRH/LH surge

Oestradiol provides the drive to reproductive cyclicity in female mammals through its ability to stimulate the GnRH surge. In contrast, progesterone can be seen as the 'clutch and brakes' within reproductive cycles, as it can modify the response of the GnRH neurosecretory system to oestradiol. In this regard, progesterone has multiple and sometimes opposing effects on the GnRH neurosecretory system. For example, dependent upon the timing of exposure, progesterone enhances the amplitude of the oestradiol-induced LH (rats) and GnRH surge (within cerebrospinal fluid in sheep, mRNA concentrations in rats), but can also inhibit pulsatile GnRH secretion, and delay or even block expression of the surge (monkeys, rats and sheep). Investigations of the mechanisms of action of progesterone are complicated further by the fact that some of the observed effects of progesterone, such as the ability to block the oestradiol-induced surge, appear to be mediated via several different routes. Consequently, a variety of approaches are needed to advance our understanding of this fundamental reproductive neuroendocrine system. In this context, large animal neuroendocrine models have provided important information about the mechanisms of progesterone action and provide many exciting opportunities for future research.

Sexual differentiation of the neuroendocrine control of gonadotrophin secretion: concepts derived from sheep models

In our laboratory the sheep is used as an experimental model to study the early programming of the neuroendocrine mechanisms timing the pubertal increase in GnRH secretion. This interest has arisen because puberty in male lambs occurs much earlier than that in female lambs. Such sex differences in the timing of puberty are present in most species, as well as in the patterns of reproduction in the adult. Although this finding could merely reflect differences in the function of the ovary and testes, many of these differences arise from early sexual differentiation of central mechanisms controlling GnRH secretion. Two models are used for our studies. One model (Model I) has been developed to understand how the male reproductive neuroendocrine system becomes differentiated from that of the female system. The other (Model II) is used to study abnormal female sexual differentiation and the possible aetiologies of reproductive diseases. The discussion focuses on how these two models can be used to study the organizational action of steroids on the mechanisms timing puberty and the secretion patterns of reproductive hormones in the adult. Broadly, our findings indicate that an extended period of steroid action on the developing brain programmes sex differences in GnRH secretion that are manifest later in life: in the expression of pulsatile GnRH release after birth or earlier; in its amplification during puberty; in its differential regulation during young adulthood. Inappropriate programming of the control of GnRH secretion can lead to impaired fertility.

Sexually differentiated regulation of gnRH release by gonadal steroid hormones in sheep

Exposure of the sheep fetus to testosterone from day 30 to day 90 of a 147 day gestation causes the neurones that control GnRH secretion, the GnRH neuronal network, to become organized in a sex-specific manner. After androgen exposure in utero, GnRH neurones are activated in a sexually differentiated pattern by gonadal steroid hormones. Specifically, follicular phase concentrations of oestrogen trigger a GnRH 'surge' in ewes, but not in rams or females treated with androgen during fetal life. Furthermore, progesterone is a less potent inhibitor of GnRH release in rams or females treated with androgen during fetal life. The reasons for the sexual differentiation of these steroid feedback mechanisms probably reside in a dimorphism in steroid-sensitive neural inputs to GnRH neurones. The density of neurones containing oestrogen receptor alpha is sexually differentiated in areas of the ovine brain that are known to be involved in the steroidal regulation of GnRH. Furthermore, neurones in these regions are activated in a gender-specific pattern. A determination of the neural phenotype of these steroid-sensitive cells will form a basis for understanding the mechanisms by which the GnRH neuronal network is organized and activated in a sexually differentiated manner.

Progesterone blocks the estradiol-stimulated luteinizing hormone surge by disrupting activation in response to a stimulatory estradiol signal in the ewe

The preovulatory surges of GnRH and LH are activated by increased concentrations of circulating estradiol, but ovulation is blocked when progesterone concentrations are elevated. Although it is has been shown that this action of progesterone is due to a central inhibition of the GnRH surge, the mechanisms that underlie the blockade of the GnRH surge are poorly understood. In this study we investigated whether progesterone can block the estradiol-dependent activation stage of the GnRH surge induction process, and thus prevent expression of the LH surge. The results demonstrated that exposure to progesterone for half or the full duration of the activation stage can prevent the stimulation of LH surges by estradiol (experiment 1), whereas exposure to progesterone midway though a period of estradiol exposure, which in itself is sufficient to activate the surge, did not block the LH surge (experiment 2). These results suggest that progesterone 1) disrupts activation of the surge induction system in response to a stimulatory estradiol signal and 2) does not compromise the ability of animals to respond to a stimulatory estradiol signal applied immediately after progesterone exposure. Because the disruptive effects of activated progesterone in response to estradiol are rapid but transient, it may be that progesterone directly interferes with the activation of estradiol-responsive neural systems to block the GnRH/LH surge.

Role of endogenous opioid peptides in mediating progesterone-induced disruption of the activation and transmission stages of the GnRH surge induction process

How progesterone blocks the E2-induced GnRH surge in females is not known. In this study we assessed whether the endogenous opioid peptides (EOPs) that mediate progesterone negative feedback on pulsatile GnRH secretion also mediate the blockade of the GnRH surge. We treated ovariectomized ewes with physiological levels of E2 and progesterone to stimulate and block the GnRH surge, respectively, using LH secretion as an index of GnRH release. A pilot study confirmed that blocking opioidergic neurotransmission with the opioid receptor antagonist, naloxone (NAL; 1 mg/kg.h, i.v.), could prevent the suppression of pulsatile LH secretion by progesterone in our model. By contrast, antagonizing EOP receptors with NAL did not restore LH surges in ewes in which the E2-induced GnRH surge was blocked by progesterone treatment during the E2-dependent activation stage (Exp 1) of the GnRH surge induction process. However, in ewes treated with progesterone during the E2-independent transmission stage (Exp 2), NAL partially restored blocked LH surges, as indicated by increased fluctuations in LH that, in some cases, resembled LH surges. We conclude, therefore, that the EOPs that mediate progesterone negative feedback on pulsatile GnRH secretion are not involved in blockade of activation of the E2-induced GnRH surge by progesterone, but do appear to be part of the mechanism by which progesterone disrupts the transmission stage.

Characterization of neutralization epitopes of simian immunodeficiency virus (SIV) recognized by rhesus monoclonal antibodies derived from monkeys infected with an attenuated SIV strain

A major limitation in the simian immunodeficiency virus (SIV) system has been the lack of reagents with which to identify the antigenic determinants that are responsible for eliciting neutralizing antibody responses in macaques infected with attenuated SIV. Most of our information on SIV neutralization determinants has come from studies with murine monoclonal antibodies (MAbs) produced in response to purified or recombinant SIV envelope proteins or intact SIV-infected cells for relatively short periods of time. While these studies provide some basic information on the potential immunogenic determinants of SIV envelope proteins, it is unclear whether these murine MAbs identify epitopes relevant to antibody responses elicited in monkeys during infection with either wild-type or attenuated SIV strains. To accomplish maximum biological relevance, we developed a reliable method for the production of rhesus monoclonal antibodies. In the present study, we report on the production and characterization of a unique panel of monoclonal antibodies derived from four individual monkeys inoculated with SIV/17E-CL as an attenuated virus strain at a time when protective immunity from pathogenic challenge was evident. Results from these studies identified at least nine binding domains on the surface envelope glycoprotein; these included linear determinants in the V1, V2, cysteine loop (analogous to the V3 loop in human immunodeficiency virus type 1), and C5 regions, as well as conformational epitopes represented by antibodies that bind the C-terminal half of gp120 and those sensitive to defined mutations in the V4 region. More importantly, three groups of antibodies that recognize closely related, conformational epitopes exhibited potent neutralizing activity against the vaccine strain. Identification of the epitopes recognized by these neutralizing antibodies will provide insight into the antigenic determinants responsible for eliciting neutralizing antibodies in vivo that can be used in the design of effective vaccine strategies.

Regioselective and enantiospecific rhodium-catalyzed allylic amination with N-(arylsulfonyl)anilines

[reaction: see text]. The regioselective and enantiospecific rhodium-catalyzed allylic amination of secondary allylic carbonates 1 with N-(arylsulfonyl)anilines provides a convenient process for the construction of arylamines 2. This method, in conjunction with ring-closing metathesis and radical cyclization reactions, allows the direct construction of biologically relevant pharmacophores as exemplified by the construction of dihydroquinoline and dihydrobenzo[b]indoline derivatives.

Progesterone treatment that either blocks or augments the estradiol-induced gonadotropin-releasing hormone surge is associated with different patterns of hypothalamic neural activation

Progesterone can either augment or inhibit the surge of gonadotropin-releasing hormone (GnRH) that drives the preovulatory luteinizing hormone (LH) surge. This study investigated the central mechanisms through which progesterone might achieve these divergent effects by examining the effects of exogenous steroids on the activation of GnRH neurons and non-GnRH-immunopositive cells in the preoptic area/anterior hypothalamus of steroid-treated ovariectomized ewes. Fos expression (an index of cellular activation) was examined during the estradiol-induced GnRH surge in ewes treated with progesterone using regimes that have been reported to either augment (progesterone pretreatment) or inhibit (progesterone treatment at the time of the surge-inducing estradiol increment) the GnRH surge. Control groups received either no progesterone pretreatment or no surge-inducing estradiol increment. Induction of an LH surge was associated with a significant (p < 0.0001) increase in the proportion of activated GnRH neurons, irrespective of whether ewes received progesterone pretreatment. However, the number of non-GnRH-immunopositive cells activated during the surge was significantly (p < 0.0001) increased in ewes that received the progesterone pretreatment. By contrast, the proportion of GnRH neurons and non-GnRH-immunopositive cells that expressed Fos was significantly (p < 0.0001) reduced in ewes in which the surge was inhibited by progesterone compared to ewes in which a surge was stimulated. These data indicate that (1) progesterone pretreatment increases the activation of non-GnRH cells during the estradiol-induced surge, but does not affect the proportion of GnRH neurons activated and (2) when administered concurrently with a surge-inducing estradiol increment, progesterone prevents the activation of GnRH neurons and non-GnRH cells that is normally associated with the estradiol-induced surge. Therefore, progesterone does not appear to augment the GnRH surge by increasing the proportion of GnRH neurons that are activated by estradiol, whereas inhibition of the GnRH surge involves prevention of the activation of GnRH neurons. Thus, the augmentation and inhibition of the GnRH surge by progesterone appear to be regulated via different effects on the GnRH neurosecretory system.

Identification of neurokinin B-expressing neurons as an highly estrogen-receptive, sexually dimorphic cell group in the ovine arcuate nucleus

Studies were undertaken to examine the hypothesis that neurons expressing neurokinin B (NKB) may represent an estrogen-receptive input to GnRH neurons in the sheep. Cells immunoreactive for NKB were located almost exclusively within the arcuate nucleus of the ovine hypothalamus. Dual labeling experiments revealed that essentially all NKB neurons (97%) were immunoreactive for estrogen receptor alpha and that NKB-immunoreactive fibers were found in close proximity to approximately 40% of GnRH neurons located in the rostral preoptic area as well as intermingled with GnRH fibers in the median eminence. The analysis of male and female brains revealed a marked female-dominant sex difference in the numbers of NKB neurons, and sections obtained from in utero androgen-treated females indicated that this sex difference resulted from an organizational influence of testosterone during neural development. In adult ovariectomized ewes, in situ hybridization studies failed to detect any significant effect of 8- to 26-h exposure of estrogen on cellular NKB messenger RNA levels. Together, these studies identify the first sexually differentiated neuronal cell population in the ovine hypothalamus and, remarkably, show that essentially all of these female-dominant NKB neurons express estrogen receptors. Although these neurons may be involved in any number of steroid-dependent, sexually differentiated functions in the sheep, the neuroanatomical evidence for potential NKB inputs to GnRH neurons suggests a role for this novel population in the regulation of reproductive function.

Access to employment for people with disabilities: findings of a consumer-led project

PURPOSE

A consumer led initiative which aimed to gather information from local employers and disabled people which might inform future action to improve work opportunities for disabled people.

METHOD

(1) A survey of 500 companies with more than 20 employees randomly sampled from 4 locations across Suffolk was undertaken. The survey generated both numerical and verbal data. Response rate was low (25%) but achieved a reasonable spread of organizations in terms of size, type of industry and geographical location. (2) Semi-structured interviews were carried out with nine disabled people. Open-ended questions were used to elicit information about the nature of their disability, experiences of education and experiences of seeking and/or maintaining work.

RESULTS

43% of respondents had one or more disabled employees. Evidence of obstacles to employment included a lack of understanding about the capability of disabled people, lack of knowledge about financial and technical assistance and undifferentiated approaches to access and accommodation. Interview data supported the importance of paid employment to self esteem and quality of life and showed high levels of frustration in their search for work.

CONCLUSIONS

This study demonstrates the need for better interagency communication and a more effective information distribution strategy for employers, particularly in relation to the availability of systems of support and the capability of disabled employees.

The negative feedback action of progesterone on luteinizing hormone release is not associated with changes in GnRH mRNA expression in the Ewe

Progesterone is the ovarian hormone that times events in the ovine reproductive cycle. When elevated, this ovarian hormone acts centrally to inhibit both the tonic and surge modes of gonadotrophin releasing hormone (GnRH) release. Two studies were performed to address the underlying neural mechanisms. The first tested the hypothesis that the rapid rise in GnRH release, that results from an acute fall in progesterone concentrations (such as occurs following luteolysis), is temporally associated with a rapid rise in the cellular content of GnRH mRNA. Three groups of ovariectomised (OVX) ewes were treated with exogenous progesterone for 10 days, while one remained steroid free (OVX, n=7). To determine the effects of acute progesterone (P) withdrawal, ewes were killed on day 10 while implants were still in place (OVX+P, n=6) or 4 (OVX-P4, n=7) or 12 h (OVX-P12, n=7) after progesterone removal. Coronal sections through the rostral portion of the medial preoptic area (rPOA) were processed for cellular in-situ hybridization for GnRH mRNA. An increase in progesterone concentrations markedly suppressed luteinizing hormone (LH) release, while removal of the implants caused progesterone concentrations to fall (P<0.01) within 1 h and LH pulse frequency to increase (P<0.05) within 4 h. Despite these progesterone-induced changes in LH/GnRH release there were no differences in the cellular content of GnRH mRNA among the four groups. In the second study, three groups of ovariectomised ewes were used to determined whether the inhibitory actions of early (EL; n=8) and mid-luteal (ML; n=8) phase concentrations of progesterone on LH release are accompanied by a decrease in GnRH mRNA expression. P inhibited the secretion of LH in a dose dependant manner; pulses of LH were virtually absent in the ML group. Despite this marked inhibitory steroid action, there was no significant difference in the cellular content of GnRH mRNA among the OVX, OVX (EL) and OVX (ML) groups. Thus, both the negative feedback actions of physiological concentrations of progesterone on GnRH release and the rapid escape from progesterone-inhibition are independent of changes in the cellular content of GnRH mRNA. These data suggest that the mechanism by which progesterone controls the timing of events in the ovine oestrous cycle is primarily by altering the secretion of GnRH rather than GnRH biosynthesis.

Familial hypokalemic periodic paralysis and Wolff-Parkinson-White syndrome in pregnancy

PURPOSE

To describe the anesthetic and obstetrical management of a pregnant patient with co-existing Familial Hypokalemic Periodic Paralysis (FHPP) and Wolff-Parkinson-White syndrome (WPW).

CLINICAL FEATURES

A 29 yr-old primigravida with FHPP and WPW presented to the antenatal clinic at 18 wk gestation, for consideration of her anesthetic and obstetrical management during labour and delivery. A plan was constructed to avoid the known precipitating factors of FHPP including carbohydrate loading, cold, mental stress and exercise, which could lead to acute attacks of weakness. She presented for induction of labour at 41 wk and three days. An epidural catheter was sited early in labour. The second stage was limited to less than one hour. She had a rotational forceps delivery for which the epidural was extended to provide anesthesia. A healthy male baby was delivered. The patient made an uncomplicated recovery and was discharged home on the second postnatal day. The peripartum potassium was kept within the normal range with intravenous as well as oral potassium supplementation. No arrhythmias were reported.

CONCLUSION

Assessment of the patient at an early stage in her pregnancy allowed for a multidisciplinary approach to this patient and her medical problems. A plan was made to avoid known precipitating factors during labour, delivery and the postnatal period well in advance of her date of confinement, leading to a successful outcome for mother and child.

Regioselective Rh-catalyzed allylic amination/ring-closing metathesis approach to monocyclic azacycles: diastereospecific construction of 2,5-disubstituted pyrrolines

[formula: see text] Regioselective rhodium-catalyzed allylic amination followed by ring-closing metathesis, using the Grubbs' catalyst, provides an expeditious route to monosubstituted azacycles. The enantiomerically enriched allylamine 1 can also be resubjected to the reaction sequence with (R)- and (S)-2b to facilitate the diastereospecific construction of 2,5-disubstituted pyrrolines 3/4.

In utero exposure of female lambs to testosterone reduces the sensitivity of the gonadotropin-releasing hormone neuronal network to inhibition by progesterone

Exposure of the female ovine fetus to exogenous androgens during early gestation permanently masculinizes the reproductive anatomy, physiology, and behavior of the adult ewe. In utero testosterone exposure has been shown to act centrally on the GnRH neuronal network to alter the response to both the stimulatory and inhibitory actions of estrogen. It is currently unknown whether fetal androgens alter other mechanisms that are critical for the regulation of GnRH release and, specifically, other important regulatory steroid feedback loops. Three studies were performed on gonadectomized postpubertal sheep to determine whether the inhibitory actions of progesterone on episodic LH release are also sex-specific and engendered by early in utero exposure to testosterone. In each study, the pulsatile pattern of LH release was determined both before and after the sc implantation of a progesterone releasing CIDR device. The studies involved 7 female, 7 male, and 12 androgenized female sheep (T60 (n = 7) and T30 (n = 5) groups; 200 mg testosterone propionate/week im to the mother for 60 or 30 days, respectively, from day 30-90 or 60-90 of pregnancy). The first two studies were performed in the anestrous season in the presence (Exp 1) or absence (Exp 2) of a low circulating concentration of estradiol. Exp 3 was carried out in the breeding season in the absence of exogenous estrogen. In all three studies progesterone inhibited LH pulse frequency only in the females. Progesterone had no action on mean LH concentrations or the frequency or amplitude of LH pulses in the males or either group of androgenized ewes. We conclude that the inhibition of episodic LH release by progesterone is sexually differentiated in the sheep, males being less responsive than females to steroid negative feedback. Further, these sex differences are a consequence of in utero exposure to androgens for a period as short as 30 days between days 60 and 90 of a 147-day pregnancy.

The impact of managed care on nursing regulations in nine western states

With the recent increase in health care service delivery across state lines, national organizations have perceived the need for standardization of nursing practice. In 1995, the Pew Commission recommended that states standardize entry-into-practice requirements and adopt inter-state licensure by endorsement. Over the past two years, the National Council of Nursing has been in the process of developing approaches which would allow nursing licenses to be recognized across state lines. These recommendations and activities suggest that nursing regulation may be moving towards national standardization. This paper presents qualitative data from State Boards of Nursing in nine western states. A review of the priorities and activities of the nine boards indicates that the apparent movement towards standardization of nursing regulations is misleading. States continue to have distinctive approaches to nursing regulation based on unique political context and historical development of nursing regulatory agencies, population growth rates in the respective states, and access to rural health care. While managed care may be resulting in standardization of payment approaches and services purchased, it has not substantially impacted each state's unique nursing regulations and educational approaches.

Rey-Osterrieth Complex Figure performance in adults with attention deficit hyperactivity disorder: a validation study of the Boston Qualitative Scoring System

Rey-Osterrieth Complex Figure (ROCF) productions from 18 adults with Attention Deficit Hyperactivity Disorder (ADHD) were compared to 18 matched controls using the Boston Qualitative Scoring System (BQSS). ADHD adults showed impairment in measures of configural accuracy, planning, and neatness. A logistic regression model resulted in 75% sensitivity and 81% specificity in discriminating ADHD from control subjects. In contrast, there was no significant difference on the traditional ROCF 36-point score, and the sensitivity and specificity for the 36-point score were lower (68% and 71%, respectively). These findings suggest persisting executive dysfunction in adults with ADHD that can be detected in ROCF productions. Thus, the BQSS may be a useful tool contributing to the neuropsychological evaluation of adults with ADHD.

Indolocarbazoles: potent, selective inhibitors of human cytomegalovirus replication

In our search for new, safer anti-HCMV agents, we discovered that the natural product Arcyriaflavin A (la) was a potent inhibitor of HCMV replication in cell culture. A series of analogues (symmetrical indolocarbazoles) was synthesised to investigate structure activity relationships in this series against a range of herpes viruses (HCMV, VZV, HSV1, and 2). This identified a number of novel, selective and potent inhibitors of HCMV, 12,13-dihydro-2,10-difluoro-5H-indolo[2,3-a]pyrrolo[3,4-c]carbazol e-5,7-(6H)-dione (1d) being the best example (IC50=40 nM, therapeutic index > 1450). Compounds described in this series were generally poor inhibitors of protein kinase C betaII, and no correlation was found between the ability to inhibit HCMV and the enzyme PKC.

Sialidase inhibitors related to zanamivir: synthesis and biological evaluation of 4H-pyran 6-ether and ketone

Synthesis of 5R-Acetamido-4S-amino-4H-pyran-6R-O-( -ethyl)propyl and 6R-(1-oxo-2-ethyl)butyl 2-carboxylic acids (4 and 5) and their evaluation as inhibitors of influenza virus sialidase is described. Both compounds showed good inhibitory activity with marked selectivity for influenza A sialidase.

Progesterone can block transmission of the estradiol-induced signal for luteinizing hormone surge generation during a specific period of time immediately after activation of the gonadotropin-releasing hormone surge-generating system

The preovulatory GnRH/LH surge in the ewe is stimulated by a rise in the circulating estradiol concentration that occurs in conjunction with preovulatory ovarian follicle development. In the presence of high levels of progesterone, such as during the luteal phase of the estrous/menstrual cycle, the stimulatory effects of elevated estradiol on GnRH/LH secretion are blocked. Recent work in the ewe has shown that a relatively short period of estradiol exposure can stimulate a GnRH/LH surge that begins after estrogenic support has been removed. This result suggests that surge generation is characterized by an estradiol-dependent period (during which the signal is read) and an estradiol-independent period (during which a cascade of neuronal events transmits the stimulatory signal to the GnRH neurosecretory system, which releases a surge of GnRH). In this series of studies, we addressed the hypothesis that progesterone can block transmission of the stimulatory estradiol signal after it has been read. Nine ovariectomized ewes were run through repeated artificial estrous cycles by sequential addition and removal of exogenous steroids. In study one, ewes received three treatments in a randomized cross-over design. Exposure to a follicular phase estradiol concentration for 10 h (positive control treatment) stimulated an LH surge in all ewes, as determined in hourly jugular blood samples. Maintenance of luteal phase progesterone concentrations throughout the artificial follicular phase (2 x CIDR-G devices, negative control) blocked the stimulatory effects of a 10-h estradiol signal, and no ewes that received this treatment expressed an LH surge. In the experimental group, exposure to luteal phase levels of progesterone, during the period after the surge generating system had been activated by estradiol, blocked the LH surge in six of nine ewes. This result demonstrates that progesterone can block the surge, even when applied after the surge-generating system has been activated and, therefore, that it inhibits either the transmission of the estradiol signal and/or the release of the GnRH/LH surge. In study 2, we assessed whether sensitivity to the inhibitory effects of progesterone was confined to a specific stage of the transmission of the estradiol signal. Eight ewes were exposed to four treatments, over successive artificial estrous cycles. Positive and negative controls were similar to those described in Study 1, except the duration of the stimulatory estradiol signal was reduced to 8 h. The two experimental groups consisted of an EARLY P (progesterone) treatment, in which progesterone was given from hours 8-13 after estradiol insertion (immediately after estradiol removal), and a LATE P treatment, in which progesterone was given from hours 13-18 (immediately before LH surge secretion). As expected, LH surges were stimulated and blocked, in response to the positive and negative controls, respectively. Whereas the EARLY P treatment blocked the LH surge in seven of eight ewes, the LATE P treatment was only successful in inhibiting a surge in one of eight animals. This result demonstrates that progesterone can block the estradiol-induced surge-generating signal soon after the onset of signal transmission (immediately after estradiol removal) but not during the later stages of signal transmission (at the time of GnRH/LH surge onset).

Neuropsychological functioning in cocaine abusers with and without alcohol dependence

Thirty codependent cocaine and alcohol users were compared with age-, education-, race-, and sex-matched cocaine abusers (N = 30) and normals (N = 30) using an extended Halstead-Reitan Neuropsychological Test Battery to determine whether cocaine abusers with alcohol dependence were more cognitively impaired than singly addicted cocaine abusers. Tests were grouped and analyzed according to 8 major ability areas. Participants who abused both cocaine and alcohol did not differ from normals on the majority of test measures. An unexpected but consistent finding was the poorer performance of the cocaine sample relative to cocaine and alcohol abusers on measures of complex psychomotor and simple motor functioning (ps < .001). Pure cocaine abusers, but not abusers of both cocaine and alcohol, also performed more poorly than normals on a measure of global neuropsychological functioning (p < .01). These results are consistent with previous reports of generally mild cognitive dysfunction in cocaine abusers. The findings also suggest that cocaine and alcohol abusers of relatively young ages may be less cognitively impaired than demographically comparable cocaine abusers. Evidence from studies of vascular functioning in abusers of cocaine and alcohol alone and in combination is discussed as possible explanation for these findings.

Production and characterization of SIV envelope-specific rhesus monoclonal antibodies from a macaque asymptomatically infected with a live SIV vaccine

Five rhesus monoclonal antibodies (RhMAbs) were produced by rhesus EBV transformation of peripheral blood B cells from a rhesus macaque that had been asymptomatically infected with an attenuated, macrophage-tropic SIV strain, 17E-Cl. These MAbs recognized conformation-dependent epitopes on SIV gp120 and could not be mapped using synthetic peptides. All five RhMAbs were able to neutralize the vaccine strain and a heterologous isolate, SIV/DeltaB670. The RhMAbs did not cross-react with HIV-2; by contrast, four human MAbs derived from an HIV-2-infected person were broadly cross-reactive with both SIV and HIV-2 gp120s. Cross-competition analysis indicated that the five RhMAbs could be placed in two groups recognizing two nonoverlapping epitopes; while the HMAbs were placed in two additional competition groups. Binding of the three group I RhMAbs (1.7F, 3.11B, and 1.10A) as well as HMAb 17A was shown to be sensitive to specific amino acid alterations in V4 occurring in natural env variants. The results of this study demonstrate that RhEBV transformation provides a means to probe rhesus antibody responses to SIV infection at the monoclonal level. RhMAbs will allow structural and functional studies of envelope glycoprotein determinants that elicit protective immune responses against SIV.

In a different voice: the attitudes of licensed practical nurses towards the future

In the fall of 1997, the Idaho Commission of Nursing and Nursing Education undertook a survey of Idaho nurses to collect data on future workforce and educational needs. The results of the survey demonstrated substantial attitudinal differences between licensed practical nurses and registered nurses in the areas of educational motivation, role differentiation, skills by type of nurse, trends in nursing supply, and educational preparation. Given that the Idaho workforce is comparable to the national nursing workforce in numbers, educational background, and age, these findings have implications for health policy planners and nursing educators throughout the country. This article presents the findings and then uses the data as a basis for suggesting their implications for nursing education and workforce planning.

Gonadotropin-releasing hormone messenger ribonucleic acid expression changes before the onset of the estradiol-induced luteinizing hormone surge in the ewe

The preovulatory LH surge in the ewe is stimulated by the massive and sustained release of GnRH into the pituitary portal vessels. This study has examined the temporal relationship between changes in LH secretion and GnRH messenger RNA (mRNA) expression at the time of the estradiol-induced LH surge. Ovariectomized Clun Forest ewes were treated with exogenous progesterone and estradiol (E) to mimic estrous cycle concentrations of these gonadal steroids and to induce the LH surge. Ewes were killed at five time points relative to the time of onset of the LH surge: pre-E, before E insertion (n = 6); presurge, after E insertion and 8-10 h before surge onset (n = 5); ascending limb, 2-6 h after surge onset (n = 5); midpeak, 9-12 h after surge onset (n = 5); and postsurge, 21-27 h after surge onset (n = 5). Control animals (n = 5/group), which received no E, were killed at identical time intervals alongside the E-treated ewes. Coronal sections containing the diagonal band of Broca through to the anterior hypothalamus were processed for cellular in situ hybridization using an 35S-labeled oligonucleotide probe complementary to ovine GnRH. No changes were found in the number of GnRH mRNA-expressing cells detected in the rostral preoptic area or the medial septum in either gonadal steroid-treated or control ewes. In contrast, cellular GnRH mRNA expression (as assessed by silver grain density) decreased significantly (P < 0.05) between presurge and ascending limb groups within both the rostral preoptic area (0.64 +/- 0.06 vs. 0.43 +/- 0.05 silver grain density/microm2) and medial septum cells (1.08 +/- 0.09 vs. 0.77 +/- 0.07). No significant changes were detected in control ewes. These results show that the estradiol-induced LH surge in the ewe is associated with a decrease in GnRH mRNA expression that occurs in advance of the onset of the GnRH surge. This suggests that neural mechanisms controlling GnRH biosynthesis may be distinct from those regulating GnRH secretion.

Distribution and morphology of luteinising hormone-releasing hormone neurones in a species of wild antelope, the springbok (Antidorcas marsupialis)

The distribution and morphology of luteinising hormone-releasing hormone (LHRH) neurones varies between species. The primary purpose of this study was to characterize the distribution and morphology of the LHRH system in a species of antelope, the springbok. This wild antelope has a well-defined social structure in which reproductive activity is confined to a few dominant, territorial rams. We also sought to determine whether social or reproductive status could be accounted for by differences in the distribution or morphology of hypothalamic LHRH neurones. Eleven anoestrous female, nine breeding territorial male (TM) and eight "bachelor" male (BM) springbok were obtained, and their reproductive and body conditions were assessed. By using standard immunocytochemical techniques, the LHRH system was visualised in the brains of four animals from each group. Immunoreactive neurones were located in a continuum from the septum to the arcuate nucleus, with the majority at the level of the organum vasculosum of the lamina terminalis. Neither the distribution nor the number of cells differed among the three groups. Furthermore, the area of LHRH perikarya was similar in both groups of males, suggesting that reproductive differences between TMs and BMs lie at another level of the neuroendocrine axis. The anoestrous females had significantly larger neurones than males (TM plus BM). This may reflect a sex difference in the LHRH system of this wild antelope. However, an alternative explanation is that the male/female difference is related to the comparatively inactive reproductive neuroendocrine state of the females.

Anti-human immunodeficiency virus type 1 human monoclonal antibodies that bind discontinuous epitopes in the viral glycoproteins can identify mimotopes from recombinant phage peptide display libraries

A phage display library screening approach was used to identify peptide sequences that could bind to anti-HIV-1 MAbs whose binding specificities are complex. Most of the antibodies used recognize discontinuous epitopes in gp120 and one recognizes gp41. Both a 15-mer and a 21-mer display library (each with a complexity of greater than 60 x 10[6]) and two constrained, V3 region-biased libraries, all expressed as recombinant pIII protein of filamentous phage, were used. The unmapped anti-gp120 human MAb A32 recognized a set of related linear sequences and repeatedly identified a single phage sequence that could form a cyclic disulfide structure. Selection methods were also developed so that phage could be obtained by competition selection in the presence of antibody bound to native, monomeric gp120 antigen (used with MAb IgG1b12 and the anti-gp120 V3 region MAb 447-52D) or gp120 variable region 3 synthetic peptides (used with anti-gp120 V3 region MAb 19b). The potent, virus-neutralizing MAb IgG1b12 recognized numerous sequences and, when used in competition with gp120, recognized only one sequence. These studies extend the range of antibody determinant studies that can be performed with display phage libraries, demonstrate a workable experimental strategy for use of competition ligands to discriminate among phage mimotopes, and provide a large number of mimotopes that bind potent virus-neutralizing MAbs for HIV-1 vaccine studies.

Luteinising hormone secretion from the perifused ovine pars tuberalis and pars distalis: effects of gonadotropin-releasing hormone and melatonin

It is not known where melatonin acts to influence the neuroendocrine axis of seasonally breeding mammals. However, since the pars tuberalis (PT) contains the highest density of melatonin receptors, this adenohypophyseal subdivision is a potential target. Gonadotropes are the only immunocytochemically detectable adenohypophyseal cell type of abundance in the PT. This study investigated whether melatonin could modulate basal and/or gonadotropin-releasing hormone (GnRH)-stimulated luteinising hormone (LH) secretion from the ovine PT and pars distalis (PD) in vitro. Tissue fragments from both pituitary areas were placed in separate chambers in a constant-environment perifusion system (37 degrees C; 100 microl/min) and 10-min effluent fractions were collected, frozen and later assayed for LH. Sixty minutes prior to a GnRH challenge (10 min; 10 nM), melatonin (1 microM or 100 nM) was added to the perifusate of half the tissue fragments. GnRH increased (p < 0.01) LH output from both pituitary subdivisions. Melatonin attenuated (p < 0.05) the GnRH-induced increase in LH output from the PT but not from the PD. The physiological importance of this melatonin-attenuated PT LH is unknown but it may play a role in modulating the neuroendocrine reproductive axis.

Rupture of the medial collateral ligament of the first metatarsophalangeal joint in a professional soccer player

Worldwide, more people play soccer than any other team sport. The Federation Internationale de Football Association (FIFA) registered more than 150 million players in 1984. Although foot injuries in soccer range from midfoot sprains to stress fractures to capsulitis of the first metatarsophalangeal joint, we could find no case reports of a rupture of the lateral collateral ligaments of the great toe in soccer players. This is a report of the diagnosis, treatment, and outcome of such an injury in a professional soccer player.

Neutralization of the human immunodeficiency virus type 1 primary isolate JR-FL by human monoclonal antibodies correlates with antibody binding to the oligomeric form of the envelope glycoprotein complex

To test whether antibodies that are neutralizing or nonneutralizing for human immunodeficiency virus type 1 (HIV-1) primary isolates can be distinguished by their affinities for the oligomeric envelope glycoproteins, we selected HIV-1(JR-FL) as a model primary virus and a panel of 13 human monoclonal antibodies (MAbs) and evaluated three parameters: (i) half-maximal binding to recombinant monomeric envelope, gp120(JR-FL); (ii) half-maximal binding to oligomeric envelope of HIV-1(JR-FL) expressed on the surface of transfected 293 cells; and (iii) neutralization of HIV-1(JR-FL) in a peripheral blood mononuclear cell-based neutralization assay. Two conclusions can be drawn from these experiments. First, we confirm that antibody interactions with monomeric gp120 do not predict primary virus neutralization. Second, we show that neutralization correlates qualitatively with the relative affinity of an antibody for the oligomeric envelope glycoproteins, at least for HIV-1(JR-FL).

Addiction severity and MMPI-derived typologies in cocaine abusers

This study replicated the two Minnesota Multiphasic Personality Inventory subtypes (psychopathic and severe psychiatric) found in inpatient male cocaine abusers in an outpatient sample of 132 men and women. The Addiction Severity Index validated these subtype differences on the basis of psychiatric severity.

Low-molecular-weight inhibitor of in vitro fibroblast colony formation from human urine

The role of urinary toxins in interstitial cystitis (IC) has been suggested. This report describes the partial purification of a substance from human urine that inhibited in vitro colony formation by mouse fibroblasts. Urine samples from 15 women with IC and 17 healthy women serving as volunteers were fractioned by ultrafiltration and chromatography methods and tested by the inhibition of Swiss 3T3 fibroblast colony formation. The fibroblasts were cultured at low density with varying concentrations of whole or fractioned urine. Colonies were counted at 10 days. Colony formation was reduced by incubation with whole urine, ultrafiltrate, and nonadsorbed C18 fractions. Inhibition of colony formation by urine from healthy volunteers or women with IC was not significantly different. In vitro colony formation by Swiss 3T3 cells was inhibited by a component of human urine. The toxicity of urine from IC patients was not different from that of urine from healthy controls.

The pars tuberalis of the ewe: no effect of season or ovariectomy on the distribution, density or presence of immunoreactive cells

This study investigated whether season or long-term ovariectomy influence the presence, distribution and density of immunoreactive cells in the ovine pars tuberalis. Three groups of ewes were used: breeding season (BS; n=5), anoestrous (AS; n=8) and ovariectomised (OVX; n=4). Two rams were also investigated for possible sex-dependent differences. Employing standard immunocytochemical techniques, paraformaldehyde-fixed sagittal pars tuberalis and pars distalis sections were immunoreacted against luteinising hormone, luteinising hormone beta-subunit, thyroid-stimulating hormone, prolactin, growth hormone, beta-endorphin and adrenocorticotrophic hormone. Numerous gonadotrophs were detected in the anteroventral region of the pars tuberalis and there was no significant difference in the density (gonadotrophs/0.01 mm2; BS: 44+/-13, AS: 29+/-2, OVX: 27+/-4) or percentage of total cells (%; BS: 48+/-8, AS: 45+/-4, OVX: 49+/-2); the rams also appeared similar (27+/-2 gonadotrophs/0.01 mm2; 49+/-1%). In contrast, few gonadotrophs (less than 1%) were detected in the anterodorsal and posterior pars tuberalis regions. Apart from occasional thyrotrophs in the anteroventral pars tuberalis (less than 4%), no other pars distalis hormone-containing cells were detected in the pars tuberalis. This study demonstrates, therefore, that the anteroventral pars tuberalis represents an enriched population of immunoreactive gonadotrophs, whose number and distribution is similar in variable endocrine states. The protein phenotype(s) of cells in the other pars tuberalis regions remains undetermined.

Reproducibility of the circadian blood pressure fall at night in healthy young volunteers

The aim of this study was to evaluate the reproducibility of the circadian blood pressure (BP) change in normal healthy volunteers. The subjects were 32 healthy, young, normotensive volunteers who underwent 24 h ambulatory BP monitoring on two occasions, at least 4 weeks apart. Data were analysed using standard definitions of day and night (i.e. 07.00-22.00 for daytime and 22.00-07.00 for night time), event diaries to identify individual's day and night time and a time independent method (cusum analysis). Intraindividual variations of BP were assessed using the coefficient of variation (CV). The mean 24 h BP was very reproducible with a CV of 4.7%. Using the fixed definition of day and night, mean night time systolic blood pressure (SBP) was significantly reduced on the second visit compared to the first (P < 0.001). Using fixed times for day and night, day-night difference was poorly reproducible, with a CV of 52% for SBP and 59% for diastolic blood pressure (DBP), however this improved using diary based day-night to 40/41% and cusum analysis to 24.6/28.1%. We recommend that circadian BP changes are studied using individual definitions of day and night or time independent methods such as cusum analysis.