Toward the improvement of total nitrogen deposition budgets in the United States

Frameworks for limiting ecosystem exposure to excess nutrients and acidity require accurate and complete deposition budgets of reactive nitrogen (Nr). While much progress has been made in developing total Nr deposition budgets for the U.S., current budgets remain limited by key data and knowledge gaps. Analysis of National Atmospheric Deposition Program Total Deposition (NADP/TDep) data illustrates several aspects of current Nr deposition that motivate additional research. Averaged across the continental U.S., dry deposition contributes slightly more (55%) to total deposition than wet deposition and is the dominant process (>90%) over broad areas of the Southwest and other arid regions of the West. Lack of dry deposition measurements imposes a reliance on models, resulting in a much higher degree of uncertainty relative to wet deposition which is routinely measured. As nitrogen oxide (NOx) emissions continue to decline, reduced forms of inorganic nitrogen (NHx = NH3 + NH4+) now contribute >50% of total Nr deposition over large areas of the U.S. Expanded monitoring and additional process-level research are needed to better understand NHx deposition, its contribution to total Nr deposition budgets, and the processes by which reduced N deposits to ecosystems. Urban and suburban areas are hotspots where routine monitoring of oxidized and reduced Nr deposition is needed. Finally, deposition budgets have incomplete information about the speciation of atmospheric nitrogen; monitoring networks do not capture important forms of Nr such as organic nitrogen. Building on these themes, we detail the state of the science of Nr deposition budgets in the U.S. and highlight research priorities to improve deposition budgets in terms of monitoring and flux measurements, leaf- to regional-scale modeling, source apportionment, and characterization of deposition trends and patterns.

Design, Synthesis and Characterization of Covalent KDM5 Inhibitors

Histone lysine demethylases (KDMs) are involved in the dynamic regulation of gene expression and they play a critical role in several biological processes. Achieving selectivity over the different KDMs has been a major challenge for KDM inhibitor development. Here we report potent and selective KDM5 covalent inhibitors designed to target cysteine residues only present in the KDM5 sub-family. The covalent binding to the targeted proteins was confirmed by MS and time-dependent inhibition. Additional competition assays show that compounds were non 2-OG competitive. Target engagement and ChIP-seq analysis showed that the compounds inhibited the KDM5 members in cells at nano- to micromolar levels and induce a global increase of the H3K4me3 mark at transcriptional start sites.

Discovery of an MLLT1/3 YEATS Domain Chemical Probe

YEATS domain (YD) containing proteins are an emerging class of epigenetic targets in drug discovery. Dysregulation of these modified lysine-binding proteins has been linked to the onset and progression of cancers. We herein report the discovery and characterisation of the first small-molecule chemical probe, SGC-iMLLT, for the YD of MLLT1 (ENL/YEATS1) and MLLT3 (AF9/YEATS3). SGC-iMLLT is a potent and selective inhibitor of MLLT1/3-histone interactions. Excellent selectivity over other human YD proteins (YEATS2/4) and bromodomains was observed. Furthermore, our probe displays cellular target engagement of MLLT1 and MLLT3. The first small-molecule X-ray co-crystal structures with the MLLT1 YD are also reported. This first-in-class probe molecule can be used to understand MLLT1/3-associated biology and the therapeutic potential of small-molecule YD inhibitors.

Clinical Neuroscience in Practice: An Experiential Learning Course for Undergraduates Offered by Neurosurgeons and Neuroscientists

Many pre-health students pursue extracurricular shadowing opportunities to gain clinical experience. The Virginia Tech School of Neuroscience introduced a formal course that provides a clinical experience superior to that received by many medical students. This course is composed of weekly 75-minute seminars that cover diseases affecting the nervous system, their diagnosis and treatment, complemented by weekly half-day intensive clinical experiences with unprecedented access to a team of neurosurgeons (in hospital operating rooms, Intensive Care Units, emergency room, angiographic suites, and wards). In the operating rooms, students routinely "scrub-in" for complex surgeries. On hospital rounds, students experience direct patient care and receive in-depth exposure to modern nervous system imaging. Students participate in two 24-hour "on-call" experiences with team providers. After call, students participate in cognitive and psychological studies to assess physiological and psychological effects of call-related sleep deprivation. Students prepare weekly essays on challenging socioeconomic and ethical questions, exploring subjects such as the cost of medicine and inequalities in access to health care. Towards the end of the course, students meet with the admission dean of the Virginia Tech Carilion medical school; they prepare a personal statement for medical school/graduate school applications, and attend a half-day block of mock medical school/graduate school interviews delivered by experienced clinicians. In lieu of a final exam, each student presents to the entire neurosurgery department, an in-depth clinical analysis of a case in which they participated. We provide details on implementation, challenges and outcomes based on experiences from three semesters with a total enrollment of approximately 60 students.

Discovery of a PCAF Bromodomain Chemical Probe

The p300/CBP‐associated factor (PCAF) and related GCN5 bromodomain‐containing lysine acetyl transferases are members of subfamily I of the bromodomain phylogenetic tree. Iterative cycles of rational inhibitor design and biophysical characterization led to the discovery of the triazolopthalazine‐based L‐45 (dubbed L‐Moses) as the first potent, selective, and cell‐active PCAF bromodomain (Brd) inhibitor. Synthesis from readily available (1R,2S)‐(−)‐norephedrine furnished L‐45 in enantiopure form. L‐45 was shown to disrupt PCAF‐Brd histone H3.3 interaction in cells using a nanoBRET assay, and a co‐crystal structure of L‐45 with the homologous Brd PfGCN5 from Plasmodium falciparum rationalizes the high selectivity for PCAF and GCN5 bromodomains. Compound L‐45 shows no observable cytotoxicity in peripheral blood mononuclear cells (PBMC), good cell‐permeability, and metabolic stability in human and mouse liver microsomes, supporting its potential for in vivo use.

LP99: Discovery and Synthesis of the First Selective BRD7/9 Bromodomain Inhibitor

The bromodomain-containing proteins BRD9 and BRD7 are part of the human SWI/SNF chromatin-remodeling complexes BAF and PBAF. To date, no selective inhibitor for BRD7/9 has been reported despite its potential value as a biological tool or as a lead for future therapeutics. The quinolone-fused lactam LP99 is now reported as the first potent and selective inhibitor of the BRD7 and BRD9 bromodomains. Development of LP99 from a fragment hit was expedited through balancing structure-based inhibitor design and biophysical characterization against tractable chemical synthesis: Complexity-building nitro-Mannich/lactamization cascade processes allowed for early structure-activity relationship studies whereas an enantioselective organocatalytic nitro-Mannich reaction enabled the synthesis of the lead scaffold in enantioenriched form and on scale. This epigenetic probe was shown to inhibit the association of BRD7 and BRD9 to acetylated histones in vitro and in cells. Moreover, LP99 was used to demonstrate that BRD7/9 plays a role in regulating pro-inflammatory cytokine secretion.

LP99: Discovery and Synthesis of the First Selective BRD7/9 Bromodomain Inhibitor

The bromodomain‐containing proteins BRD9 and BRD7 are part of the human SWI/SNF chromatin‐remodeling complexes BAF and PBAF. To date, no selective inhibitor for BRD7/9 has been reported despite its potential value as a biological tool or as a lead for future therapeutics. The quinolone‐fused lactam LP99 is now reported as the first potent and selective inhibitor of the BRD7 and BRD9 bromodomains. Development of LP99 from a fragment hit was expedited through balancing structure‐based inhibitor design and biophysical characterization against tractable chemical synthesis: Complexity‐building nitro‐Mannich/lactamization cascade processes allowed for early structure–activity relationship studies whereas an enantioselective organocatalytic nitro‐Mannich reaction enabled the synthesis of the lead scaffold in enantioenriched form and on scale. This epigenetic probe was shown to inhibit the association of BRD7 and BRD9 to acetylated histones in vitro and in cells. Moreover, LP99 was used to demonstrate that BRD7/9 plays a role in regulating pro‐inflammatory cytokine secretion.

Design and synthesis of potent and selective inhibitors of BRD7 and BRD9 bromodomains

We describe potent and selective inhibitors of the BRD7 and BRD9 bromodomains intended for use as chemical probes to elucidate the biological roles of BRD7 and BRD9 in cells.

Discovery and optimization of small-molecule ligands for the CBP/p300 bromodomains

Small-molecule inhibitors that target bromodomains outside of the bromodomain and extra-terminal (BET) sub-family are lacking. Here, we describe highly potent and selective ligands for the bromodomain module of the human lysine acetyl transferase CBP/p300, developed from a series of 5-isoxazolyl-benzimidazoles. Our starting point was a fragment hit, which was optimized into a more potent and selective lead using parallel synthesis employing Suzuki couplings, benzimidazole-forming reactions, and reductive aminations. The selectivity of the lead compound against other bromodomain family members was investigated using a thermal stability assay, which revealed some inhibition of the structurally related BET family members. To address the BET selectivity issue, X-ray crystal structures of the lead compound bound to the CREB binding protein (CBP) and the first bromodomain of BRD4 (BRD4(1)) were used to guide the design of more selective compounds. The crystal structures obtained revealed two distinct binding modes. By varying the aryl substitution pattern and developing conformationally constrained analogues, selectivity for CBP over BRD4(1) was increased. The optimized compound is highly potent (K_d = 21 nM) and selective, displaying 40-fold selectivity over BRD4(1). Cellular activity was demonstrated using fluorescence recovery after photo-bleaching (FRAP) and a p53 reporter assay. The optimized compounds are cell-active and have nanomolar affinity for CBP/p300; therefore, they should be useful in studies investigating the biological roles of CBP and p300 and to validate the CBP and p300 bromodomains as therapeutic targets.

A series of potent CREBBP bromodomain ligands reveals an induced-fit pocket stabilized by a cation-π interaction

The benzoxazinone and dihydroquinoxalinone fragments were employed as novel acetyl lysine mimics in the development of CREBBP bromodomain ligands. While the benzoxazinone series showed low affinity for the CREBBP bromodomain, expansion of the dihydroquinoxalinone series resulted in the first potent inhibitors of a bromodomain outside the BET family. Structural and computational studies reveal that an internal hydrogen bond stabilizes the protein-bound conformation of the dihydroquinoxalinone series. The side chain of this series binds in an induced-fit pocket forming a cation–π interaction with R1173 of CREBBP. The most potent compound inhibits binding of CREBBP to chromatin in U2OS cells.

Biocompatibility and enhanced osteogenic differentiation of human mesenchymal stem cells in response to surface engineered poly(D,L-lactic-co-glycolic acid) microparticles

Tissue engineering strategies can be applied to enhancing osseous integration of soft tissue grafts during ligament reconstruction. Ligament rupture results in a hemarthrosis, an acute intra-articular bleed rich in osteogenic human mesenchymal stem cells (hMSCs). With the aim of identifying an appropriate biomaterial with which to combine hemarthrosis fluid-derived hMSCs (HF-hMSCs) for therapeutic application, this work has investigated the biocompatibility of microparticles manufactured from two forms of poly(D,L-lactic-co-glycolic acid) (PLGA), one synthesized with equal monomeric ratios of lactic acid to glycolic acid (PLGA 50:50) and the other with a higher proportion of lactic acid (PLGA 85:15) which confers a longer biodegradation time. The surfaces of both types of microparticles were functionalized by plasma polymerization with allylamine to increase hydrophilicity and promote cell attachment. HF-hMSCs attached to and spread along the surface of both forms of PLGA microparticle. The osteogenic response of HF-hMSCs was enhanced when cultured with PLGA compared with control cultures differentiated on tissue culture plastic and this was independent of the type of polymer used. We have demonstrated that surface engineered PLGA microparticles are an appropriate biomaterial for combining with HF-hMSCs and the selection of PLGA is relevant only when considering the biodegradation time for each biomedical application.

Engineering an in-vitro model of rodent cartilage

OBJECTIVES

The purpose of this study was to identify a cell source, scaffold substrate and culture environment suitable for use in engineering an in-vitro model of rodent cartilage.

METHODS

The chondrogenic activity and stability of cells isolated at Day 18 of gestation was assessed under normoxia and hypoxia using a cytokine stimulation assay and gene expression analysis. The ability of the selected cells seeded in fibrous electrospun scaffolds to form cartilaginous tissue during longterm static and dynamic culture was assessed using immunocytochemistry and biochemical analysis.

KEY FINDINGS

Rodent fetal chondrocytes appear to have enhanced phenotypic stability compared with other cell sources. Following 16 weeks under static culture, the engineered constructs were found to have greater cellularity and collagen content that native rodent cartilage.

CONCLUSIONS

A cell source, scaffold and culture environment have been identified that support the generation of in-vitro rodent cartilage. In future work, cytokine treatment of the engineered tissues will take place to generate in-vitro osteoarthritis models.

Regulation of the pharynx of Caenorhabditis elegans by 5-HT, octopamine, and FMRFamide-like neuropeptides

More than fifty FMRFamide-like neuropeptides have been identified in nematodes. We addressed the role of a subset of these in the control of nematode feeding by electrophysiological recording of the activity of C. elegans pharynx. AF1 (KNEFIRFamide), AF2 (KHEYLRFamide), AF8 (KSAYMRFamide), and GAKFIRFamide (encoded by the C. elegans genes flp-8, flp-14, flp-6, and flp-5, respectively) increased pharyngeal action potential frequency, in a manner similar to 5-HT. In contrast, SDPNFLRFamide, SADPNFLRFamide, SAEPFGTMRFamide, KPSVRFamide, APEASPFIRFamide, and AQTVRFamide (encoded by the C. elegans genes flp-1; flp-1; flp-3; flp-9; flp-13, and flp-16, respectively) inhibited the pharynx in a manner similar to octopamine. Only three of the neuropeptides had potent effects at low nanomolar concentrations, consistent with a physiological role in pharyngeal regulation. Therefore, we assessed whether these three peptides mediated their actions either directly on the pharynx or indirectly via the neural circuit controlling its activity by comparing actions between wild-type and mutants with deficits in synaptic signaling. Our data support the conclusion that AF1 and SAEPFGTMRFamide regulate the activity of the pharynx indirectly, whereas APEASPFIRFamide exerts its action directly. These results are in agreement with the expression pattern for the genes encoding the neuropeptides (Kim and Li, 1999) as both flp-8 and flp-3 are expressed in extrapharyngeal neurons, whereas flp-13 is expressed in I5, a neuron with synaptic output to the pharyngeal muscle. These results provide the first, direct, functional information on the action of neuropeptides in C. elegans. Furthermore, we provide evidence for a putative inhibitory peptidergic synapse, which is likely to have a role in the control of feeding.

Differential sensitivity to calciseptine of L-type Ca(2+) currents in a 'lower' vertebrate (Scyliorhinus canicula), a protochordate (Branchiostoma lanceolatum) and an invertebrate (Alloteuthis subulata)

Voltage-dependent calcium currents in vertebrate (Scyliorhinus canicula), protochordate (Branchiostoma lanceolatum), and invertebrate (Alloteuthis subulata) skeletal and striated muscle were examined under whole-cell voltage clamp. Nifedipine (10 microM) suppressed and cobalt (5 mM) blocked striated/skeletal muscle calcium currents in all of the animals examined, confirming that they are of the L-type class. Calciseptine, a specific blocker of vertebrate cardiac muscle and neuronal L-type calcium currents, was applied (0.2 microM) under whole-cell voltage clamp. Protochordate and invertebrate striated muscle L-type calcium currents were suppressed while up to 4 microM calciseptine had no effect on dogfish skeletal muscle L-type calcium currents. Our results demonstrate the presence of at least two sub-types of L-type calcium current in these different animals, which may be distinguished by their calciseptine sensitivity. We conclude that the invertebrate and protochordate L-type current sub-type that we have examined has properties in common with vertebrate 'cardiac' and 'neuronal' current sub-types, but not the skeletal muscle sub-type of the L-type channel.

Epithelial ingrowth: causes, prevention, and treatment in 5 cases

PURPOSE

To examine the clinical course, treatment, and outcome in 5 cases of epithelial ingrowth following laser in situ keratomileusis (LASIK).

SETTING

The Eye Institute, Sydney, Australia.

METHODS

Five patients with adequate follow-up were selected. Each patient had developed epithelial ingrowth as a consequence of LASIK, and each represented a different clinical course in terms of severity, time, and treatment of the epithelial ingrowth.

RESULTS

Treatment ranged from observation, lifting and manual removal, phototherapeutic keratectomy, alcohol application, removal of the corneal cap, and penetrating keratoplasty (PKP). Outcomes ranging from retention of preoperative best corrected visual acuity to the need for PKP reflect the wide disparity in the severity of this complication and the therapeutic interventions required.

CONCLUSION

Epithelial ingrowth is a relatively uncommon complication following LASIK. Suggestions for prevention and treatment are made.

Recutting the Cornea Versus Lifting the Flap: Comparison of Two Enhancement Techniques Following Laser in situ Keratomileusis

PURPOSE

To evaluate enhancement techniques following laser in situ keratomileusis (LASIK).

METHODS

Recutting was performed on 263 eyes and the flap was lifted in 55 eyes that had LASIK for simple myopia or myopic astigmatism. The time interval between LASIK and retreatment was 340+/-46 days (range, 270 to 892 days) in the recutting group and 215+/-36 days (range, 53 to 617 days) in the flap lifting group. Mean spherical equivalent refraction, refractive cylinder, uncorrected and best spectacle-corrected visual acuity were examined prior to, and 1, 3, and 6 months after retreatment.

RESULTS

Seventeen eyes were lost to follow-up in the lifting group and 53 eyes in the recutting group. In the recutting group, mean spherical equivalent refraction improved from -1.48+/-1.25 D to -0.49+/-0.88 D at 6 months. In the flap lifting group, mean spherical equivalent refraction improved from -1.05+/-1.49 D to -0.45+/-0.39 D at 6 months. Refractive cylinder did not change significantly in either group (P = .2). There was a significant increase in uncorrected visual acuity (UCVA) of 6/6 in each group. In the recutting group, UCVA of 6/6 increased from 3.8% to 65.2% at 6 months, and in the lifting group from 3.6% to 71.1% at 6 months. In the recutting group, seven free flaps and three macerated flaps that required removal occurred. One eye in the recutting group and two in the lifting group developed significant epithelial ingrowth. No patient lost more than one line of best spectacle-corrected visual acuity (BSCVA).

CONCLUSION

Both procedures were safe, effective, and highly predictable for enhancements, but flap complications may be more likely with recutting.

Corneal deposition after high-dose chlorpromazine hydrochloride therapy

PURPOSE

To report a case of dermal and ocular changes after prolonged use of high-dose chlorpromazine hydrochloride therapy.

METHOD

This case report includes clinical history, clinical findings, and photographic images of ocular and dermal changes. RESULTS. Chlorpromazine therapy in a cumulative dosage exceeding 1,100 g resulted in dramatic skin discoloration and multiple crystalline deposits in both corneas. Anterior capsular opacities were binocularly present. These changes were sufficient to cause reduction in visual acuity.

CONCLUSIONS

Chlorpromazine deposition at high levels can cause reduction in visual acuity and significant skin discoloration.

Successful treatment of Paecilomyces lilacinus endophthalmitis after foreign body trauma to the cornea

PURPOSE

To report the successful treatment of a patient with Paecilomyces lilacinus endophthalmitis infection after foreign body (FB) trauma to the cornea.

METHODS

A 30-year-old man presented to us with a corneal abscess and iritis 2 months after removal of a metal corneal FB. Initial corneal biopsy culture was negative. Treatment with topical 5% natamycin, 0.9% fortified gentamycin, and 5% cephalothin hourly was commenced. As a result of developing signs of endophthalmitis, two more biopsies were taken, a week apart, from the vitreous and anterior chamber, successively. The last biopsy yielded positive microbiologic results of the specious Paecilomyces lilacinus. Intravitreal injection of 50 microg/0.5 mL of amphotericin was administered during the vitreal biopsy. Soon after isolating the specious Paecilomyces lilacinus, the following treatment was administered: 200 mg of itraconazole bd by mouth, 5% topical natamycin every hour, 2 mg/mL of topical fluconazole every 2 hours, three anterior chamber injections of 0.35 mL of 0.1% fluconazole and two amphotericin B injections to the anterior chamber of 50 microg/0.5 mL each.

RESULTS

There appeared to be no sign of infection 6 months after initial treatment. A large, dense scar existed in the medial part of the cornea only. The pupil was secluded. The patient's visual acuity was 6/21. The eye was comfortable and all topical antifungal medication was ceased.

Ring keratitis from topical anaesthetic misuse

BACKGROUND

Topical anaesthetic abuse is now an established differential diagnosis of ring keratitis. Published evidence suggests that this condition often has a poor prognosis, with the eyes sometimes requiring penetrating keratoplasty or the patient becoming blind.

METHOD

A case of topical anaesthetic abuse and its subsequent management is presented. Ocular examination including pachymetry and specular microscopy is reported.

RESULTS

The cornea made an excellent recovery, allowing a visual acuity of 6/6. Pachymetry showed corneal thickening and specular microscopy demonstrated a decreased cell count in the affected eye.

CONCLUSIONS

With prompt recognition and appropriate treatment the prognosis for these cases can be excellent. However, there is evidence to suggest permanent cellular damage to the endothelium.

LASIK for post penetrating keratoplasty astigmatism and myopia

AIMS

To report the results of a series of patients who were treated with LASIK to correct post penetrating keratoplasty ametropia.

METHODS

26 eyes of 24 patients underwent LASIK to correct astigmatism and myopia after corneal transplantation; 14 eyes also received arcuate cuts in the stromal bed at the time of surgery. The mean preoperative spherical equivalent was -5.20D and the mean preoperative astigmatism was 8.67D.

RESULTS

The results of 25 eyes are reported. The mean 1 month values for spherical equivalent and astigmatism were -0.24D and 2.48D respectively. 18 eyes have been followed up for 6 months or more. The final follow up results for these eyes are -1.91D and 2.92D for spherical equivalent and astigmatism. The patients undergoing arcuate cuts were less myopic but had greater astigmatism than those not. The patients receiving arcuate cuts had a greater target induced astigmatism, surgically induced astigmatism, and astigmatism correction index than those eyes that did not. One eye suffered a surgical complication. No eyes lost more than one line of BSCVA and all eyes gained between 0 and 6 lines UCVA.

CONCLUSIONS

LASIK after penetrating keratoplasty is a relatively safe and effective procedure. It reduces both the spherical error and the cylindrical component of the ametropia. Correction of high astigmatism may be augmented by performing arcuate cuts in the stromal bed.

Staphylococcal infection under a LASIK flap

PURPOSE

To report a staphylococcal infection under a laser in situ keratomileusis (LASIK) flap and to discuss the management of this rare and potentially devastating complication.

METHODS

A patient was referred to our practice having had bilateral LASIK. She was found to have abscesses under the left corneal flap. Staphylococcus aureus was identified as the infecting organism by corneal scrape and treated with appropriate antibiotics. The cornea improved, and then the abscess recurred. The abscess was again scraped and intensive treatment reinstituted.

RESULTS

After successful treatment, the patient recovered excellent visual acuity with only a minimal astigmatic error.

CONCLUSION

The possible reasons for the apparent improvement and then recurrence of the abscess are discussed. The management of this case including the need for corneal scrape and antibiotic prophylaxis is discussed in relation to previously reported cases.

Toric laser in situ keratomileusis for myopic astigmatism using an ablatable mask

BACKGROUND

To assess the results of toric laser in situ keratomileusis (LASIK) correction of myopic astigmatism.

METHODS

A prospective study was performed over a 20 week period for consecutive patients treated for myopic astigmatism. Spectacle-corrected visual acuity, uncorrected visual acuity, spectacle refraction, videokeratography, and complications were recorded. Vector analysis was performed by the ASSORT program.

RESULTS

Sixty-five eyes of 42 patients underwent toric LASIK with a Summit Technologies Apex Plus excimer laser. Mean preoperative spherical equivalent refraction at the spectacle plane was -6.24 +/- 2.42 D (range, -1.63 to -14.63 D) and mean pre-operative refractive cylinder magnitude was 1.99 +/- 1.35 D (range, 0.75 to 7.00 D); mean attempted refractive cylinder correction was 1.90 +/- 1.00 D. Six months after LASIK (43 eyes followed), mean spherical equivalent refraction at the spectacle plane was -0.40 +/- 0.55 D and 31 eyes (72.1%) were within +/- 0.50 D of emmetropia. At 6 months, mean refractive cylinder magnitude was 0.74 +/- 0.70 D, mean surgically induced astigmatism was 1.46 +/- 0.86 D, mean absolute angle of error was 10.33 degrees, mean astigmatic correction index was 0.93 +/- 0.36 D, and mean index of success was 0.46 +/- 0.39. Uncorrected visual acuity was 6/12 or better in 34 eyes (79.1%) and 6/6 in 15 eyes (35%); spectacle- corrected visual acuity was 6/9 or better in 41 eyes (95.35%). Six eyes (14.0%) lost 1 line of spectacle-corrected visual acuity at 6 months and one eye (2.3%) lost 2 lines. Ten eyes (23.3%) gained 1 line at 6 months.

CONCLUSION

Toric LASIK with an ablatable mask using the Summit Apex Plus excimer laser is a safe and relatively accurate procedure for the correction of myopic astigmatism.

Central Focal Interface Opacity After Laser in situ Keratomileusis

BACKGROUND

The acute onset of a focal central interface opacity with visual loss following LASIK has not been described in the peer reviewed literature. Non-peer reviewed reports of various inflammatory lesions have been recorded.

METHODS

We describe three cases in which an acute focal stromal interface opacification was identified within 1 week of laser in situ keratomileusis (LASIK). Each case was performed by a different surgeon on a different day, but using the same method, materials, and the Summit Apex Plus excimer laser. Immediately after surgery, all eyes were normal with good unaided vision. The appearance of the central stromal opacity was associated with acute visual deterioration. Preoperative and postoperative cycloplegic refractions, videokeratography, and postoperative slit-lamp biomicroscopy were performed. Each case was treated with intensive topical corticosteroids.

RESULTS

Each case demonstrated a central circular opacity in the interface between corneal flap and stromal bed, with associated variable stromal thinning. Resolution of the pathological process followed 2 to 4 weeks of treatment with topical corticosteroids and subsequent improvement in slit-lamp biomicroscopy, corneal topography, and vision. Etiology was uncertain.

CONCLUSION

Central interface opacification is a rare but visually important inflammatory complication of LASIK.

Different excitation-contraction coupling mechanisms exist in squid, cuttlefish and octopod mantle muscle

Excitation-contraction (EC) coupling was studied in central zone mantle muscle fibres of a squid (Alloteuthis subulata), a cuttlefish (Sepia officinalis) and an octopod (Eledone cirrhosa). Thin slices of muscle were used for twitch experiments and enzymatic isolation of single fibres for whole-cell patch-clamp studies. The current required for a supramaximal twitch response during direct stimulation of muscle slices was lower for squid than for cuttlefish. In squid, but not in cuttlefish, the current-response relationship was independent of slice thickness (range 0.1-0.5 mm). Twitches of squid and cuttlefish slices were reversibly abolished by removal of extracellular Ca2+. In squid, but not in cuttlefish, the current-response relationship was Na+-dependent, and in the absence of Na+ higher current strengths were required to generate a supramaximal response. In whole-cell voltage-clamp experiments on isolated muscle fibres from squid, cuttlefish and Eledone cirrhosa, a sustained inward current was recorded upon depolarisation. This current was blocked by 5 mmol l-1 Co2+ and suppressed by 10 micromol l-1 nifedipine. In squid, an additional inward fast-activating transient current was seen which was blocked by 2 micromol l-1 tetrodotoxin and depolarised holding potentials. The fast current represents a voltage-activated Na+ channel, and the slow currents represent L-type Ca2+ channels. We conclude that squid possess a specialised rapid EC coupling mechanism in central zone fibres that is absent in cuttlefish and Eledone cirrhosa.

Retreatment of undercorrected photorefractive keratectomy for myopia

Fourteen eyes treated by photorefractive keratectomy (PRK) for myopia required retreatment because of undercorrection. The mean preoperative refraction of these eyes had been -9.82 D (range 5.25 to 17.13). No eyes before photorefractive keratectomy had low myopia, three eyes had myopia between -3.10 and -6.00 D, four were between -6.10 and -10.00 D, and seven had more than -10.00 D of myopia. Retreatment was required for manifest scars in association with regression, unresponsive to topical corticosteroids. The retreatments were performed using a Summit ExciMed UV200LA excimer laser with a dual ablation technique utilizing a phototherapeutic keratectomy followed by a photorefractive keratectomy. Follow-up ranged from 1 to 9 months. Eight eyes followed more than 3 months had a mean spherical equivalent refraction of -0.58 D (range -7.35 to +1.25).

Photorefractive keratectomy for myopia of more than -10 diopters

Twenty-seven consecutive eyes of 18 patients with myopia of more than -10.00 diopters (D) were treated by photorefractive keratectomy (PRK) using the ExciMed UV200LA excimer laser and a double ablation technique in an attempt to achieve a refraction of plano. The preoperative mean spherical equivalent refraction was -13.32 D (standard deviation 2.54, range -10.25 to -20.50). Preoperative spectacle corrected visual acuity ranged from 6/6 to 6/60 and one eye had had two previous refractive keratotomies. Follow up ranged from 3 to 15 months (mean 8.9). At 6 months after surgery, the mean change in refraction was 11.03 D, from a preoperative mean of -13.32 D to a postoperative mean of -2.29 D. The mean keratometric flattening was 5.83 D, from a preoperative mean of 42.92 D to a postoperative mean of 39.09 D. The reason for this large difference is uncertain. At three months the mean spherical equivalent refraction was +0.07 D (SD 2.94, range -10.50 to +3.25). The 14 eyes that had achieved 12 months follow up had a mean spherical equivalent of -1.91 D (SD 3.87, range -11.00 to +2.50). Seven of these 14 eyes have been reablated for manifest scars in association with regression. All 14 eyes had best spectacle corrected visual acuity at or better than their preoperative level.

Localisation of the mitogenic epitope of staphylococcal enterotoxin B

Limited digestion of staphylococcal enterotoxin B (SEB) with trypsin resulted in the generation of a 12-Kda amino-terminal fragment and a 17-Kda carboxy-terminal fragment which were isolated by preparative iso-electric focusing. The carboxy-terminal fragment exhibited significant mitogenic activity for murine splenocytes, whereas the isolated amino-terminal fragment possessed little detectable mitogenic activity. Monoclonal antibodies (MAbs) specific for the carboxy-terminal fragment neutralised most of the mitogenic activity of both the intact toxin and the carboxy-terminal fragment. MAbs specific for the amino-terminal fragment had no detectable neutralising activity. These results support the hypothesis that the epitope(s) responsible for mitogenic activity is located in the carboxy-terminal region of SEB.

Calmodulin is associated with microtubules forming in PTK1 cells upon release from nocodazole treatment

To investigate the association of calmodulin (CaM) with microtubules (MTs) in the mitotic apparatus (MA), the distributions of CaM and tubulin were examined in cells in which the normal spindle organization had been altered. A fluorescent CaM conjugate with tetramethylrhodamine isothiocyanate (CaM-TRITC) and a dichlorotriazinyl aminofluorescein conjugate with tubulin (tubulin-DTAF) were injected into cells that had been treated with the MT inhibitor nocodazole. With moderate nocodazole concentration (0.3 micrograms/ml, 37 degrees C, 4 h) in live cells, CaM-TRITC and tubulin-DTAF concentrated identically on or near the centrosomes and kinetochores. In serial sections of these cells, small MT segments were observed by transmission electron microscopy (TEM) in the regions where fluorescent protein had concentrated. When a higher drug concentration was used (3.0 micrograms/ml, 37 degrees C, 4 h), no regions of CaM-TRITC or tubulin-DTAF localization were observed, and no MTs were observed when serial sections were examined by TEM. However, following release from the high-concentration nocodazole block, CaM-TRITC colocalized with newly formed MTs at the kinetochores and centrosomes. Later in the recovery period, when chromosome-to-pole fibers had formed, CaM association with kinetochores diminished, ultimately attaining its normal pole-proximal association with kinetochore MTs in cells that progressed through mitosis. We interpret these observations as supporting the hypothesis that in the MA, CaM attains a physical association with kinetochore MTs and suggest that CaM-associated MTs may be inherently more stable.

Calmodulin stabilization of kinetochore microtubule structure to the effect of nocodazole

To investigate the function of calmodulin (CaM) in the mitotic apparatus, the effect of microinjected CaM and chemically modified CaMs on nocodazole-induced depolymerization of spindle microtubules was examined. When metaphase PtK1 cells were microinjected with CaM or a CaM-TRITC conjugate, kinetochore microtubules (kMTs) were protected from the effect of nocodazole. The ability of microinjected CaM to subsequently protect kMTs from the depolymerizing effect of nocodazole was dose dependent, and was effective for approximately 45 min, with protection decreasing if nocodazole treatment was delayed for more than 60 min after injection of CaM. The CaM-TRITC conjugate, similar to native CaM, displayed the ability to activate bovine brain CaM-dependent adenylate cyclase in a Ca++-dependent manner and showed a Ca++-dependent mobility shift when subjected to PAGE. A heat-altered CaM-TRITC conjugate also protected kMTs from the effect of nocodazole. However, this modified CaM was not able to activate adenylate cyclase nor did it display a Ca++-dependent mobility shift when electrophoresed. In a permeabilized cell model system, both CaM analogs were observed to bind to the spindle in a Ca++-independent manner. In contrast, a performic acid-oxidized CaM did not have a protective effect on spindle structure when microinjected into metaphase cells before nocodazole treatment. The oxidized CaM did not activate adenylate cyclase and did not exhibit Ca++-dependent mobility on polyacrylamide gels. These results are interpreted as supporting the hypothesis that CaM binds to the mitotic spindle in a Ca++-independent manner and that CaM may serve in the spindle, at least in part, to stabilize kMTs.

Macular suprastructure, stereociliary bonding and kinociliary/stereociliary coupling in rat utricular macula

This report considers rat utricular macular suprastructure after chemical treatment with the sodium salt of N,N-Naphthaloylhydroxylamine (NHA), used alone or in combination with tannic acid (TA). NHA and TA preserve calcium and complex carbohydrate-protein molecules, respectively. Macromolecules of supramacular substance appear comparable morphologically to material of the external lamina of glycocalyx. Similar material crosslinks stereocilia with approximately equal to 58 nm periodicity and couples parts of kinocilia with specific stereocilia. Particles which occur within kinocilia at certain attachment sites connect to dynein arms of the kinocilia. Interstereociliary connections are aligned with internal linkers to actin. Thus, a basis for dynamic communication between kinocilia and stereociliary actin has been shown. The mechanism would appear to be calcium dependent. The findings support the concept that kinocilia are motile and lead to the stereociliary tuft in vestibular hair cells.

Pharmacokinetics of antituberculosis drugs in patients

The pharmacokinetics of rifampin, isoniazid, and ethambutol were determined in 26 ambulatory male patients (aged 49.5 +/- 9.9 yr) with tuberculosis. Rifampin and isoniazid were given individually or together, with or without ethambutol; studies were done after a single dose and after chronic administration. Under the study conditions, with large variability in the extent of disease and physical status and history of alcohol and tobacco abuse and narrow age range, the pharmacokinetics of these three antituberculosis drugs were not modified significantly by patient age. Furthermore, appreciable drug-drug interactions did not occur when the three drugs were administered concurrently. Self-induction of rifampin clearance by chronic dosing with the drug may lead to subtherapeutic levels of rifampin. Administration of isoniazid and ethambutol in two divided doses resulted in peak plasma concentrations below the accepted therapeutic levels of the two drugs. Our findings indicate that at least in the middle-aged patients with tuberculosis, the current single daily dose, multiple-drug regimen is therapeutically sound pharmacokinetically, and clinicians do not have to make adjustments in dosages of these drugs for age and the extent of disease.

Innervation patterns in rat saccular macula. A structural basis for complex sensory processing

Serial sections through the anterior part of rat saccular macula were reconstructed as montages. Findings are that type II hair cells are integrated into the neural circuitry of type I cells, chiefly by synapses with neighboring calyces and their collaterals; and that complex interactions between afferent- and efferent-type nerve elements take place. Three basic types of nerve/calyx pattern are present: U-type nerves lose their myelin before they enter the macula and have complex calyces with several collaterals; M-type nerves are myelinated up to the calyx, which lacks collaterals; and M/U-type nerves have short, unmyelinated segments proximal to their calyces, which have few collaterals. Both afferent- and efferent-type collaterals spring from calyces, chiefly from those of U-type nerves. Type II cells are presynaptic both to electron-lucent and to vesiculated terminals; some synapses are reciprocal. Electron-lucent boutons sometimes are presynaptic to calyces and to type II hair cells; and morphologically afferent-to-afferent kinds of synapses occur in the neuroepithelium. The anatomical findings indicate that complex information processing must occur in mammalian gravity receptors.

Induction of suppressor cells in vitro by Candida albicans

Normal splenocytes cultured with Formalin-killed Candida albicans were shown to acquire significant suppressor cell activity in a period of 3 days. These cells were found to suppress both the phytohemagglutinin-induced mitogen response as well as the anti-sheep erythrocyte antibody response. Experiments were carried out to determine the nature of the suppressor cell population. Results showed that these cells were not susceptible to treatment with anti-Thy 1 antibody and complement. Panning experiments showed that the suppressor cells were not plastic-adherent or Mac-1 antigen-positive. The suppressor cells were, however, adherent to anti-mouse immunoglobulin (F(ab')2-fragment)-coated dishes. Additional experiments showed that the suppressor cell activity was susceptible to treatment with monoclonal anti-Lyb 2.1 antibody and complement. These results suggest that the suppressor cell induced in vitro by Candida is a member of the B-lymphocyte lineage.

Microinjected ras family oncogenes stimulate DNA synthesis in quiescent mammalian cells

Oncogenes of the ras family stimulate DNA synthesis when microinjected into quiescent mouse and hamster fibroblasts, as detected by in situ autoradiography. The molecularly cloned genomes of Harvey and Kirsten sarcoma viruses, the cloned Harvey ras gene, and the product of the v-ras gene, the p21v-rasH protein, stimulate DNA synthesis in quiescent cells. This stimulation is comparable to the stimulatory activity of the microinjected SV40 T-antigen-coding gene. The demonstration that these oncogenes can stimulate transient DNA synthesis in quiescent cells is relevant to understanding the mechanism by which these genes are able to transform cells in vitro and induce tumors in animals.

Effects of Wy-18,251 (3-p-chlorophenyl)thiazolo[3,2-a]benzimidazole- 2-acetic acid), levamisole and indomethacin on the generation of murine T suppressor cells in vitro

In vitro culture of normal BALB/c spleen cells with staphylococcal enterotoxin B (SEB) activates antigen non-specific suppressor T cells (Ts) which can be assayed by their ability to suppress antibody production in a plaque assay. Addition of the experimental immunomodulatory drug Wy-18,251 (10-100 microM) to cultures of spleen cells plus SEB significantly increased Ts activity relative to cultures without the drug. Similar results were obtained with levamisole, but, in contrast, indomethacin (0.1-10 microM) inhibited SEB-induced suppressor cell activity. The ability of Wy-18,251 to augment Ts activity could be therapeutically useful in the treatment of those autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus, in which hyperactive B cell function is a characteristic feature.