Evaluation of the catalytic mechanism of AICAR transformylase by pH-dependent kinetics, mutagenesis, and quantum chemical calculations

The catalytic mechanism of 5-aminoimidazole-4-carboxamide ribonucleotide transformylase (AICAR Tfase) is evaluated with pH dependent kinetics, site-directed mutagenesis, and quantum chemical calculations. The chemistry step, represented by the burst rates, was not pH-dependent, which is consistent with our proposed mechanism that the 4-carboxamide of AICAR assists proton shuttling. Quantum chemical calculations on a model system of 5-amino-4-carboxamide imidazole (AICA) and formamide using the B3LYP/6-31G level of theory confirmed that the 4-carboxamide participated in the proton-shuttling mechanism. The result also indicated that the amide-assisted mechanism is concerted such that the proton transfers from the 5-amino group to the formamide are simultaneous with nucleophilic attack by the 5-amino group. Because the process does not lead to a kinetically stable intermediate, the intramolecular proton transfer from the 5-amino group through the 4-carboxamide to the formamide proceeds in the same transition state. Interestingly, the calculations predicted that protonation of the N3 of the imidazole of AICA would reduce the energy barrier significantly. However, the pK(a) of the imidazole of AICAR was determined to be 3.23 +/- 0.01 by NMR titration, and AICAR is likely to bind to the enzyme with its imidazole in the free base form. An alternative pathway was suggested by modeling Lys266 to have a hydrogen-bonding interaction with the N3 of the imidazole of AICAR. Lys266 has been implicated in catalysis based on mutagenesis studies and the recent X-ray structure of AICAR Tfase. The quantum chemical calculations on a model system that contains AICA complexed with CH3NH3+ as a mimic of the Lys residue confirmed that such an interaction lowered the activation energy of the reaction and likewise implicated the 4-carboxamide. To experimentally verify this hypothesis, we prepared the K266R mutant and found that its kcat is reduced by 150-fold from that of the wild type without changes in substrate and cofactor Km values. The kcat-pH profile indicated virtually no pH-dependence in the pH range 6-10.5. The results suggest that the ammonium moiety of Lys or Arg is important in catalysis, most likely acting as a general acid catalyst with a pK(a) value greater than 10.5. The H267A mutant was also prepared since His267 has been found in the active site and implicated in catalysis. The mutant enzyme showed no detectable activity while retaining its binding affinity for substrate, indicating that it plays a critical role in catalysis. We propose that His267 interacts with Lys266 to aid in the precise positioning of the general acid catalyst to the N3 of the imidazole of AICAR.

Idiopathic intracranial hypertension: mechanisms of visual loss and disease management

Idiopathic intracranial hypertension (IIH) is a disorder of increased intracranial pressure of unknown cause. It is a disorder, predominantly of overweight women in the childbearing years. The major morbidity of the disease is visual loss. Damage to the visual system occurs at the optic nerve head. This damage is most likely due to axoplasm flow stasis and resultant intraneuronal ischemia. Management of IIH begins with educating the patient about the disease and its potential outcomes. I recommend modest dieting and following a low-salt regimen with caution against overuse of fluids. Acetazolamide and Lasix appear to be efficacious. Patients failing medical therapy have optic nerve sheath fenestration performed if visual loss is the main morbidity. Shunting procedures are considered if headache is the main symptom. Most patients respond well to therapy, but idiopathic intracranial hypertension may recur throughout life.

SITA standard in optic neuropathies and hemianopias: a comparison with full threshold testing

PURPOSE

To compare visual sensitivity, fatigue effect, and probability plot data between Full Threshold (FT) Humphrey automated perimetry and Swedish Interactive Threshold Algorithm (SITA) standard strategies in patients with optic neuropathies and hemianopias.

METHODS

Twenty-four patients with nonglaucomatous optic neuropathies and 18 patients with a relative homonymous or bitemporal hemianopia were tested with both conventional perimetry (Humphrey 24-2 program) and "back to back" SITA standard tests (SITA 1, SITA 2) to approximate the test time of the FT test conditions. Also, 28 normal subjects between the ages of 20 and 80 were tested with this protocol. The visual field quadrants with the most damage were used to evaluate any fatigue effect (i.e., possible lack of fatigue effect with SITA standard due to the shorter test time) and to compare probability plot data between FT, SITA 1, and SITA 2. Pointwise total and pattern deviation probability plot defects were weighted by degree of significance and summed.

RESULTS

Test times for normal subjects were 45 seconds longer for FT than for the combined test time of SITA 1 + SITA 2. Patients' test times were 40 seconds longer for hemianopias and 90 seconds longer for optic neuropathies with FT than the combined times for two SITA tests. There were higher sensitivities found with SITA 1 compared with Full Threshold (1.06 dB, P< 0.001) and SITA 2 with Full Threshold (0.73 dB, P< 0.001) in the most damaged quadrant for the optic neuropathy patients; for the hemianopia patients the difference in values were between SITA 1 and Full Threshold (0.96 dB, P = 0.07) and between SITA 2 and Full Threshold (0.11 dB, P = 0.87). The second SITA standard test had lower sensitivity than the first SITA standard test by 0.82 dB in hemianopias and by 0.71 dB in optic neuropathy patients. Analysis of the total and pattern deviation probability plot data showed slightly more defects (number and magnitude) with SITA 1 compared to FT for both groups, but the differences were not statistically significant.

CONCLUSIONS

Sensitivities were higher in patients with hemianopias or optic neuropathies using SITA standard compared with FT by approximately 1 dB. The probability plot comparison suggests SITA standard is at least as good as FT for detection of visual loss in individual examinations. However, efficacy of SITA standard for serial examinations has not yet been evaluated.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Pancreatitis in a cat demonstrating pancreatic duct dilatation ultrasonographically

A 17-year-old, castrated male domestic shorthair cat presented with nonspecific clinical findings of three days' duration. Complete blood counts and serum biochemistry profiles revealed evidence of hepatic dysfunction. Ultrasonographic evaluation revealed abnormalities consistent with pancreatitis, with suspected pancreatic duct dilatation in the left limb of the pancreas. Surgery and eventual necropsy confirmed a diagnosis of pancreatitis, along with pancreatic duct dilatation. Dilatation of the pancreatic duct may be another ultrasonographic change to look for when suspecting feline pancreatitis.

Prolonged use of intraluminal arterial shunts without systemic anticoagulation

BACKGROUND

Temporary arterial shunts maintain perfusion while surgeons postpone arterial repairs. The common indications are combined orthopedic and vascular injuries and damage control. The duration of patency and the need for systemic anticoagulation remain in question. We examined our experience for answers.

METHODS

We searched for patients who had temporary arterial shunts and collected the following: mechanism, artery injured, shunt time, blood loss and transfusions, injury severity score (ISS,) mangled extremity severity score (MESS,) and anticoagulation.

RESULTS

Of 19 patients, 10 had shunts for damage control (group 1,) and 9, for orthopedic/vascular injuries (group 2.) group 1 had significantly higher shunt time, mortality, ISS, and MESS. Shunt time ranged from 47 to 3,130 minutes (52 hours.) Two patients, 1 in each group, required amputations.

CONCLUSION

Temporary arterial shunts can be use for combined orthopedic and vascular injuries and for damage control. Shunts can stay open for 52 hours without systemic anticoagulation.

Is regionalization of trauma care using telemedicine feasible and desirable?

BACKGROUND

The judgement and skill of an experienced surgeon are crucial ingredients during trauma resuscitation, so that errors of omission, commission, and misprioritization can be avoided. Trauma represents a potential paradigm application for telemedicine owing to its ubiquitous and urgent nature and the limited availability of specialized care.

METHODS

A two-phase project was performed, using an Advanced Trauma Life Support (ATLS)-based evaluation tool. In phase I, we reviewed 24 videotaped trauma resuscitations on a single pass. Clinical data thus observed were compared with the clinical chart for agreement. In phase II, we performed real time, remote, initial evaluations of 17 trauma victims.

RESULTS

In phase I, 19 of 44 variables had agreement rates >90%, 10 had agreement rates between 70% and 90%. In phase II, agreement rates were similar to those in phase I, with improved accuracy in documenting initial and secondary vital signs and the secondary physical examination.

CONCLUSION

Remote evaluation of trauma victims is feasible. Accurate clinical data can be recorded, tasks delegated, and therapeutic measures advised using telemedicine. This can make expert trauma care available to hospitals without advanced trauma systems and potentially reduce cost, prevent unnecessary transfers, and promote early transfer when indicated.

Human AICAR transformylase: role of the 4-carboxamide of AICAR in binding and catalysis

We have prepared 4-substituted analogues of 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR) to investigate the specificity and mechanism of AICAR transformylase (AICAR Tfase). Of the nine analogues of AICAR studied, only one analogue, 5-aminoimidazole-4-thiocarboxamide ribonucleotide, was a substrate, and it was converted to 6-mercaptopurine ribonucleotide. The other analogues either did not bind or were competitive inhibitors, the most potent being 5-amino-4-nitroimidazole ribonucleotide with a K(i) of 0.7 +/- 0.5 microM. The results show that the 4-carboxamide of AICAR is essential for catalysis, and it is proposed to assist in mediating proton transfer, catalyzing the reaction by trapping of the addition compound. AICAR analogues where the nitrogen of the 4-carboxamide was derivatized with a methyl or an allylic group did not bind AICAR Tfase, as determined by pre-steady-state burst kinetics; however, these compounds were potent inhibitors of IMP cyclohydrolase (IMP CHase), a second activity of the bifunctional mammalian enzyme (K(i) = 0.05 +/- 0.02 microM for 4-N-allyl-AlCAR). It is proposed that the conformation of the carboxamide moiety required for binding to AICAR Tfase is different than the conformation required for binding to IMP CHase, which is supported by inhibition studies of purine ribonucleotides. It is shown that 5-formyl-AICAR (FAICAR) is a product inhibitor of AICAR Tfase with K(i) of 0.4 +/- 0.1 microM. We have determined the equilibrium constant of the transformylase reaction to be 0.024 +/- 0.001, showing that the reaction strongly favors AICAR and the 10-formyl-folate cofactor. The coupling of the AICAR Tfase and IMP CHase activities on a single polypeptide allows the overall conversion of AICAR to IMP to be favorable by coupling the unfavorable formation of FAICAR with the highly favorable cyclization reaction. The current kinetic studies have also indicated that the release of FAICAR is the rate-limiting step, under steady-state conditions, in the bifunctional enzyme and channeling is not observed between AICAR Tfase and IMP CHase.

Improved general health status in an unselected infant population following an allergen-reduced dietary intervention programme: the ZUFF-STUDY-PROGRAMME. Part II: infant growth and health status to age 6 months. ZUg-FrauenFeld

AIM OF THE STUDY

An allergen-reduced dietary intervention programme with strict dietary requirements was implemented over the first four months of life in an unselected population-based infant cohort and compared to a non-intervention cohort (the ZUFF study). Recommendations for the dietary programme in the intervention cohort were extended, but not strictly implemented, until the end of month six. The intervention was based on breastfeeding, a moderate whey hydrolysate formula (pHF), and delayed introduction of weaning foods with a high allergenicity. This study was a prospective, controlled, and unblinded study, the first to assess the effects of an allergen-reduced, pHF-based early nutritional programme in a broad unselected infant population. Because overall healthy development of the infant is a major objective of any nutritional programme, the study evaluated the effects of the dietary intervention on infant growth and general health status rather than specific allergic manifestations. Part I of this paper gave results for nutritional behaviour only, and Part II gives results for growth and general health status during the intervention period through the sixth month of life.

METHODS

Assignment of study infants was to demographically comparable intervention (Z) or control (FF) cohorts according to place of birth. In the intervention cohort (Z=564), the recommended dietary regimen was breastfeeding and--if exclusive breastfeeding was not possible--supplementation with a moderately hydrolysed, allergen-reduced infant formula (pHF). Weaning foods were delayed until four months of age or later in case of weaning foods with high allergenicity. In the control cohort (FF=566), there was no specific intervention. Imbalances between cohorts in confounding (adjuvant) factors that could influence health-related outcomes were integrated as covariates into the logistic regression of the main analyses. Growth parameters included weight, length, head circumference, BMI, and Z scores (SDS). General health status was assessed by clinically significant findings in gastrointestinal, respiratory, or skin symptoms.

RESULTS

Growth at 6 weeks and at 3 and 6 months was similar for Z and FF. Significantly fewer Z than FF infants had clinically noteworthy health findings at 3 months (Z=27% versus FF=37%, odds ratio=0.63, CI=0.48-0.82) and 6 months (Z=33% versus FF=49%, odds ratio=0.51, CI= 0.40-0.66). This corresponds to a 30 % reduction in overall health concerns at 6 months for the intervention cohort. At 3 and 6 months, differences between cohorts in most measures of general health status were strongly influenced by a lower incidence of skin symptoms in the Z cohort. Within FF, there were fewer exclusively breastfed (eBF) infants with health problems at 3 months compared with those who were partially (pBF) or non-breastfed (nBF) (eBF=31%, pBF=40%, nBF=39%, p< 0.05). In contrast, in the Z intervention cohort, the number of infants with health concerns was similar for exclusively breastfed infants and for those in whom mother's milk was supplemented or replaced by pHF (eBF=29%, pBF=25%, nBF=26%, ns). In a subanalysis of overall health findings in infants without a family risk of allergies, there were again significantly fewer Z than FF infants with any health or any skin problem.

CONCLUSION

An allergen-reduced dietary recommendation that includes a moderate whey hydrolysate infant formula (pHF) has no negative effects on growth parameters up to 6 months of life in an infant population unselected for atopic risk. The dietary intervention produced improvements in general health status when compared with a control cohort that received infant formula with unhydrolysed proteins (IF), and high allergenic weaning foods at an earlier age. The difference between cohorts was principally due to fewer adverse skin findings. (ABSTRACT TRUNCATED)

Improved general health status in an unselected infant population following an allergen reduced dietary intervention programme. The ZUFF-study-programme. Part I: Study design and 6-month nutritional behaviour

BACKGROUND

The best nutritional option for newborn infants is mother's milk. However, some newborn babies may not be exclusively breastfed during the first months of life, potentially leading to reduced overall health status and the early onset of allergic diseases in some infants. Considerable research has been devoted to the development and assessment of infant nutrition programmes, particularly to the prevention of allergies in high-risk infants. However, equal numbers of infants with and without an elevated familial risk of allergies will eventually develop allergic diseases. Therefore, optimizing nutritional programmes for the early infant population as a whole is an important--but as yet insufficiently studied--area of investigation. Moreover, although safe and effective nutrition must primarily support healthy development of the infant, few studies have evaluated the overall health benefits of nutritional interventions, but have focussed on specific allergic manifestations. In animal models, an allergen-reduced moderate whey hydrolysate formula (pHF, Nestlé Beba HA) induces the development of oral tolerance towards cow's milk proteins, without inducing sensitization. In infants with a high risk for allergies, pHF formulae reduce the early onset of allergic disease during the first 5 years of life by approximately 50% compared with a dietary regimen of unaltered proteins. At present, very little is known about the overall health benefits of such a dietary intervention on the unselected infant population as a whole.

AIM OF THE STUDY

The aim of our prospective, controlled study was to investigate the overall health benefits of an allergen-reduced nutritional programme in a newborn infant population unselected for atopic risk factors. The population in our study was as comparable as possible to the general population of healthy newborn infants. Our study included exclusive breastfeeding, use of a moderate whey hydrolysate formula (pHF, Nestlé Beba HA) if infant formula was needed, and delayed introduction of low-allergenic weaning foods. The study included assessments of compliance with the dietary programme, and evaluated nutritional habits, growth, and overall health status for 24 months. The health evaluation included allergic manifestations but did--by porpose--not define or evaluate them specifically. Part I of this paper gives results for nutritional habits during the first 6 months of life, Part II gives results for growth and general health status for the same time period, Part III will present feeding habits during the second half of the first year of life, and Part IV will present results to 24 months of age. The complete study report is published as a supplement to this journal.

METHODS

Nutritional assignment was to demographically comparable intervention (Z) or control (FF) cohorts according to the infant's place of birth. In the intervention cohort (Z, n = 564), the recommended dietary regimen was breastfeeding and/or the pHF formula, with no weaning food before 4 months of age. In the control cohort (FF, n = 566), there was no intervention. Longitudinal diet groups, defined for 4 months, excluding dropouts and noncompliants, were exclusive breastfeeding (eBF, Z, n = 201, FF, n = 162), partial breastfeeding (pBF, Z, n = 222, FF, n = 311), or non-breastfeeding (nBF, Z, n = 43, FF, n = 62). Imbalances between groups and cohorts in confounding factors that could influence health-related symptoms were integrated as covariates into the main analyses using logistic regression. Nutritional surveillance was carried out using continuous prospective monitoring.

RESULTS

The overall rate of breastfeeding, irrespective of partial or exclusive breastfeeding or the additional use of weaning foods, was similar in both cohorts at 4 and 6 months. However, from ages 3 to 6 months, significantly more Z than FF infants were exclusively breastfed (p < 0.05), and weaning foods were introduced at a significantly later age in Z t

Effect of instructions on conventional automated perimetry

PURPOSE

To investigate the effect of perimetrists' instructions on automated perimetry thresholds.

METHODS

Eighteen volunteers in two age groups participated in a series of three test sessions. Each session consisted of a Humphrey Field Analyzer 30-2 test, a questionnaire, and a customized test program using a Humphrey perimeter to construct frequency of seeing (FOS) curves from which thresholds were calculated, and a descriptive measure of response criterion was derived. The FOS curves were obtained at a central and a peripheral test location within the same test session. The three test sessions differed only by the instructions given. The instructions were adapted from those listed in the manufacturer's instruction manual and were designed to influence participants to respond to the stimuli in a conservative, liberal, or neutral manner.

RESULTS

For the 30-2 threshold test, a significant difference in mean deviation was found among the three instruction types (P = 0.001) and between the two age groups (P = 0.001). Although differences were small in the younger subjects (2.04 dB), the means for the responses from liberal to conservative differed by 6.57 dB in the older subjects. Thresholds obtained in a peripheral location by the customized threshold test were found to differ significantly between the age groups (younger group mean, 31.0 dB; older group mean, 27.2 dB) and among the instruction types (liberal mean, 30.9 dB; conservative mean, 28.1 dB; and neutral mean, 30.3 dB; P < 0.001). The descriptive measurement of response criterion suggests that a difference in criteria occurred as a result of the instructions in both peripheral and central locations for both age groups (P = 0.0001). In addition, according to self-reports, liberal instructions caused participants to be more likely to respond, whereas the conservative instructions caused them to be more reluctant to respond.

CONCLUSIONS

Perimetrists' instructions can significantly affect obtained automated perimetry thresholds.

Quantitative phase-sensitive imaging in a transmission electron microscope

This paper presents a new technique for forming quantitative phase and amplitude electron images applicable to a conventional transmission electron microscope. With magnetised cobalt microstructures used as a test object, we use electron holography to obtain an independent measurement of the phase shift. After a suitable calibration of the microscope, we obtain quantitative agreement of the phase shift imposed on the 200 keV electrons passing through the sample.

Differential patterns of executive function in children with attention-deficit hyperactivity disorder according to gender and subtype

The present investigation examined differential patterns in executive functions of children with attention-deficit hyperactivity disorder (ADHD; no diagnosed comorbid disorders) according to subtype and gender, and identified instrumentation sensitive to executive function in children aged 6 to 12 years with ADHD. Data were obtained from 94 children diagnosed with ADHD (predominantly inattentive, n = 32, ADHD combined, n = 62), and from 28 controls. Participants with ADHD, who were unmedicated at the time of testing, were administered five tests of executive function (the Wisconsin Card Sorting Test, the Stroop Color-Word Test, the Matching Familiar Figures Test, the Trail Making Test, and the Tower of London). A two-way multivariate analysis of covariance with age as the covariate and subtype and gender as the independent variables was conducted on all of the tests administered. While children with ADHD predominantly inattentive and those with ADHD combined differed from controls, it was only the latter subtype that differed significantly in perseveration and response inhibition. The absence of diagnosed comorbidity in the children with ADHD at the time of test administration demonstrates that the impairments in executive function are clearly located in ADHD, particularly in the ADHD combined subtype, thus providing support for Barkley's proposed unifying theory of ADHD.

Production of cyclic peptides and proteins in vivo

Combinatorial libraries of synthetic and natural products are an important source of molecular information for the interrogation of biological targets. Methods for the intracellular production of libraries of small, stable molecules would be a valuable addition to existing library technologies by combining the discovery potential inherent in small molecules with the large library sizes that can be realized by intracellular methods. We have explored the use of split inteins (internal proteins) for the intracellular catalysis of peptide backbone cyclization as a method for generating proteins and small peptides that are stabilized against cellular catabolism. The DnaE split intein from Synechocystis sp. PCC6803 was used to cyclize the Escherichia coli enzyme dihydrofolate reductase and to produce the cyclic, eight-amino acid tyrosinase inhibitor pseudostellarin F in bacteria. Cyclic dihydrofolate reductase displayed improved in vitro thermostability, and pseudostellarin F production was readily apparent in vivo through its inhibition of melanin production catalyzed by recombinant Streptomyces antibioticus tyrosinase. The ability to generate and screen for backbone cyclic products in vivo is an important milestone toward the goal of generating intracellular cyclic peptide and protein libraries.

Serum vitamin A concentration is elevated in idiopathic intracranial hypertension

OBJECTIVE

The primary purpose was to investigate whether serum vitamin A concentration is associated with idiopathic intracranial hypertension (IIH). The secondary aim was to obtain pilot data regarding the amount of vitamin A ingested by patients and controls.

BACKGROUND

Vitamin A is an attractive candidate mediator of IIH as many of the symptoms and signs of hypervitaminosis A mimic those of IIH.

METHODS

We prospectively determined serum retinol and retinyl ester concentration in 16 women with IIH and 70 healthy young women. Using a survey instrument, we also determined the average daily vitamin A ingestion in a convenience sample of patients and controls.

RESULTS

Serum retinol concentration was significantly higher in the patient group (median 752 ug/L) compared with the control group (median 530 ug/L), even after adjusting for age and body mass index (p < 0.001). Retinyl ester concentration, however, was similar in the patient (median 48 ug/L) and control (median 41 ug/L) groups (p = 0.32). There was no significant correlation between serum retinol concentration and body mass index in the patients (r = 0.16) or controls (r = -0.02). Finally, there was no significant difference in the amounts of vitamin A ingested by the patients or controls, although the small number of subjects in both groups reduced the power of this conclusion.

CONCLUSIONS

Elevated serum retinol concentration is associated with IIH. Obesity, by itself, does not explain these higher levels. Patients may ingest an abnormally large amount of vitamin A, metabolize it abnormally, or be unusually sensitive to its effects. Alternatively, elevated level of serum retinol may reflect an epiphenomenon of another variable we did not measure or a nonspecific effect of elevated retinol binding capacity.

Random dot motion stimuli are more sensitive than light stimuli for detection of visual field loss in ocular hypertension patients

PURPOSE

To determine whether motion detection perimetry or luminance size threshold perimetry (a test using the motion perimetry method with luminance stimuli) is more sensitive in detecting visual loss in ocular hypertension patients.

METHODS

Motion perimetry uses a customized computer graphics program to detect a subject's ability to identify a coherent shift in position of moving dots in a defined circular area against a background of fixed dots. Motion size threshold is defined as the smallest circular area within which dot motion is detected. Patients respond by touching the area of the computer monitor where they perceive the stimulus with a light pen. The localization errors are measured as the number of pixels from target center for each trial. Luminance size threshold perimetry uses the same technique except the background is dark gray and the stimuli are filled lighter gray circles. We tested one eye in each of 27 ocular hypertension patients and 27 age-matched normal subjects with both tests. Our main outcome measures were motion and luminance size thresholds, total deviation probability plot data, and spatial localization errors.

RESULTS

With the total deviation probability plot analysis, the ocular hypertension patients had a greater number of abnormal test locations with motion perimetry stimuli than with luminance stimuli. The abnormal test points were located most often in the superior and inferior nasal regions. Six subjects had nerve fiber bundle-like defects to motion stimuli whereas three patients had defects with luminance size threshold perimetry. The ocular hypertension patients had significantly greater localization errors than the controls with both tests.

CONCLUSIONS

Using a size thresholding technique in ocular hypertension patients, random dot motion stimuli appear to be more sensitive than luminance stimuli. Errors in stimulus localization are significantly increased in ocular hypertension patients, independent of the stimulus (motion or luminance) used.

Normal aging effects for frequency doubling technology perimetry

PURPOSE

To determine the influence of normal aging on contrast sensitivity for frequency doubling technology (FDT) perimetry.

METHODS

Contrast sensitivity measures were obtained for frequency-doubled stimuli (0.25 cycles per degree sinusoidal gratings undergoing 25 Hz counterphase flicker) at 17 target locations (4 per quadrant plus the central 5 degrees ) using a prototype of the Welch Allyn (Skaneateles, NY)/Humphrey Systems FDT perimeter (Humphrey Systems, Dublin, CA). A total of 407 normal subjects (761 eyes) between the ages of 15 and 85 years were tested.

RESULTS

Between the ages of 15 and 60 years there was an approximately linear decrease in contrast sensitivity of 0.6 dB per decade. After the age of 70, there was a slightly greater sensitivity loss with age. There were no meaningful differences in sensitivity loss as a function of age for different visual field locations. A small but consistent reduction in contrast sensitivity (approximately 0.7 dB) was found at all visual field locations for the second eye tested that may be due to a central adaptation process.

CONCLUSIONS

Normal aging effects for FDT perimetry are similar to those obtained for conventional automated perimetry, except that the FDT perimetry aging effects do not appear to be eccentricity dependent. These normative data provide a basis for establishing a statistical analysis procedure and probability plots for FDT perimetry.

Multibubble sonoluminescence in aqueous salt solutions

The sonoluminescence from aqueous solutions containing various salts in the concentration range of 0 to 7 M has been examined using 3.5 ms pulses of 515 kHz ultrasound. In almost all cases the sonoluminescence intensity recorded increased with increasing salt level until a critical concentration (in the range of 1-2 M) was reached. At salt levels above the critical concentration the signal intensity decreased sharply with increasing salt concentration. It is not possible to satisfactorily account for the trends in terms of changes in solution viscosity, rate of bubble coalescence, water vapour pressure, air/water interfacial tension or ionic strength. However, a good correlation of the increase in the signal with the extent of gas solubilisation in the solutions with changing salt concentration was observed. Possible reasons for the signal increase with the addition of salts and the marked decrease at high salt concentrations are discussed.

Automated perimetry in amblyopia: a generalized depression

PURPOSE

To quantitate the visual field abnormalities associated with amblyopia.

METHODS

In a prospective study, 37 amblyopic patients (11 anisometropic, 13 strabismic, 9 combination, 4 deprivation) performed automated perimetry in each eye using the Humphrey 30-2 program. Primary outcome measures were foveal threshold, mean deviation, and average threshold.

RESULTS

When the probability plots were examined, 21 visual fields in amblyopic eyes were normal, 8 had central scotomas, and 7 had diffuse depressions. No focal defects other than mild central scotomas were seen. However, the foveal threshold of amblyopic eyes was decreased by an average of 7.2 +/- 8.0 dB (P < .0001) compared with fellow eyes; intereye differences in mean deviation (3.2 +/- 5.4 dB; P < .001) and average threshold (2.9 +/- 5.3 dB; P < .005) were also seen. This decrease in sensitivity for the amblyopic eye occurred for all types of amblyopia. The depression in threshold was greatest at the fovea but was detectable and significant at all eccentricities of the 30-degree field. The average threshold in the amblyopic eye was highly correlated with visual acuity (r = .839; P < .001).

CONCLUSIONS

Although automated visual fields in amblyopic eyes typically appear normal, all four types of amblyopia are associated with a generalized depression of light sensitivity, which is proportionately greatest at the fovea and highly correlated with visual acuity loss. In general, amblyopia is not associated with any area of focal loss of threshold light sensitivity. If a focal defect is present in the visual field of the amblyopic eye, organic causes of visual loss should be suspected. The Humphrey visual field analyzer STATPAC program (Allergan-Humphrey, Inc, San Leandro, California) may artifactually transform small and generalized full-field depressions in a manner that makes them appear to be isolated central defects.

Risk moderation of parent and child outcomes in a preventive intervention: a test and replication

Family risk-related variations in proximal parent and young adolescent outcomes of a universal family-focused preventive intervention were examined using a cumulative index of risk incorporating sociodemographic characteristics and social-emotional adjustment measures. Results of an initial investigation involving 209 families of young adolescents suggested that intervention efficacy was largely unrelated to cumulative family risk. These findings were replicated with a second sample of 428 families. Implications for future intervention applications and outcome research are discussed.