Importance of TREC and KREC as molecular markers for immunological evaluation of down syndrome children

Recurrent and severe infections occurred in children with Down Syndrome (DS) due to immunological parameter defects have been reported. The aim of the study is to evaluate the importance of using T-cell receptor excision circle (TREC) and kappa-deleting recombination excision circle (KREC) as molecular markers for immunological investigation of children with DS. The study included 40 non-disjunction trisomy 21 confirmed DS children, and 25 healthy controls. Peripheral blood (PB) was analyzed for lymphocyte subpopulations by flow cytometry, serum immunoglobulin levels, and TREC and KREC copy numbers using quantitative real-time PCR. DS patients showed significantly lower absolute counts of PB T lymphocytes, T helper lymphocytes, T cytotoxic lymphocytes, B lymphocytes, and Natural killer cells, and lower serum IgA, IgG, and IgM levels compared to healthy controls. Copy number of TREC and KREC showed no significant differences between DS patients and healthy controls. There is a significant positive correlation between TREC copy number with a percentage and absolute count of helper T lymphocytes in patients. Also, the KREC copy number was significantly negatively correlated with the age of patients. These findings suggest that copy numbers of TREC and KREC could be useful as molecular markers for immunological evaluation of patients with DS.

Genetic Implications in High-Risk Pregnancy and Its Outcome: A 2-Year Study

OBJECTIVE

The aim of this study is to evaluate high-risk pregnant females' offspring as regard the presence of any medical condition, hereditary disorder, or major anomaly as well as to document parental sociodemographic characteristics and compliance with follow-up schedules of fetal medicine and clinical genetic clinics.

STUDY DESIGN

This prospective 2-year cohort study of neonates and infants reported the referral indications, investigations, and diagnoses obtained through prenatal and postnatal examinations. It also reported their parental follow-up vigilance.

RESULTS

Of the 811 infants of high risk females referred 460 (56.7%) came for assessment. Mean parental consanguinity and endogamy were 67 and 71.3%, respectively. All pregnant mothers underwent first-trimester biochemical testing (plasma protein-A, α-fetoprotein [AFP], human chorionic gonadotropin [hCG]) and serial ultrasound examinations. Seventy mothers needed second-trimester biochemical testing (AFP, hCG, and estriol). Sixty-two mothers underwent amniocentesis where G-banding karyotype, fluorescence in situ hybridization and targeted molecular testing for the specific gene mutation of single gene disorders were conducted according to suspected disorders. High quality fetal ultrasound was performed when brain malformations were suspected, while 16 fetuses required brain MRI examination. Mean age of newborns at first examination was 26.5 days. They were grouped according to the maternal indication for referral. Upon examination, 18 neonates had confirmed congenital malformations/genetic disorders. Five of them were diagnosed prenatally. In four other fetuses with single gene disorder, the molecular diagnosis of their affected siblings was not established prior to this pregnancy; thus, prenatal diagnosis was not possible. The remaining nine cases were diagnosed postnatally.

CONCLUSION

Parental consanguinity and endogamy were increased among high-risk pregnancies. Public awareness about potential adverse effects of consanguineous marriages and the importance of genetic testing are imperative. A structured multidisciplinary team of specialists in fetal medicine, clinical genetics, and neonatology provides good genetic services. Expansion and financial support of these services are urgently required.

KEY POINTS

· A multidisciplinary team provides good genetic services in high-risk pregnancies.. · Parental consanguinity and endogamy are increased among high-risk pregnancies.. · Increased public awareness about genetic testing importance and financial support are imperative..

First Report of Two Egyptian Patients with Desbuquois Dysplasia due to Homozygous CANT1 Mutations

Desbuquois dysplasia type 1 (DBQD1) is a very rare skeletal dysplasia characterized by growth retardation, short stature, distinct hand features, and a characteristic radiological monkey wrench appearance at the proximal femur. We report on 2unrelated Egyptian patients having the characteristic features of DBQD1 with different expressivity. Patient 1 presented at the age of 45 days with respiratory distress, short limbs, faltering growth, and distinctive facies while patient 2 presented at 5 years of age with short stature and hypospadias. The 2 patients shared radiological features suggestive of DBQD1. Whole-exome sequencing revealed a homozygous frameshift mutation in the CANT1 gene (NM_001159772.1:c.277_278delCT; p.Leu93ValfsTer89) in patient 1 and a homozygous missense mutation (NM_138793.4:c.898C>T; p.Arg300Cys) in patient 2. Phenotypic variability and variable expressivity of DBQD was evident in our patients. Hypoplastic scrotum and hypospadias were additional unreported associated findings, thus expanding the phenotypic spectrum of the disorder. We reviewed the main features of skeletal dysplasias exhibiting similar radiological manifestations for differential diagnosis. We suggest that the variable severity in both patients could be due to the nature of the CANT1 gene mutations which necessitates the molecular study of more cases for phenotype-genotype correlations.

Clinical Implications of S100A12 and Resolvin D1 Serum Levels, and Related Genes in Children with Familial Mediterranean Fever

The aim of this article was to study the role of S100A12 and resolvin D1-related genes and serum levels in the diagnosis and detection of subclinical inflammation in children with familial Mediterranean fever (FMF) during the quiescent stage of the disease. Seventy-eight children with FMF during the silent state and 60 healthy control were studied. Serum S100A12 and resolvin D1 were quantitatively measured using enzyme-linked immunosorbent assay. In addition, the levels of C-reactive protein, erythrocyte sedimentation rate, and hemoglobin were determined. The clinical severity was evaluated. The link between the Mediterranean fever (MEFV) gene and the genes related to the two studied biomarkers was also assessed. Correlation between S100A12 and resolvin D1 and the clinical severity was assessed. The mean serum levels of S100A12 and resolvin D1 were 847.4 and 793.3, respectively, which were highly significantly increased (p = 0.001) compared with the controls (324.3 and 235.1, respectively). The receiver operating characteristic curve test showed that S100A12 had a sensitivity of 97.4% and specificity of 80% with cutoff value of 529.5, while resolvin D1 showed a sensitivity of 100% and specificity of 50% with cutoff value of 231.2. A correlation was detected between the clinical severity and S100A12 and resolvin D1. This study delineated that S100A12 and resolvin D1 are sensitive biomarkers to detect the degree of inflammation in children with FMF during the silent period. Consequently, we recommend adjusting the colchicine dose to ameliorate the disease's symptoms and to improve the quality of life in these patients.

Clinical and genetic characterization of ten Egyptian patients with Wolf-Hirschhorn syndrome and review of literature

Background

Wolf–Hirschhorn syndrome (WHS) (OMIM 194190) is a multiple congenital anomalies/intellectual disability syndrome. It is caused by partial loss of genetic material from the distal portion of the short arm of chromosome.

Methods

We studied the phenotype–genotype correlation.

Results

We present the clinical manifestations and cytogenetic results of 10 unrelated Egyptian patients with 4p deletions. Karyotyping, FISH and MLPA was performed for screening for microdeletion syndromes. Array CGH was done for two patients. All patients exhibited the cardinal clinical manifestation of WHS. FISH proved deletion of the specific WHS locus in all patients. MLPA detected microdeletion of the specific locus in two patients with normal karyotypes, while array CGH, performed for two patients, has delineated the extent of the deleted segments and the involved genes. LETM1, the main candidate gene for the seizure phenotype, was found deleted in the two patients tested by array CGH; nevertheless, one of them did not manifest seizures. The study emphasized the previous.

Conclusion

WHS is a contiguous gene syndrome resulting from hemizygosity of the terminal 2 Mb of 4p16.3 region. The Branchial fistula, detected in one of our patients is a new finding that, to our knowledge, was not reported.

Measurement of Serum Chemerin, Oxidized LDL, and Vitamin D Levels in Prader–Willi Syndrome: A Cross-Sectional Study in Pediatric Egyptian Patients

Prader–Willi syndrome (PWS) is the commonest genetic cause of obesity. Oxidative stress and chronic low-grade inflammation play a crucial role in the pathogenesis of obesity. Alterations of vitamin D (25-OHD) levels are commonly encountered with obesity. The aim of this study was to analyze serum chemerin, oxidized low-density lipoprotein (ox-LDL), and 25-OHD values in pediatric PWS patients in comparison with obese healthy children and nonobese control groups, highlighting possible correlations with body mass index (BMI) and obesity. Twenty-six PWS Egyptian patients and 26 obese healthy individuals referred to the outpatient clinic of the Clinical Genetics Department, National Research Centre, Cairo, Egypt, and 20 control patients with matching age and sex were enrolled in the study. Patients were clinically diagnosed and confirmed by routine cytogenetic and fluorescence in-situ hybridization analysis. Anthropometric measurements were performed, and BMI was calculated by weight/height2 (kg/m2), and BMI z score was also determined. Serum chemerin, ox-LDL, and vitamin D were determined by enzyme-linked immunosorbent assay. Chemerin levels, which reflected chronic inflammation, were significantly elevated as compared with obese and nonobese controls (p ≤ 0.0001). Concerning oxidative damage, children with PWS showed higher Ox-LDL levels compared with obese and nonobese controls (p < 0.0001). Vitamin D levels were significantly lower in PWS patients compared with obese and nonobese controls (p ≤ 0.0001). Our data showed that obesity in PWS is associated with oxidative stress and chronic low-grade inflammation. Ox-LDL is a good indicator of oxidative stress, and chemerin could be used as a biomarker for the chronic inflammatory state. Furthermore, vitamin D supplementation is recommended in PWS patients

A founder mutation in PEX12 among Egyptian patients in peroxisomal biogenesis disorder

At least 14 distinctive PEX genes function in the biogenesis of peroxisomes. Biallelic alterations in the peroxisomal biogenesis factor 12 (PEX12) gene lead to Zellweger syndrome spectrum (ZSS) with variable clinical expressivity ranging from early lethality to mildly affected with long-term survival. Herein, we define 20 patients derived from 14 unrelated Egyptian families, 19 of which show a homozygous PEX12 in-frame (c.1047_1049del p.(Gln349del)) deletion. This founder mutation, reported rarely outside of Egypt, was associated with a uniformly severe phenotype. Patients showed developmental delay in early life followed by motor and mental regression, progressive hypotonia, unsteadiness, and lack of speech. Seventeen patients had sparse hair or partial alopecia, a striking feature that was not noted previously in PEX12. Neonatal cholestasis was manifested in 2 siblings. Neurodiagnostics showed consistent cerebellar atrophy and variable white matter demyelination, axonal neuropathy in about half, and cardiomyopathy in 10% of patients. A single patient with a compound heterozygous PEX12 mutation exhibited milder features with late childhood onset with gait disturbance and learning disability. Thus, the PEX12 relatively common founder mutation accounts for the majority of PEX12-related disease in Egypt and delineates a uniform clinical and radiographic phenotype.

Unilateral Isolated Proximal Femoral Focal Deficiency in an Egyptian Infant and Review of Literature

Proximal femoral focal deficiency (PFFD) is a rare congenital anomaly of the femur ranging from mild shortening to total agenesis. If left untreated, it could lead to impaired child growth, abnormal gait, vertebral abnormalities, cosmetic problems, and behavioral changes. We report on an Egyptian female, presenting to us at the age of 15 days with a short left lower limb. Both upper limbs and the right lower limb were normal and she was not dysmorphic. The skeletal survey showed an isolated short left femur. At the age of 11 months, clinical reexamination confirmed left femur shortening. Echocardiogram and abdominal sonography revealed no abnormality. Magnetic resonance imaging (MRI) of the pelvis and lower limbs revealed isolated left proximal femoral focal deficiency. Her developmental milestones were normal. She was referred to pediatric orthopaedics for early intervention and proper management. To our knowledge and after reviewing the literature, this patient represents the first case of unilateral isolated proximal focal femoral deficiency in Egypt. In conclusion, PFFD diagnosis needs a systemic skeletal–facial–genital phenotyping to differentiate from overlapping genetic disorders. Early diagnosis and radioimaging are highly important for proper management.

Mutation in the SLC29A3 Gene in an Egyptian Patient with H Syndrome: A Case Report and Review of Literature

Histiocytosis-lymphadenopathy plus syndrome (H syndrome) is caused by mutations in the SLC29A3 gene that result in histiocytic infiltration of numerous organs. Patients suffering from this disorder can be easily mistaken for similar conditions such as Muckle-Wells syndrome. We present a 9.5-year-old boy, who is the offspring of a consanguineous marriage. He suffered from sensorineural hearing loss, dark hyperpigmented indurated dry areas on the medial thighs sparing the knees with hypertrichosis on the affected areas, and areas of hypopigmentation on the abdomen. The patient displayed mild dysmorphism including frontal bossing, synophrys, bilateral proptosis (with normal thyroid function), thick eyebrows, flat nose, long philtrum, and pectus excavatum. Formal intelligence testing showed that he was a slow learner. Laboratory findings included elevated serum amyloid-A, erythrocyte sedimentation rate, and total proteins in urine tests. Complete blood count showed mild microcytic hypochromic anemia. The molecular analysis was crucial to confirm the provisional clinical diagnosis. H syndrome is a rare autoinflammatory syndrome with pleiotropic manifestations that affect many organs and can be mistaken for other conditions. Our patient's description may expand the phenotype of H syndrome, as areas of hypopigmentation were observed on the abdomen. Molecular analysis of SLC29A3 -related diseases is essential to highlight the variability and increase the awareness of H syndrome aiming for early diagnosis and proper treatment.

Oxidative Stress -a Phenotypic Hallmark of Fanconi Anemia and Down Syndrome: The Effect of Antioxidants

Background:

Oxidative stress plays a major role in the pathogenesis of leukemia-prone diseases such as Fanconi anemia (FA) and Down syndrome (DS)

Aim:

To explore the oxidative stress state in children with DS and FA by estimating the levels of antioxidants (e.g., malondialdehyde [MDA], total antioxidant capacity, and superoxide dismutase [SOD] activity) and DNA damage, and to evaluate of the effect of antioxidant treatment on these patients.

Subjects and methods

The study included 32 children clinically diagnosed with (15 patients) and FA (17 patients) in addition to 17 controls matched for age and sex. MDA, total antioxidant capacity, SOD activity, and DNA damage were measured. Antioxidants including Vitamin A, E, and C were given to the patients according to the recommended daily allowance for 6 months. Clinical follow-up and re-evaluation were conducted for all patients. Laboratory tests including complete blood count, karyotyping, DNA damage, and oxidative stress were re-evaluated. Statistical analysis was performed using statistical computer program Statistical Package for the Social Sciences version 14.0.

Results:

Children with FA and DS had elevated levels of oxidative stress and more DNA damage than controls. Oxidative stress parameters and DNA damage improved in FA and DS patients after antioxidant administration.

Conclusion:

Early administration of antioxidants to FA and DS patients is recommended for slowing of the disease course with symptoms amelioration and improvement of general health.

De Novo 17q24.2-q24.3 microdeletion presenting with generalized hypertrichosis terminalis, gingival fibromatous hyperplasia, and distinctive facial features

Generalized hypertrichosis is a feature of several genetic disorders, and the nosology of these entities is still provisional. Recent studies have implicated chromosome 17q24.2-q24.3 microdeletion and the reciprocal microduplication in a very rare form of congenital generalized hypertrichosis terminalis (CGHT) with or without gingival hyperplasia. Here, we report on a 5-year-old Egyptian girl born to consanguineous parents. The girl presented with CGHT and gingival hyperplasia for whom we performed detailed clinical, pathological, and molecular studies. The girl had coarse facies characterized by bilateral epicanthic folds, thick and abundant eyelashes, a broad nose, full cheeks, and lips that constituted the distinctive facial features for this syndrome. Biopsy of the gingiva showed epithelial marked acanthosis and hyperkeratosis with hyperplastic thick collagen bundles and dense fibrosis in the underlying tissues. Array analysis indicated a 17q24.2-q24.3 chromosomal microdeletion. We validated this microdeletion by real-time quantitative PCR and confirmed a perfect co-segregation of the disease phenotype within the family. In summary, this study indicates that 17q24.2-q24.3 microdeletion caused CGHT with gingival hyperplasia and distinctive facies, which should be differentiated from the autosomal recessive type that lacks the distinctive facies.

Terminal 2q deletion and partial trisomy chromosome 15q: a clinical and cytogenetic study

We report on a 5 years old female patient with a karyotype 46, XX, add (2), t(2;15) (q37;q22) associated with dysmorphic facial features, digital deformities, heart defect (mild mitral regurge) and severe mental retardation. This is the third reported case worldwide on the terminal 2q deletion and trisomy of chromosome 15q syndrome. The findings in this case and our literature review, delineates the pattern of malformations secondary to trisomy of 15q and deletion of 2q.

Gómez-López-hernández syndrome versus rhombencephalosynapsis spectrum: a rare co-occurrence with bipartite parietal bone

Rhombencephalosynapsis (RES) is a rare hindbrain malformation that could occur in isolation or as a part of a syndrome for example, Gómez-López-Hernández syndrome (GLH) or VACTERL-H. We identified male patient with severe RES. Ventriculomegaly, agenesis of septum pellucidum, very thin corpus callosum with interhemispheric cyst were additional neuroimaging findings. He had brachyturricephaly, midface retrusion, low-set posteriorly rotated ears and bilateral parietal well circumscribed areas of alopecia. No corneal anesthesia was observed; thus, demonstrating many of the diagnostic criteria of GLH. Interestingly, he additionally had bilateral bipartite parietal bone (BPB) that is an extremely rare anomaly of the parietal sutures. This is the first co-occurrence of this rare anomaly with GLH. We believe the presence of this unique finding could represent an important clue for understanding the pathogenesis of this malformation.

Muscle fatigue and excitation-contraction coupling responses following a session of prolonged cycling

AIM

The mechanisms underlying the fatigue that occurs in human muscle following sustained activity are thought to reside in one or more of the excitation-contraction coupling (E-C coupling) processes. This study investigated the association between the changes in select E-C coupling properties and the impairment in force generation that occurs with prolonged cycling.

METHODS

Ten volunteers with a peak aerobic power (VO(2peak)) of 2.95 ± 0.27 L min(-1) (mean ± SE), exercised for 2 h at 62 ± 1.3%. Quadriceps function was assessed and tissue properties (vastus lateralis) were measured prior to (E1-pre) and following (E1-post) exercise and on three consecutive days of recovery (R1, R2 and R3).

RESULTS

While exercise failed to depress the maximal activity (V(max) ) of the Na(+) ,K(+) -ATPase (P = 0.10), reductions (P < 0.05) were found at E1-post in V(max) of sarcoplasmic reticulum Ca(2+) -ATPase (-22%), Ca(2+) -uptake (-26%) and phase 1(-33%) and 2 (-38%) Ca(2+) -release. Both V(max) and Ca(2+) -release (phase 2) recovered by R1, whereas Ca(2+) -uptake and Ca(2+) -release (phase 1) remained depressed (P < 0.05) at R1 and at R1 and R2 and possibly R3 (P < 0.06) respectively. Compared with E1-pre, fatigue was observed (P < 0.05) at 10 Hz electrical stimulation at E1-post (-56%), which persisted throughout recovery. The exercise increased (P < 0.05) overall content of the Na(+), K(+)-ATPase (R1, R2 and R3) and the isoforms β2 (R1, R2 and R3) and β3 (R3), but not β1 or the α-isoforms (α1, α2 and α3).

CONCLUSION

These results suggest a possible direct role for Ca(2+)-release in fatigue and demonstrate a single exercise session can induce overlapping perturbations and adaptations (particularly to the Na(+), K(+)-ATPase).

STUDIES ON X-RAY EFFECTS : II. STIMULATIVE ACTION ON THE LYMPHOCYTES

This study consists of blood counts on nine rabbits after an exposure to x-rays of a 7/8 inch spark-gap, milliamperage 25, distance from the target 8 inches, and time of exposure 20 minutes. In seven of the nine animals there resulted an increase of the circulating lymphocytes. In five of these the increase was marked and in two others definite but not striking. Of the two animals which showed no stimulation one showed marked fluctuation of counts both before and after x-rays and the other little or no change. The higher penetrating dose (6 inch spark-gap, milliamperage 5, distance from the target 10 inches, time 26 minutes and 57 seconds) given to two animals produced no appreciable stimulation.

Building capacity in local government for integrated planning to increase physical activity: evaluation of the VicHealth MetroACTIVE program

Integrated planning is a holistic approach to addressing the needs of local communities built on partnerships between those responsible for development, environmental quality and service provision. This study investigated the extent and key influences on the use of integrated planning to promote physical activity among six metropolitan councils in Melbourne Australia, which took part in the MetroACTIVE Project funded by the Victorian Health Promotion Foundation from 2005 to 2007. The evaluation entailed interviews conducted at the mid-term (N = 67) and completion (N = 50) of the project, and the review of relevant documents. Respondents included elected councillors, chief executive officers, officers from different council divisions and the project staff employed in each council. Three councils showed evidence of integrated planning for physical activity, whereas the remainder focused on the delivery of community participation programs. Leadership from senior management and an organizational culture that supported collaboration across council departments were prerequisites for integrated planning. Employment of a dedicated project officer with skills for engaging management and building partnerships within the organization was important. Barriers to integrated planning were a complex organization structure, high demands on the council due to a growing residential population and a poor climate among staff. Overall, integrated planning was found to be a viable approach for developing a coordinated approach to this issue involving the range of council services and functions. Ongoing strategies are needed to facilitate senior management commitment and organizational capacity for integrated planning, with leadership provided by departments responsible for infrastructure or corporate planning.

Rapid diagnosis of Mycobacterium tuberculosis meningitis by enumeration of cerebrospinal fluid antigen-specific T-cells

SETTING

Hospital in-patients with suspected tuberculous meningitis (TBM), predominantly in India.

OBJECTIVE

To determine whether interferon-gamma (IFN-gamma) secreting Mycobacterium tuberculosis antigen-specific T-cells are present in the cerebrospinal fluid (CSF) of patients with TBM and to evaluate the feasibility of CSF enzyme-linked immunospot (ELISpot) for the diagnosis of active TBM.

DESIGN

Prospective blinded hospital-based study.

RESULTS

The overnight ELISpot assay detected M. tuberculosis antigen-specific IFN-gamma secreting T-cells in CSF from nine of 10 prospectively recruited patients with TBM, and zero of seven control patients with meningitis of other aetiology. This corresponds to a diagnostic sensitivity of 90% (95%CI 56-100) and specificity of 100% (95%CI 59-100).

CONCLUSION

This pilot study demonstrates proof-of-principle for a new T-cell-based diagnostic test for TBM which is rapid, sensitive and specific.

On the perils of mycorrhizal status lists: the case of Buddleja davidii

One observation in a mycorrhizal check-list that Buddleja davidii is nonmycorrhizal has been perpetuated in subsequent citations and used in a number of analyses of mycorrhizal ecology and evolution. Direct observation of B. davidii from New Zealand and the UK shows extensive arbuscular mycorrhizal fungal structures inside B. davidii roots. The suggestion that B. davidii is nonmycorrhizal is therefore not supported. The use of mycorrhizal checklists for analysis of plant traits and evolution needs to be undertaken with care to ensure the validity of underlying data.

Reversal of muscle fatigue during 16 h of heavy intermittent cycle exercise

This study examined the effects of extended sessions of heavy intermittent exercise on quadriceps muscle fatigue and weakness. Twelve untrained volunteers (10 men and 2 women), with a peak oxygen consumption of 44.3 ± 2.3 ml·kg−1·min−1, exercised at ∼91% peak oxygen consumption for 6 min once per hour for 16 h. Muscle isometric properties assessed before and after selected repetitions (R1, R2, R4, R7, R12, and R15) were used to quantitate fatigue (before vs. after repetitions) and weakness (before vs. before repetitions). Muscle fatigue at R1 was indicated by reductions ( P < 0.05) in peak twitch force (135 ± 13 vs. 106 ± 11 N) and by a reduction ( P < 0.05) in the force-frequency response, which ranged between ∼53% at 10 Hz (113 ± 12 vs. 52.6 ± 7.4 N) and ∼17% at 50 Hz (324 ± 27 vs. 270 ± 30 N). No recovery of force, regardless of stimulation frequency, was observed during the 54 min between R1 and R2. At R2 and for all subsequent repetitions, no reduction in force, regardless of stimulation frequency, was generally found after the exercise. The only exception was for R2, where, at 20 Hz, force was reduced ( P < 0.05) by 18%. At R15, force before repetitions for high frequencies (i.e., 100 Hz) returned to R1 (333 ± 29 vs. 324 ± 27 N), whereas force at low frequency (i.e., 10 Hz) was only partially ( P < 0.05) recovered (113 ± 12 vs. 70 ± 6.6 N). It is concluded that multiple sessions of heavy exercise can reverse the fatigue noted early and reduce or eliminate weakness depending on the frequency of stimulation.

Time course of the flash response of dark- and light-adapted human rod photoreceptors derived from the electroretinogram

1. The a-wave of the electroretinogram was recorded from human subjects with normal vision, using a corneal electrode and ganzfeld stimulation. We applied the paired-flash technique, in which an intense 'probe' flash was delivered at different times after a 'test' flash. The amplitude of the probe-flash response provided a measure of the circulating current remaining at the appropriate time after the test flash. 2. We extended previous methods by measuring not at a fixed time, but at a range of times after the probe flash, and then calculating the ratio of the 'test-plus-probe' response to the 'probe-alone' response, as a function of time. 3. Under dark-adapted conditions the rod response derived by the paired-flash technique (in response to a relatively dim test flash) peaked at ca 120 ms, with a fractional sensitivity at the peak of ca 0.1 Td(-1) s(-1). 4. As reported previously, background illumination reduced the maximal response, reflecting a reduction in rod circulating current. In addition, it shortened the time to peak (to ca 70 ms at an intensity of 170 Td), and reduced the flash sensitivity measured at the peak. The flash sensitivity declined approximately according to Weber's Law, with a 10-fold reduction occurring at an intensity of 100-200 Td. We could not reliably measure responses at significantly higher background intensities because the circulating current became so small. 5. In order to investigate the phototransduction process after correction for response compression, we expressed the derived response as a fraction of the maximal response that could be elicited in the presence of the background. The earliest rising phase of this 'fractional response per unit intensity' was little affected by background illumination, suggesting that the amplification constant of transduction was unaltered by light adaptation.

Light adaptation and dark adaptation of human rod photoreceptors measured from the a-wave of the electroretinogram

1. We recorded the a-wave of the human electroretinogram from subjects with normal vision, using a corneal electrode and ganzfeld (full-field) light stimulation. From analysis of the rising phase of rod-isolated flash responses we determined the maximum size (amax) of the a-wave, a measure of the massed circulating current of the rods, and the amplification constant (A) of transduction within the rod photoreceptors. 2. During light adaptation by steady backgrounds the maximal response was reduced, as reported previously. amax declined approximately as I0/(I0 + IB), where IB is retinal illuminance and I0 is a constant. In different subjects I0 ranged from 40 to 100 trolands, with a mean of 70 trolands, corresponding to about 600 photoisomerizations s-1 per rod. (1 troland is the retinal illuminance that results when a surface luminance of 1 cd m-2 is viewed through a pupil area of 1 mm2.) The amplification constant A decreased only slightly in the presence of steady backgrounds. 3. Following a full bleach amax recovered along an S-shaped curve over a period of 30 min. There was no detectable response for the first 5 min, and half-maximal recovery took 13-17 min. 4. The apparent amplification constant decreased at early times after large bleaches. However, upon correction for reduced light absorption due to loss of pigment, with regeneration of rhodopsin occurring with a time constant of 9-15 min in different subjects, it appeared that the true value of A was probably unchanged by bleaching. 5. The recovery of amax following a bleach could be converted into recovery of equivalent background intensity, using a 'Crawford transformation' derived from the light adaptation results. Following bleaches ranging from 10 to > 99 %, the equivalent background intensity decayed approximately exponentially, with a time constant of about 3 min. 6. The time taken for amax to recover to a fixed proportion of its original level increased approximately linearly (rather than logarithmically) with fractional bleach, with a slope of about 12 min per 100 % bleach. Similar behaviour has previously been seen in psychophysical dark adaptation experiments, for the dependence of the 'second component' of recovery on the level of bleaching.

Role of S-100 staining in differentiating leprosy from other granulomatous diseases of the skin

Since Mycobacterium leprae are rarely demonstrable in the tuberculoid spectrum of leprosy, a confirmatory diagnosis of leprosy can be made on the basis of finding active destruction of cutaneous nerves by granulomatous inflammation in a skin biopsy. Immunoperoxidase staining for S-100 protein, which is a marker for Schwann cells, was used to delineate nerves in lesional skin biopsies of 25 patients with tuberculoid and borderline tuberculoid leprosy as well as 15 controls with nonleprous granulomatous inflammation. Four different patterns of nerve damage were observed: infiltrated, fragmented, absent, and intact. All of the nonleprous granulomatous dermatoses showed only intact nerves, either inside or outside the granuloma, and so S-100 staining can be used to rule out leprosy.

Amyotrophic lateral sclerosis immunoglobulins are ineffective in altering calcium influx through presynaptic voltage-sensitive calcium channels

Recent work has suggested that one factor in the etiology of the neuromuscular disease, amyotrophic lateral sclerosis (ALS), may be an autoimmune mechanism in which presynaptic voltage-sensitive calcium channels are an antigenic target. We have developed a fluorescence technique to measure rapid Ca2+ influx through presynaptic calcium channels in isolated nerve terminals (synaptosomes) from rat cerebral cortex. Depolarization of the synaptosomes by elevated external K+ concentration caused a rapid increase in cytoplasmic Ca2+, as measured by a change in fluorescence of the Ca2+ chelating dye, Fura-2, which was loaded inside the synaptosomes. Pharmacological characterization suggests that the P- and Q-subtypes of voltage-sensitive calcium channels mediate the majority of this Ca2+ influx. The synaptosome preparation has been used as a model system to investigate the effects of IgG, purified from eight ALS patients, on presynaptic calcium channel function. IgG (1 microgram ml-1 to 1 mg ml-1) was preincubated with the synaptosomes prior to depolarization. IgG, from these eight ALS patients, had no systematic effects on presynaptic Ca2+ influx. Thus, using this system, we find no evidence for an effect of ALS IgG on the function of presynaptic calcium channels.

Effects of calcium channel blockers on the kinetics of voltage-dependent changes in synaptosomal calcium concentrations

Synaptosomal preparations from rat cerebral cortex have been used in stopped-flow fluorescence studies to measure rapid changes in intrasynaptosomal calcium concentrations upon depolarization. Synaptosomes were loaded with the fluorescent calcium chelating dye, Fura-2, by incubation with the membrane permeant acetoxymethyl ester derivative. Depolarization by elevated external K+ concentration resulted in a rapid increase in cytoplasmic Ca2+ as measured by a quench in Fura-2 fluorescence when excited at 390 nm. The fluorescence change could be reasonably fit by a single exponential process with an apparent rate of 10-15 s-1 and the magnitude of the response was voltage-dependent, increasing with increasing external K+ over the range of 5-30 mM. The observed quench was blocked by micromolar concentrations of the inorganic calcium channel blockers, Cd2+, Co2+ and La3+. Nimodipine, a dihydropyridine which blocks L-type calcium channels, inhibited only 10-15% of the flux response while nitrendipine had no consistent effect. omega-Conotoxin GVIA, a blocker of N-type channels in many species, had only a small inhibitory effect at high (1-10 microM) concentrations. The response was, however, inhibited by pre-incubation of the synaptosomes with venom of the funnel web spider. Agelenopsis aperta (0.1-300 micrograms/ml). Inhibition was observed with both a purified polyamine fraction (FTX) from the venom (IC50 = 4 nl/ml) and a purified peptide toxin, omega-AgaIVA (IC50 = 30 nM). These results indicate that voltage-dependent Ca2+ uptake by mammalian nerve terminals is mediated primarily by channels that are insensitive to dihydropyridines and omega-conotoxin GVIA but are sensitive to components of funnel web spider venom.

A new rat spinal cord injury model: a ventral compression technique

A new rat spinal cord injury model, which uses a modification of a DeBakey aortic aneurysm clamp to create the injury, is presented. The model produces a ventral persisting mass (bone and soft tissue) without the requirement of a prior decompressive operation (laminectomy). Modifications of the original technique have resulted in a nil surgical mortality rate. This technique has been applied to 138 animals. It has produced a consistent percentage of animals with complete myelopathies, as well as incomplete myelopathies and animals without apparent injury. The percent of baseline neurological function lost (change in degrees of the angle of tilt as measured by the inclined plane technique) in each group of surviving animals was 58, 36, and 9%, respectively. Sagittal postmortem sections confirmed mass lesions located ventral to the spinal cord. Histological sections confirmed neuronal loss consistent with the neurological findings.

Dose-dependent effects of naloxone and methylprednisolone in the ventral compression model of spinal cord injury

A study of the dose-response effects of naloxone and methylprednisolone after rat ventral spinal cord injury is presented. The spinal cord injury model used herein is unique in that it results in a ventral compression of the spinal cord without the need for a prior laminectomy. This allows for a close approximation of the human clinicopathological situation. There was a statistically significant positive effect on neurological outcome with a naloxone dose of 2.5 mg/kg, whereas higher and lower doses yielded little or no influence on outcome. Methylprednisolone was observed to offer similar results. These results, however, did not achieve statistical significance. The early administration of moderately high doses (45-60 mg/kg), however, offered the best results. The responses to the treatment regimens presented here offer hope for spinal cord injury victims. The observed dose-response relationships indicate that erroneous conclusions may arise from studies using inappropriate doses of narcotic antagonists, as well as other drugs.

Incidence of complications from coronary angiography in 463 USAF aviators

Over 600 fliers have had coronary angiography at the USAF School of Aerospace Medicine since 1971. This paper concerns the incidence of complications, long- and short-term, on the first 463. Information on short-term complications was compiled from computerized data storage and included all 463 patients. Mean age of patients was 40.5 with a range of 22-57 years. Information about long-term complications was obtained from 357 respondents to a three-page questionnaire (77% return rate). Most frequent indication for angiography was an abnormal treadmill stress test, and more than 90% of the patients were asymptomatic. There was no short-term mortality. Nine individuals reported some residual complaints involving the hand, but had no job or physical activity limitation from the procedure. The local arterial complications were more frequent with brachial cutdown than with the femoral percutaneous approach, but the difference in frequency was not statistically significant.

An experimental analysis of a program to reduce retail theft

A program for elementary school-aged youth, designed for and implemented by a retail business, was evaluated. The program included visual instructions to youth, tokens (exchangeable for special prizes) for appropriate verbal behavior, visual feedback to youth, and rewards for reducing merchandise loss, all continued to a criterion level. A 54% reduction in losses of popular youth merchandise was achieved.

Evaluation of outpatient client progress: time-series telephone interview data

A cost-efficient information system that allows for the continual monitoring of the verbal reports of mental health outpatient behavior was designed and implemented. Verbal descriptions of patients' problem behaviors were collected during baseline, therapy, and post-therapy periods using a telephone interview procedure. Descriptive data were presented for 25 patients, demonstrating that: (a) adequate baseline measures can be taken to evaluate therapy interventions, (b) there are wide differences among patients' reports as to the change in frequency of problems that occurs, and (c) patients' reported satisfaction with therapeutic services may be inconsistent with their verbal reports of behavioral change.

Care of patients after cardiac catheterization

In an effort to provide more definitive diagnosis for Air Force flyers referred to the USAF School of Aerospace Medicine, cardiac catherization has been performed, as indicated, on over 425 flyers since 1971. Since they are an apparently healthy and asymptomatic population, their recovery after cardiac catheterization is usually uneventful. However, the nurse must be able to recognize and interpret significant potential and/or existing post-catheterization complications. Nursing care of the patient after this procedure is essential to the successful completion of the test. Since any invasive procedure can lead to complications, quick and accurate nursing assessment and action are essential. The possible complications of cardiac catheterization which the nurse may encounter have been divided into possible causes, and a suggested plan of action. Reference tables are provided for each of the two main classifications, in an effort to provide quick guidance for the nurse responsible for care of the patients after catheterization.