Site-specific analysis of ribosomal 2'O-methylation by quantitative reverse transcription PCR under low deoxynucleotide triphosphate concentrations

Ribose 2'O-methylation (Nm, ribomethylation) is the most abundant RNA modification present in rRNA. It has been shown that alterations in ribosomal 2'O-methylation at individual Nm sites likely reflect regulated cellular processes. Although several analytical approaches for Nm detection and profiling have been developed, a simple and affordable method for the screening and measurement of individual Nm sites in large numbers of tissue samples is required to examine their potential for clinical translation. Here, we describe a new quantitative reverse transcription PCR-based method that can sensitively assess ribomethylation levels at specific rRNA sites at single-nucleotide resolution in low input amounts of total RNA.

The trend of percutaneous and open surgical procedures for peripheral arteriovenous malformations in the National Health Service England

INTRODUCTION

This study aimed to assess the trend of percutaneous and open surgical procedures for peripheral arteriovenous malformations (AVMs) performed in NHS hospitals in England between 2012 and 2018.

METHODS

Hospital Episode Statistics (HES) is a freely available data warehouse that represents the whole population of England served by the NHS. Data from the HES database was obtained and analysed for all hospital episodes between 2012 and 2018 for the total number and trend of 'primary diagnosis', and 'primary procedures and interventions' identified for peripheral AVMs.

RESULTS

Over the period studied, there was an increase in the total number of admissions for peripheral AVMs; total primary diagnosis increased from 2242 to 2857 per year. Open surgery remained more commonly performed than percutaneous procedures throughout the studied period. However, the overall percentage of primary procedures and interventions being percutaneous in this period increased from 29.8% to 41.0% per year. The increase in the number of percutaneous procedures per year seemed to occur in both children (from 43 to 124) and adults (from 408 to 492) over the course of the study period.

CONCLUSIONS

This study concluded that open surgery remained the most commonly performed primary procedure for peripheral AVMs, although there was an increasing trend for percutaneous procedures in NHS hospitals in England. The increase in the number and percentage of percutaneous procedures for peripheral AVMs was likely to have significant resource implications for the provision of care for patients with peripheral AVMs in NHS hospitals.

522 Early Follow-Up Quality of Life and Mental Health of Patients with Congenital Vascular Malformations Cared for in a Multi-Disciplinary Specialist Center

Aim

To evaluate the early follow-up quality of life (QoL), pain and mental health of patients with congenital vascular malformation (CVM) receiving care by a single multi-disciplinary specialist center

Method

This was a prospective observational study. All patients with CVM who received care (supportive treatment only, open surgery, targeted pharmacological therapy, embolosclerotherapy), and had follow-up, between February 1st 2018 and January 31st 2020 were included. The health-related QoL, pain, and mental health were assessed with validated questionnaires: SF-36, VAS-P and HADS. The CVM were categorized into types – low-flow (LFVM) and high-flow (HFVM), and anatomical locations. Paired t-test was used for all analyses. P<0.05 were considered significant.

Results

110 patients (85 LFVM and 25 HFVM) with a mean age of 36.9 years were included. Significant improvement was found in the bodily pain domain of SF-36 and VAS-P (both P = 0.01) in all patients. However, only patients with HFVM reported significant improvement in the bodily pain domain of SF-36 (P=0.002) and VAS-P (P = 0.02). Patients who received supportive treatment only reported significant improvement in mental health (P=0.004) and social functioning (P=0.03) domains of SF-36. Meanwhile, patients treated with embolo-sclerotherapy reported significant improvement only in VAS-P (P=0.02). Patients who received targeted pharmacological therapy reported no significant early changes.

Conclusions

The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.

O064 Early follow-up quality of life and mental health of patients with congenital vascular malformations cared for in a multi-disciplinary specialist center

Introduction

To evaluate the early follow-up quality of life (QoL), pain and mental health of patients with congenital vascular malformation (CVM) receiving care by a single multi-disciplinary specialist centre

Methods

All patients with CVM who received care (supportive treatment only, open surgery, targeted pharmacological therapy, embolosclerotherapy), and had follow-up, between 1 February 2018 and 31 January 2020 were included. The health-related QoL, pain, and mental health were assessed with validated questionnaires: SF-36, VAS-P and HADS. The CVM were categorized into types – low-flow (LFVM) and high-flow (HFVM), and anatomical locations. Paired t-test was used for all analyses. Differences were considered significant at P<0.05.

Results

110 patients (85 LFVM and 25 HFVM) with a mean age of 36.9 years were included. Significant improvement was found in the bodily pain domain of SF-36 and VAS-P (both P = 0.01) in all patients. However, only patients with HFVM reported significant improvement in the bodily pain domain of SF-36 (P=0.002) and VAS-P (P = 0.02). Patients who received supportive treatment only reported significant improvement in mental health (P=0.004) and social functioning (P=0.03) domains of SF-36. Meanwhile, patients treated with embolosclerotherapy reported significant improvement only in VAS-P (P=0.02). Patients who received targeted pharmacological therapy reported no significant early changes.

Conclusion

The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.

Take-home message

The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.

O47 Safe delivery of surgical tracheostomies in COVID-19 patients during the pandemic

Introduction

During the corona virus disease (COVID-19) pandemic, frontline units worldwide faced the challenging task of providing high-risk services (like surgical tracheostomy) while safe-guarding the very people performing the high risk procedures. The aim of our study was to assess the incidence of COVID-19 infection among staff involved in surgical tracheostomy on COVID-19 patients

Method

A surgical tracheostomy protocol and operation theatre modifications were put in place at our centre, dictated by local resources, staff availability and previous tracheostomy experience. Between 26/03/2020 and 27/05/2020, staff participating in 71 tracheostomy procedures were sent a questionnaire. The presence of COVID-19 symptoms (new onset continuous cough, fever, loss of taste and/or loss of smell) in tracheostomy staff and patient related data were analysed.

Result

Among the responders (72/122), compliance with personal prophylaxis equipment use was 100%. Eleven (15%,11/72) reported key COVID-19 symptoms and self-isolated. 10 had a COVID-19 swab test and three tested positive. One staff attended (1/72) hospital for symptomatic treatment, none required hospitalisation. 43/72 staff (60%) underwent a COVID-19 antibody test, 18.6% (8/43) were positive. Among the tracheostomised patients, the mean age was 58 years(29–78) and 65.5% were males. The median time from intubation to ST was 15 days (range 5–33, IQR = 9). There were no tracheostomy related deaths and overall mortality was 11%(6/55).

Conclusion

Safe delivery of tracheostomy during a pandemic like COVID-19 is possible with strict adherence to personnel protective equipment, surgical protocols and regulation of traffic flow in theatres to mitigate the potential transmission of COVID-19 among surgical staff.

Take-home Message

Compliance with PPE, adherence to tracheostomy protocol and local modifications can mitigate potential COVID-19 transmission among health care personnel.

O75: SINGLE CENTRE EXPERIENCE OF SIROLIMUS THERAPY IN HEAD AND NECK VASCULAR MALFORMATIONS

Introduction

To assess the efficacy and safety of Sirolimus in the treatment of low-flow head and neck (H&N) vascular malformations

Method

Patients who presented to our tertiary referral clinic were assessed for eligibility. Suitable patients were commenced on Sirolimus at 0.8 mg/m2, administered orally twice daily, which was approved by our trust Drug and Therapeutic Committee. Patients were reviewed on a monthly basis for a total of six months with an additional one-month review to check for effects upon ceasing treatment. Efficacy and safety were measured through functional and radiological response, laboratory investigations and quality of life questionnaire (36-Item Short Form Health Survey (SF-36), Hospital Anxiety and Depression Scale (HADS) and Visual Analogue Score for Pain (VAS-P)).

Result

Seven patients (mean age 39 years, range 23-65 years) were recruited. One patient did not complete treatment due to intolerable side effects. All patients had a partial response with no patients showing disease progression or complete response. All post-treatment MRI scans showed stable disease with five patients demonstrating a decrease in lesion volume. Five patients reported return of symptoms at one-month post review upon discontinuation of treatment. No statistical significance (P>0.05) in all eight domains of SF-36, HADS, VAS-P and radiological vascular lesion volume between pre- and post-treatment. Most common reported side effects were mouth ulcers (n=2) and metabolic/laboratory abnormality (n=2)

Conclusion

Sirolimus is an effective and safe treatment for patients with complicated low-flow H&N vascular malformations. This provides an alternative treatment where interventional therapy is considered to be limited or challenging.

Take-home message

Sirolimus is an effective and safe treatment option for patients with complicated low-flow head and neck vascular malformations where interventional therapy is limited or challenging.

130 Improving Documentation of Bowel Movement on Geriatric Wards

Introduction

Constipation is a widely prevalent issue in older adults that may result in complications such as urinary retention, delirium and bowel obstruction. Previous studies have indicated that while stool charts are well completed by nursing staff, they are infrequently monitored by doctors. This project aimed to improve the documentation of bowel movement by doctors on ward rounds to 85%, by the end of a 3-month period.

Methods

Formulation of the project was achieved using group work and a fishbone diagram which focussed on how doctors can improve on documenting bowel movements. Baseline data were collected from inpatient notes on weekdays over a three-week period on a geriatric ward in Northern General Hospital, Sheffield. Interventions of posters and stickers of the poo emoji were placed on walls and in inpatient notes respectively as a reminder. Post-intervention data were collected on weekdays over two weeks, and then repeated a month later to assess for a sustained change.

Results

The data on bowel activity documentation were collected from 28 patients. The baseline data showed that bowel activity was monitored daily on the ward 56.25% of the time. There was a significant increase in documentation of 85.75% following the interventions. The sustainability study showed that bowel activity was documented on the ward 59.09% of the time.

Conclusions

This study shows how a strong effect on behavioural change can be accomplished through simple interventions such as stickers and posters. As most wards currently still use paper notes, this is a generalisable model that other wards can trial. However, this study also shows the difficulty in maintaining behavioural change over extended periods of time. Further PDSA cycles should examine the reasons behind the difficulty sustaining the change and implement new changes that aim to overcome them.

AB1207 EFFECT ON DIET MODIFICATION ON GOUT AND METABOLIC SYNDROME RISK FACTORS

Background:

Gout is the most prevalent inflammatory arthritis globally. Despite treatment advances, the prevalence of gout has continued to increase over the last several decades. There has also been increasing evidence that gout has a strong association with the metabolic syndrome. This indicates that gout is likely both an inflammatory and a metabolic disease that has a significant effect on quality of life and healthcare costs. Although current recommendations support aggressive medical therapy for gout treatment, dietary counseling is less emphasized. We hypothesize that emphasis on this nonpharmacological therapy will likely improve management and the metabolic syndrome in gout patients.

Objectives:

To analyze the effectiveness of dietary counseling on gout management and risk factors for metabolic syndrome in gout patients at the Veteran’s Affairs Medical Center in Long Beach, CA (VALB).

Methods:

A retrospective cohort study was created from 2009-2016 involving Long Beach Veterans Affairs Hospital gout patients (n= 119) based on International Classification of Disease version 9 or 10. Patients were then stratified into two cohorts: received diet counseling (n=90) and no diet counseling (n=29). Data was reviewed for 24 months following initial gout diagnosis or intervention. Management was evaluated based on frequency of flares and related ED visits, change in creatinine clearance, serum uric acid levels (sUA), and changes to risk factors for metabolic syndrome including blood pressure, body mass index (BMI), cholesterol panel and hemoglobin A1c levels at six-month intervals.

Results:

Although patients in both cohorts were noted to have decreased number of gout attacks, patients who received diet counseling had a significant decrease in number of gout attacks by month 12 (0=0.004). In addition, after 6 months, patients who received diet counseling were more likely to have sUA at goal (sUA<6 for nontophaeous gout and sUA<5 for tophaceous gout) (p=0.003). These patients were also noted to have improved creatinine clearance (p=0.08) and increased HDL (p =0.08). In addition, patients with improved HDL and LDL values more likely to have improved sUA levels and decreased ED visits (R2=0.4, slope 0.14 and R2=0.4, slope 0.05, respectively) by month 6. Patients with improved hemoglobin A1c levels were also noted to have a significant outcome in lowering serum uric acid level at month 18 (R2=0.9, slope 2.6).

Conclusion:

Gout patients who receive diet counseling had lower rate of future attacks and better control of sUA. In addition, these gout patients were also noted to have improvement in some risk factors associated with the metabolic syndrome. Notably, patients who had better control of their hemoglobin A1c levels were able to have lower serum uric acid levels. This may imply that controlling diabetes in patients may also help improve gout management. Given the serious complications and increased cardiovascular risks that can be associated with metabolic syndrome, optimization of gout through a nonpharmacologic intervention such as diet counseling can enhance clinical outcomes and optimize healthcare resources.

References:

[1]Rai SK et al. The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study. BMJ. 2017;357:j1794.

[2]Álvarez-lario B, et al. Hyperuricemia and gout; the role of diet. Nutr Hosp. 2014;29(4):760-70.

Disclosure of Interests:

None declared

A paradigm shift in the provision of improved critical care in the emergency department

With Hong Kong's ageing population, advancement of medical technologies and hospital congestion, it is not uncommon for emergency physicians to encounter complicated critically ill patients in daily practice. It becomes a fundamental role of emergency physicians to initiate timely diagnostic and therapeutic interventions to save a patient's life and improve their prognosis. It is the reason a critical care service has been developed in emergency departments worldwide over the last decade. This article shares how emergency department intensivists can contribute to this novel model of care with some illustrative cases. Advanced airway and peri-intubation management, difficult mechanical ventilation, treatment of shock, circulatory arrest, and metabolic disturbances can be safely and efficiently handled in the current emergency department setting. Obstacles, barriers, and the road ahead will be discussed.

The innate immune system, toll-like receptors and dermal wound healing: A review

Wound healing is a complex physiological process comprised of discrete but inter-related and overlapping stages, requiring exact timing and regulation to successfully progress, yet occurs spontaneously in response to injury. It is characterised by four phases, coagulation, inflammation, proliferation and remodelling. Each phase is predominated by particular cell types, cytokines and chemokines. The innate immune system represents the first line of defence against invading microorganisms. It is entirely encoded with the genome, and comprised of a cellular response with specificity provided by pattern recognition receptors (PRRs) such as toll-like receptors (TLRs). TLRs are activated by exogenous microbial pathogen associated molecular patterns (PAMPs), initiating an immune response through the production of pro-inflammatory cytokines and further specialist immune cell recruitment. TLRs are also activated by endogenous molecular patterns termed damage associated molecular patterns (DAMPs). These ligands, usually shielded from the immune system, act as alarm signals alerting the immune system to damage and facilitate the normal wound healing process. TLRs are expressed by cells essential to wound healing such as keratinocytes and fibroblasts, however the specific role of TLRs in this process remains controversial. This article reviews the current knowledge on the potential role of TLRs in dermal wound healing where inflammation arising from pathogenic activation of these receptors appears to play a role in chronic ulceration associated with diabetes, scar hypertrophy and skin fibrosis.

Abstract S3-04: The change from brand-name to generic aromatase inhibitors and hormone therapy adherence for early stage breast cancer

Background: Non-adherence to adjuvant hormonal therapy is common and has been associated with increased copayment amount. We investigated the change in adherence patterns before and after the introduction of generic aromatase inhibitors in 2009.

Patients and Methods: Using de-identified, integrated pharmacy and medical claims data from OptumInsight, we identified women &gt;50 years old on hormonal therapy for early breast cancer with at least 2 mail order prescription refills between 1/1/07 and 12/31/11. We categorized hormonal therapy as tamoxifen (TAM), aromatase inhibitor (AI) brand and AI-generic. Variables that were evaluated included demographic and clinical information, household income, number of prescriptions, diagnostic codes, prescription refill dates, provider specialty, coverage type, deductible amount and co-payment amounts. Monthly copayment amount was categorized as &lt;$10, $10-$20, and ≥$20. Non-adherence was defined as a medication possession ratio &lt;80% of eligible days during the first year after initiation. We compared patients who completed their AI prior to July 2009 (pre-generic) to those who initiated after July 2009 (post-generic).

Results:We identified 3,351 subjects (1,658 pre-generic; 1,693 post-generic).In the pre-generic cohort, 28.5% took tam and 65.3% took AI-brand for at least 1 year. In the post-generic cohort, there was minimal change in TAM (26.5%); however, only 7.3% remained AI-brand while 67.3% became AI-generic (13.2% switched from brand to generic). Non-adherence increased from 32.7% with copayment &lt;$10/month compared to 44.4% with copayment &gt;$20/month (P&lt;0.0001). For TAM, 62% had a copay &lt;$10 while &lt;1% had a copay &gt;$20; however, for AI brand 75.5% had a copay &gt;$20. There was a non-significant increase in non-adherence of TAM and AI-brand over time. However, non-adherence to AI-brand was 40.3% and AI-generic was lower at 31.4% (P&lt;0.001). In an unadjusted model, AI-brand was associated with decreased adherence (OR = 0.66, P&lt;0.001) and AI-generic was associated with increased adherence ((OR 1.66, P&lt;0.001) compared to TAM. However, in a multivariate model controlling for copayment, only the association between increased adherence with AI-generic (OR 1.65, P&lt;0.001) remained significant. Adherence was also associated with middle-household income (OR 1.37, P&lt;0.01) and high-household income (OR 1.39, P = 0.03) compared to low income. Monthly copayment amount was inversely associated with adherence with $10-$20 (OR = 0.70; P&lt;0.001) and &gt;$20 (OR = 0.49; P&lt;0.001) compared to &lt;$10. In this cohort, adherence was not associated with race, insurance type, age or comorbidity.

Conclusions:We found that a higher prescription copayment amount was associated with non-adherence to AI. After controlling for copayment and time, adherence was similar between AI-brand and TAM, but adherence was significantly improved for AI-generic. In addition, other financial factors, such as copayment amount and income, were associated with hormone therapy adherence. Because hormone therapy non-adherence is associated with worse survival outcomes, future public policy efforts should be directed towards reducing financial constraints as a means of increasing the proper use of these life-saving medications.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S3-04.

Prevalence of cervical dystonia and spasmodic torticollis in the United States general population

PURPOSE

To examine the prevalence of cervical dystonia (CD) in the US population.

METHOD

A survey consisting of relevant demographic and CD-related questions was e-mailed to 2 million people selected from the Shopper's Voice database.

RESULTS

Across a census-weighted sample, 0.280% of 60,062 respondents (79% female, 92% Caucasian) reported a diagnosis of CD and 0.170% reported a diagnosis of ST, indicating possible prevalence of 0.390% of either/both diagnoses. Less than half (42.7%) of those who reported either diagnosis were receiving treatment.

CONCLUSIONS

CD is potentially under-diagnosed and under-treated; approaches to increase awareness of CD and its treatments are needed.

Comparison of botulinum toxin serotypes A and B for the treatment of cervical dystonia

OBJECTIVE

To directly compare two serotypes of botulinum toxin (BoNTA and BoNTB) in cervical dystonia (CD) using a randomized, double-blind, parallel-arm study design.

METHODS

Subjects with CD who had a previous response from BoNTA were randomly assigned to BoNTA or BoNTB and evaluated in a blinded fashion at baseline, 4 weeks, 8 weeks, and 2-week intervals thereafter until loss of 80% of clinical effect or completion of 20 weeks of observation. CD severity was measured with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), and adverse events were assessed by structured interview. Statistical analysis included Wilcoxon rank sum test, log rank tests, and Kaplan-Meier survival curves for duration of effect.

RESULTS

A total of 139 subjects (BoNTA, n = 74; BoNTB, n = 65) were randomized at 19 study sites. Improvement in TWSTRS score was found at 4 weeks after injection and did not differ between serotypes. Dysphagia and dry mouth were more frequent with BoNTB (dysphagia: BoNTA 19% vs BoNTB 48%, p = 0.0005; dry mouth (BoNTA 41% vs BoNTB 80%, p < 0.0001). In clinical responders, BoNT A had a modestly longer duration of benefit (BoNTA 14 weeks, BoNTB 12.1 weeks, p = 0.033).

CONCLUSION

Both serotypes of botulinum toxin (BoNTA and BoNTB) had equivalent benefit in subjects with cervical dystonia at 4 weeks. BoNTA had fewer adverse events and a marginally longer duration of effect in subjects showing a clinical response.

Coupled-wave analysis of apodized volume gratings

This work presents the use of longitudinal refractive index modulation (apodization) in photosensitive glass for improved sidelobe suppression in volume holographic optical elements. We develop a numerical model for both uniform and apodized volume holograms based on rigorous coupled-wave analysis. We validate the model by comparison with a transmissive 1.55- mum uniform volume grating in photothermorefractive glass. We then apply our numerical model to calculate the spectral response of apodized gratings. The numerical results demonstrate that apodization of the refractive index modulation envelope improves spectral selectivity and reduces first and second-order side-lobe peaks by up to 33 and 65 dB, respectively. We suggest a method for creating apodization in volume holograms with approximately Gaussian spatial refractive index profile.

Endothelial integrity and nitric oxide synthase sources are better maintained in saphenous vein harvested by a ‘no-touch’ technique

Background

The saphenous vein (SV) is a commonly used conduit in bypass procedures. Early graft occlusion rates are greater than 20 per cent in both infrainguinal vein grafts and coronary artery bypass grafts (CABGs). Contributing factors include adventitial and endothelial damage, which may reduce nitric oxide availability in grafts. Nitric oxide has important vasorelaxant and thromboresistant properties beneficial to graft patency. Conventionally, during SV harvest, the perivascular tissue is stripped and the graft distended. A ‘no-touch’ technique has been described in which the SV is harvested together with a cushion of surrounding tissue without vein distension. This study compared endothelial integrity and the potential role of nitric oxide synthase (NOS) in segments of SV harvested by the two techniques.

Methods

SV was harvested from ten patients undergoing CABG. Distal and proximal ends of the SV were harvested using the no-touch technique, while the middle portion was stripped of the adventitia and distended. Sections of SV were cut and endothelial integrity was assessed with CD31 immunohistochemistry and quantified by morphometric analysis. Putative NOS was identified by reduced nicotinamide adenine dinucleotide phosphate (NADPH)–diaphorase histochemistry and autoradiographic localization of [3H]l-NG-nitroarginine binding.

Results

More dense CD31 staining was seen on the luminal aspect and vasa vasorum of vessels harvested by the no-touch technique. Morphometric analysis revealed a significant reduction in luminal CD31 staining in conventional compared with no-touch grafts (P &lt; 0·05, Student's t test). NADPH staining was almost continuous on the luminal aspect, and was also present in the adventitia of no-touch vessels, compared with poor staining of conventionally harvested vessels. The pattern of NADPH staining corresponded to endothelial cells lining the vessel lumen as well as vasa vasorum and paravascular nerves in the adventitia. Autoradiographic analysis of specific [3H]nitroarginine binding also showed greater binding in the no-touch vessels.

Conclusion

Endothelial integrity is better maintained by the no-touch technique. NOS sources on the endothelium and adventitia are preserved, suggesting that nitric oxide availability is retained by these grafts. This technique may therefore lead to improved early patency rates of SV grafts in bypass surgery.

Daytime somnolence in patients with Parkinson's disease

We studied daytime sleepiness in 160 patients with Parkinson's disease and 40 normal subjects. We compared the prevalence of daytime sleepiness in patients who were taking levodopa alone, levodopa with bromocriptine, levodopa with ropinirole, and levodopa with pramipexole. We found that (1) all these anti-Parkinson drugs can cause daytime sleepiness; (2) 'dozing off' correlated highly with 'falling asleep without warning'; (3) after statistical adjustment for confounding variables there was no significant difference among the risks for any of these anti-Parkinson drugs causing daytime somnolence.

Expression of glial cell line-derived neurotrophic factor and its mRNA in the nigrostriatal pathway following MPTP treatment

Striatal glial cell line-derived neurotrophic factor (GDNF) mRNA levels in both young (2-month old) and old (11-month old) C57BL/6J mice were quantified at 3, 7 and 21 days following 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) treatment. MPTP did not alter the expression of GDNF mRNA in these animals. Immunoreactive staining of GDNF in the substantia nigra and the striatum was also unchanged. In conclusion, MPTP-induced dopaminergic neurotoxicity does not elicit any changes in the expression of endogenous GDNF or its mRNA in the adult mouse brain.

Effect of pretreatment of germanium-132 on Na(+)-K(+)-ATPase and galactose cataracts

PURPOSE

Recently, we reported that topical administration of 2-carboxyethyl germanium sesquioxide (Ge-132) concurrently with 50% galactose feeding delayed the establishment of mature cataracts and reduced advance glycation product. This study was to determine the effect of pretreatment of Ge-132 on galactose associated morphological changes and Na(+)-K(+)-ATPase activity.

METHODS

Young Sprague Dawley rats received topical eye drops four times a day of either saline or Ge-132 seven days prior to the 50% galactose diet and during galactose feeding. At desired intervals the lenses were extracted, photographed and processed for either light microscopy, scanning electron microscopy or the determination of Na(+)-K(+)-ATPase activity.

RESULTS

In Ge-132 pretreated lenses as compared to saline pretreated lenses the following results were observed: (a) the galactose-induced morphological alterations in the majority of lenses were delayed and (b) Na(+)-K(+)-ATPase activity was protected.

CONCLUSIONS

Our previous and current studies show that in addition to osmotic stress post-translational protein modification, such as glycation, including enzymes may play a role in initiating changes that lead to cataract development. The inhibition of protein glycation by antiglycating compounds, such as Ge-132, delays sugar cataract formation. Currently, we are investigating the status of protein glycation and advanced glycation end products following pretreatment with Ge-132 and the role of Ge-132 on the activities of enzymes such as aldose reductase and Na(+)-K(+)-ATPase.

Lamotrigine trial in idiopathic parkinsonism: a double-blind, placebo-controlled, crossover study

Increased glutamatergic transmission in the basal ganglia is implicated in the pathophysiology of idiopathic parkinsonism (IP). We investigated the effects of lamotrigine (LTG), a glutamate-release inhibitor, in the symptomatic treatment of IP in two double-blind, placebo-controlled studies. Single doses of L-dopa/carbidopa (equal to 50% of the usual morning dose) were administered together with either LTG (100, 200, or 400 mg) or two random placebo doses in 14 patients with IP. The patients were assessed using the Modified Columbia Rating Scale (MCRS) and the Purdue Pegboard Test (PPBT) at multiple intervals over 8 hours. There were no significant differences between the placebo doses and the three doses of LTG on the MCRS and PPBT scores. In a 3-month study, 12 patients took LTG titrated up to 400 mg or placebo with their antiparkinsonian medication for 3 months and were then crossed over. Nine of 12 patients did not complete the study because of dyskinesia (n = 2), hallucinations (n = 3), and deterioration of parkinsonian symptoms (n = 4) on LTG. There was no significant difference between placebo and LTG on the MCRS and PPBT in the three patients who completed the study. The results failed to demonstrate any symptomatically beneficial effects of LTG in IP.

Respiratory function of velopharyngeal constrictor muscles during wakefulness in normal adults

The levator veli palatini (LVP) and the superior pharyngeal constrictor (SPC) influence velopharyngeal patency and soft palate position, but their behavior during respiration is incompletely characterized. To further clarify their respiratory function, we recorded electromyographic activity (EMG) in the LVP and the SPC in awake normal subjects breathing orally. EMG data were obtained in six subjects for the LVP and in nine subjects for the SPC. EMG activity and timing and ventilation were measured during isocapnic hypoxia and hyperoxic hypercapnia. Phasic EMG activity was inconsistently present during unstimulated oral breathing. Timing of EMG phasic activity was variable for both muscles. Peak LVP activity was mainly or exclusively expiratory in three of six subjects. Peak SPC activity was mainly or exclusively expiratory in five of nine subjects. With chemostimulation, recruitment of phasic activity was observed in the LVP and in four of six subjects and in the SPC in five of nine subjects. Tonic activity increased in four of six subjects for the LVP and in three of nine subjects for the SPC. However, the response was alinear, and intersubject as well as breath-to-breath variability was substantial. In conclusion, LVP and SPC are characterized by the higher inter- and intrasubject variability of EMG activity, timing of activation, and response to chemostimulation.

Effect of germanium-132 on galactose cataracts and glycation in rats

Germanium compounds have been shown to be effective in preventing the formation of advanced glycation end-products and for reversible solubilization of glycated proteins. As protein glycation has been proposed to play a role in lens opacification, we initiated studies to evaluate the effects of 2-carboxyethyl germanium sesquioxide (germanium compound 132 or Ge-132) on galactose-induced cataractogenesis. For this study young Sprague-Dawley rats were fed a 50% galactose diet. One group of rats received topical saline and another group was administered Ge-132 in saline four times a day. The lenses were periodically examined with an ophthalmoscope and at desired intervals processed for light and scanning electron microscopy. Our observations, beginning at 3 days and continuing to 21 days of galactose feeding, exhibited the characteristic galactose-induced morphological alterations, which include the formation of vacuoles, cysts, membrane disruption and swelling of fibers and epithelial cells as well as disorganization of the bow in lenses of rats in both groups. However, in the majority of rats administered Ge-132 these alterations were delayed as compared to the lenses of rats administered saline. Our findings show that, although the initiation, progression and pattern of lens opacification in rats receiving saline and Ge-132 were similar, in the majority of lenses the progression and establishment of mature cataracts in the Ge-132 group of rats were delayed. Analysis of the water-soluble and water-insoluble lens-protein fractions for glycated proteins showed increased levels of the Amadori products and advanced glycation related fluorescent products in galactosemic rats treated with saline eye drops. In rats receiving the topical Ge-132 treatment the levels of these glycation products were substantially reduced to levels lower than control values. Prevention of glycation seems to be a mechanism by which cataract progression is delayed.

Aldose reductase inhibitors and galactose toxicity in neonatal and maternal rat lenses

We reported that in utero galactose-induced cataracts could be inhibited if aldose reductase inhibitors (ARIs) were included in the galactose diet of pregnant rats. These studies involved morphological and cytochemical approaches. We undertook this investigation to evaluate the effects of ARIs in preventing the formation, accumulation and depletion of dulcitol in lenses of in utero galactose exposed neonates and in mothers during and following pregnancy. Sprague Dawley rats were fed Purina Rat Chow with 50% galactose either with or without 15mg Sorbinil or 1mg Eisai compound E-0722/day/Kg body weight during and following pregnancy. The lenses of neonates and mothers were processed to determine dulcitol concentrations. At parturition there was a significant amount of dulcitol in the lenses of pups and their mothers, which reduced rapidly in the lenses of pups regardless of the diet fed to the nursing mother. While galactose had a cross-placental but not a milk-mediated effect, the ARIs had both cross-placental and milk-mediated effects on dulcitol accumulation and depletion, respectively. The galactose feeding of mothers post-parturition maintained the high lenticular dulcitol concentration and the absence of galactose led to a reduction in lenticular dulcitol. The correlation between dulcitol accumulation and cataract development is discussed.

Transient elevation of aldose reductase mRNA in lens of rats developing galactose cataracts

Aldose reductase (AR), a major enzyme in the polyol pathway, is thought to be responsible for accumulation of polyols in lenses exposed to high doses of galactose or glucose, and it may be linked to some of the complications found in diabetes. In this report we examined the level of expression of AR mRNA in lens epithelia undergoing development of galactose cataracts in vivo. The AR mRNA was quantitated by Northern blot hybridization with a [35S]-RNA transcript from a previously described AR cDNA clone. This was done on normal lens epithelia and on epithelia from lens of rats fed a diet of Purina Chow containing 50% galactose for periods of from 6 hr to 20 days. We found AR mRNA to elevate to about 5-fold the control levels by 12-24 hr on galactose, then decrease to the control levels by day 4. The increase in AR mRNA appears to be transitory. The high abundance in AR mRNA by 24 hr on galactose was confirmed by in situ hybridization. At later periods, from 8 to 20 days on galactose, a slow increase in AR mRNA took effect, as we have previously reported. Changes in the levels of galactose and dulcitol between 0 and 96 hr were also quantitated by gas chromatography, showing that there was a significant increase in both galactose and dulcitol occurring throughout the experimental period.(ABSTRACT TRUNCATED AT 250 WORDS)

Reversal of the limited proteolysis of MP26 during the reversal and prevention of the galactose cataract in rat lenses

The reversal and prevention of the galactose-induced cataract in rats were employed to study their effects on the acceleration of the limited proteolysis of MP26 into MP23-24 previously observed in cataractous lenses of galactose-fed animals. Lenses of rats on a cataract reversal-diet demonstrated the reversal of MP23-24 and MP26 levels to control levels in the clearing cortical areas but not in remaining cataractous nuclear areas. Acceleration of the limited proteolysis of MP26 was observed in the nucleus but not the cortex in the clear lenses of animals on a cataract prevention-diet. The results demonstrated that the limited proteolysis of MP26 may form part of a gradual aging process that although not directly (causally) related to cataractogenesis may at least be accelerated by cataractogenic agents or conditions.

A case of rabies in North America

A 25-year-old man developed classical hydrophobic rabies 3 months after being bitten on the face. We present his involuntary movements on videotape and discuss the clinical and epidemiological features of rabies. Though rabies is seen in tropical countries commonly and in North America occasionally, recording of the clinical features is rare.

Aldose reductase inhibitors and prevention of galactose cataracts in rats

Our previous studies have shown that the aldose reductase inhibitor (ARI), sorbinil, prevents galactose-induced alterations and cataracts in rat lenses. We have now used sorbinil as well as another ARI, Eisai compound E-0722, to determine their potency in inhibiting aldose reductase- and galactose-induced alterations in lens morphology and Na+-K+-ATPase activity. Young Sprague Dawley rats were fed Purina Rat Chow plus 50% galactose, with or without 15 mg sorbinil, 0.15, 0.5 or 1.0 mg of E-0722/kg body weight per day. Controls were given Purina Rat Chow with or without ARIs. Lenses were studied for up to 60 days following the initiation of the diet using morphological, cytochemical and biochemical approaches to assess any alterations in the lens. While galactose-induced damage and cataracts were delayed by low doses (0.15 mg and 0.5 mg) of E-0722, they were completely prevented by the administration of 15 mg of sorbinil or 1 mg of E-0722/kg body weight per day. This study further showed that just 1 mg of E-0722 was more effective in preventing cataracts than 15 mg sorbinil. Thus it appeared that E-0722 was a more potent inhibitor of aldose reductase than sorbinil.

Pharmacokinetics and oral bioavailability of scopolamine in normal subjects

The pharmacokinetics and bioavailability of scopolamine were evaluated in six healthy male subjects receiving 0.4 mg of the drug by either oral or intravenous administration. Plasma and urine samples were analyzed using a radioreceptor binding assay. After iv administration, scopolamine concentrations in the plasma declined in a biexponential fashion, with a rapid distribution phase and a comparatively slow elimination phase. Mean and SE values for volume of distribution, systemic clearance, and renal clearance were 1.4 +/- 0.3 liters/kg, 65.3 +/- 5.2 liters/hr, and 4.2 +/- 1.4 liters/hr, respectively. Mean peak plasma concentrations were 2909.8 +/- 240.9 pg/ml following iv administration and 528.6 +/- 109.4 pg/ml following oral administration. Elimination half-life of the drug was 4.5 +/- 1.7 hr. Bioavailability of the oral dose was variable among subjects, ranging between 10.7 and 48.2%. The variability in absorption and poor bioavailability of oral scopolamine indicate that this route of administration may not be reliable and effective.

Nutritional and biochemical effects of nutrition programs in the elderly

The nutritional status of this population of elderly was generally quite good. However, these individuals were interested in the program and able to participate in the program. As age in years increases and the aging process continues, all the factors mentioned earlier may combine to contribute to less frequent or nonattendance and perhaps to deterioration of nutritional status. For example, an 80-year-old may be able to drive to a site, but a 90-year-old may not. Also, the older elderly may be more likely to live alone, with all the disincentives to eat well that living alone may be associated with at any age. Therefore, one cannot assume that all of the old elderly are as adequately nourished as this group. The less well nourished may be those not participating in programs for the elderly. Finally, the data presented here illustrate the need to learn more about the differences between middle-aged elderly and the old elderly, and to better differentiate pathologic from normal aging processes.

Ultrastructural cytochemistry: effect of Sorbinil on arylsulfatases in cataractous lenses

We have demonstrated an increase in activity of arylsulfatase A and B during galactose induced cataract development in rats. Our recent investigation shows that acid phosphatase activity, which increases substantially during galactose cataract development in rats, could be contained to near normal level if Sorbinil, an aldose reductase inhibitor, was fed along with galactose to the rat. We have observed that the activity of other lysosomal enzymes, arylsulfatase A and/or B, also increases during galactose cataractogenesis. In the present report, we provide information with regards to the effect of Sorbinil on the activity of these enzymes during cataractogenesis. A modified Hopsu-Havu and Helminen method (1974) with p-nitrocatecholsulfate as substrate was used for localization of both arylsulfatase A and B; and the method of Hara et al. (1979) was utilized to obtain quantitative data on the level of arylsulfatase A and B activity. Ultrastructural cytochemistry shows that arylsulfatase activity in all lenses was primarily localized in epithelial cells in lysosomes with very little or no activity in cortical fibers. The number of arylsulfatase positive lysosomes and the activity level of these enzymes increased with the progression of cataract development. Galactose induced damage to lens morphology and increase in activity of arylsulfatase A and B was inhibited by inclusion of 50mg/Kg (diet) Sorbinil in the galactose containing cataractogenic diet. However, Sorbinil had no significant effect on the enzyme activity following the establishment of mature cataracts.

Effects of intracellular calcium on lens membrane permeability

The present investigation was designed to assess whether lens membrane permeability is affected by changes in levels of intracellular calcium. Lanthanum, an inhibitor of Ca-ATPase, affected an increase in the concentration of intracellular calcium (Cai) measured in cortical fiber cells. Preculture of lenses in lanthanum (1.0mM) caused an accumulation of 36Cl during subsequent culture at a rate three-fold higher than control lenses. Changes in calcium levels, however, were not responsible for the observed flux changes because a 40mV depolarization was observed to occur prior to a significant increase in calcium levels. The non-specific effects of lanthanum and other potential inhibitors of calcium transport were avoided by preculturing lenses in an ion-HEPES medium containing 20mM calcium chloride. In lenses with a six-fold increase in calcium levels there resulted only a 10% increase in 36Cl uptake over a 3 hr period. 86Rb efflux was also measured and the rate constant was unchanged compared to control lenses. Calcium accumulation did lead to a small (8mV) depolarization which may account for the small increase in chloride accumulation. By light microscopy, morphology of cortical lens fibers and the epithelium appeared unchanged in the calcium-loaded lens. The results provide little evidence that an increase in Cai leads to acute changes in lens membrane permeability.

Acid phosphatase II. Cytochemical localization in lenses of normal and galactose-fed rats

Previous cytochemical and biochemical studies have shown an increase in the activity of acid phosphatase and arylsulfatase during the induction of galactose cataracts in rat lenses. It was postulated that these enzymes may be involved in lens fiber degradation observed during cataractogenesis, however, the role of these enzymes in the repair process was not ruled out. The present investigation has evaluated the level of acid phosphatase activity in lenses in which the induction of opacity is inhibited with the aldose reductase inhibitor sorbinil and during the recovery of galactose induced opacity. Sprague-Dawley rats received 50% galactose diet, or galactose diet with sorbinil, or laboratory chow diet. Following 20 days on this diet all rats received lab chow plus 50 mg kg-1 sorbinil (recovery diet). The lenses were removed at desired intervals following the initiation of the above three diets and following the transfer of animals to the recovery diet. Cytochemical localization and biochemical quantitation of acid phosphatase activity were performed with methods previously reported. Most of the enzyme activity was localized within the epithelial cells and superficial cortical fibers. In the epithelial cell layer, the enzyme activity was primarily localized in lysosomes and at extracellular sites near the epithelial cell membrane which abut each other and cortical fibers. In cortical fibers the enzyme activity was observed at various extracellular sites between the cell membranes of neighboring fibers. The effect of sorbinil, if any, and the possible role of acid hydrolases in the repair process during cataract reversal is discussed.

Acid phosphatase. I. Cytochemical localization in lenses of normal and galactose-fed rats

In the present investigation we have examined the presence, distribution and probable role of acid phosphatase in lenses of normal and galactose-fed rats. Acid phosphatase was localized in lenses using two separate cytochemical procedures (Gomori and Barka-Anderson methods) and examined at the ultrastructural level. Both procedures, in general, provided similar sites of acid phosphatase activity, although with the Barka-Anderson method finer and larger amounts of well-defined reaction product were observable at the site of reaction. The reaction product was observed in lenses of both rats fed on regular laboratory chow and galactose-fed rats. The intracellular location of the reaction of this enzyme was primarily in lysosomes and occasionally in the endoplasmic reticulum cisternae. At the extracellular sites, it was near the epithelial cell membranes which abut each other and cortical fibers. However, in the cortical fibers the extracellular localization was at various sites on the entire intercellular space between neighboring fibers. The possible role of hydrolases in the lens tissue is discussed.

Arylsulfatase-cytochemical localization in lenses of normal and galactose-fed rats

Our laboratory is involved in studying the mechanism of repair in the ocular lens. As lysosomal enzymes have been shown to play an important role in tissue repair, we have been investigating the status of lysosomal enzymes, such as acid phosphatase and arylsulfatases, in the normal and injured lens. In the present investigation, we have examined the presence, distribution, and possible role of arylsulfatases (E.C. 3.1.6.1) in lenses of normal and galactose-fed rats. Arylsulfatases were localized in lenses using the cytochemical procedure described by Hopsu-Havu and Helminen (1974) using p-nitrocatechol sulfate as a substrate and then examined at the ultrastructural level. The reaction product resulting from arylsulfatase activity was mainly localized in the epithelial cells with very little activity in the cortical fibers. The intracellular activity was confined to lysosomes. Some extracellular activity was visible in the intercellular regions in both the epithelium and superficial cortex. With the progression of galactose-induced lesion in the epithelium the number of lysosomes exhibiting enzyme reaction product was found to have increased, and the lysosomes closely abutted the capsule. The biochemical assay indicated a considerable increase in the activity of arylsulfatases with the continuation of a galactose diet. The possible role of arylsulfatases in the normal and cataractous lens is discussed.