Chlorhexidine gluconate-coated gel pad dressings for prevention of central venous catheter-related bloodstream infections in patients with hematologic diseases or autologous stem cell transplantation: A registry-based matched-pair analysis

OBJECTIVES

Chlorhexidine gluconate (CHG)-coated gel pad dressings for central venous catheter (CVC) may prevent CVC-related bloodstream infections (CRBSI). However, real-world data showing beneficial effects in patients with hematologic malignancies are scarce.

METHODS

In a matched-pair analysis with data from a multicenter CVC registry, non-tunneled jugular and subclavian vein CVC in adults with hematologic malignancies or germ cell tumors (including patients receiving autologous hematopoietic stem cell transplantation [ASCT]) with CHG were compared with non-CHG dressings. The primary endpoint was definite CRBSI rate within 14 days (dCRBSI14) of CVC insertion; secondary endpoints were combined rate of definite or probable CRBSI within 14 days (dpCRBSI14), overall (dpCRBSI), and CRBSI incidences of all estimates.

RESULTS

In total, 2070 CVCs were assessed. There was no statistically significant difference in dCRBSI14 (2.3% vs. 3.5%) between patients with and without CHG gel dressings. Likewise, with regards to dpCRBSI14 (6.2% vs. 6.3%) and the overall dpCRBSI rate (9.2% vs. 10.5%), no significant difference was detected. Furthermore, dCRBSI14 incidence (2.0 vs. 3.2/1000 CVC days), dpCRBSI14 incidence (5.4 vs. 5.6/1000 CVC days), and overall CRBSI incidence (5.5 vs. 6.0/1000 CVC days) showed no significant differences.

CONCLUSIONS

CRBSI rates were not reduced by the use of CHG gel dressings in patients with hematologic malignancies and/or ASCT.

Impact of the insertion site of central venous catheters on central venous catheter-related bloodstream infections in patients with cancer: results from a large prospective registry

PURPOSE

Overall, insertion of central venous catheter (CVC) into femoral veins (FV) has been shown to be associated with a higher risk of infection compared with subclavian and internal jugular (IJV/SCV) CVC, but no data are available on the impact of the FV insertion site on the CVC-related bloodstream infections (CRBSI) risk in patients with cancer. The objective of the study is to compare CRBSI rates and incidences of FV with those of internal jugular and subclavian vein (IJV/SCV CVC) as observed in the prospective SECRECY registry.

METHODS

SECRECY is an ongoing observational, prospective, clinical CRBSI registry active in six departments of hematology/oncology in Germany. Each case of FV CVC was matched at a ratio of 1:1 to a case with IJV/SCV CVC. The propensity score was estimated using a multivariable logistic regression model adjusting for age, sex, cancer type, and duration of indwelling catheter.

RESULTS

Of 4268 CVCs included in this analysis, 52 (1.2%) were inserted into the FV and 4216 (98.8%) into the IJV/SCV. 52 cases of FV CVC were matched with 52 IJV/SCV CVC. There was no significant difference in the CRBSI rate (3.8% vs. 9.6%), the CRBSI incidence (5.7 vs. 14.2/1000 CVC days), and the median CVC time (5.5 vs. 5 days) between the FV and the IJV/SCV group.

CONCLUSION

Based on this data, inserting FV CVCs in patients with cancer does, at least in the short-term, not appear to be associated with an increased risk of CRBSI as compared to IJV/SCV CVC.

Aids for color vision deficiency: introduction to the feature issue

Approximately 8% of Caucasian males and 0.5% of females have congenital red-green color vision deficiencies (CVD), and a number of eye diseases are accompanied by acquired CVD. This feature issue includes ten contributions regarding existing and proposed algorithms and devices intended to help CVD subjects compensate for their color deficiencies. It also addresses limitations in the effectiveness of CVD aids for subjects with different types and degrees of color vision deficiency.

The role of pericytes in cardiac ageing and disease

Introduction

Cardiac disease induces remodelling which can include fibrosis, cardiomyocyte hypertrophy, cardiac dilation, and finally can lead to heart failure. Age is one of the main risk factors of cardiovascular disease and induces heart remodelling, in particular, it has profound effects on the microcirculation. Pericytes are microvascular mural cells involved in the maintenance of stability and homeostasis of the vascular network. Although the phenotypes that arise from cardiac remodelling have been well studied in cardiomyocytes, endothelial cells and fibroblasts, the effect of aging on pericytes remain largely unknown.

Purpose

The purpose of this study is to characterise pericyte responses to cardiac ageing and disease in order to determine the therapeutic potential of these mural cells to reverse, or at least reduce, structural remodelling.

Methods

We have studied 12-week-old and 18-month-old mice. We have performed histological analysis and single-nucleus-RNA-sequencing (snRNAseq). For our in vitro experiments we have used primary human pericytes.

Results

Age affects the structure of the microcirculation in the heart. Pericyte coverage is reduced and capillary diameter is increased. Gene ontology analysis of differentially expressed genes in pericytes revealed an upregulation of genes related to filopodia and actin cytoskeleton, while a reduction of genes related to focal adhesion in the pericytes of the aged heart. Interestingly, we detected a downregulation of Regulator of G-protein signalling 5 (RGS5), a repressor of GPCRs signalling. RGS5 knockdown induces a contractile, pro-inflammatory and pro-fibrotic gene expression profile reducing pericytes proliferation and migration. Mechanistically, we show that RGS5 post-transcriptionally regulates PDGFRβ, a crucial tyrosine kinase receptor for pericyte-endothelial cell interaction. RGS5 knockdown reduces the expression of the receptor at the protein level, but not at the gene expression level and furthermore reduces the phosphorylation of AKT, a downstream signal of PDGFRβ activity. Furthermore, we have identified that T-Box Transcription Factor 20 (Tbx20), a cardiogenic transcription factor, is enriched in aged pericytes. Silencing and upregulation studies have revealed that Tbx20 is a repressor of PDGFRB, the gene that encodes for PDGFRβ, and that it controls pericyte adhesion.

Conclusions

Together, these observations have identified RGS5 and Tbx20 as crucial key players maintaining pericyte function in the aged heart. We propose that RGS5 and Tbx20 regulate pericyte function by controlling PDGFRβ signalling and cellular proliferation, adhesion and migration. Given the importance of pericytes in keeping vessel homeostasis, maintaining or recovering pericyte function in context of cardiac stress would be a potential approach to reduce the malignant effects of cardiac remodelling in the aged heart.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): SFB1366 (DFG)

Effects of color-enhancing glasses on color vision in congenital red-green color deficiencies

As commercially available glasses for color vision deficiency (CVD) are classified as low risk, they are not subject to stringent marketing regulations. We investigate how EnChroma and VINO glasses affect performance on the Colour Assessment and Diagnosis (CAD) test in individuals with CVD. Data were obtained from 51 individuals with red-green CVD. Blood or saliva samples were collected to examine the structure of the OPN1LW/OPN1MW array. Individuals completed the CAD test twice without glasses and once with each pair of glasses. Although there was a statistically significant effect of both glasses, only that of VINO could be considered functionally meaningful.

Targeting LAG-3 and PD-1 to Enhance T Cell Activation by Antigen-Presenting Cells

Immune checkpoint inhibition has been shown to successfully reactivate endogenous T cell responses directed against tumor-associated antigens, resulting in significantly prolonged overall survival in patients with various tumor entities. For malignancies with low endogenous immune responses, this approach has not shown a clear clinical benefit so far. Therapeutic vaccination, particularly dendritic cell (DC) vaccination, is a strategy to induce T cell responses. Interaction of DCs and T cells is dependent on receptor-ligand interactions of various immune checkpoints. In this study, we analyzed the influence of blocking antibodies targeting programmed cell death protein 1 (PD-1), HVEM, CD244, TIM-3, and lymphocyte activation gene 3 (LAG-3) on the proliferation and cytokine secretion of T cells after stimulation with autologous TLR-matured DCs. In this context, we found that LAG-3 blockade resulted in superior T cell activation compared to inhibition of other pathways, including PD-1/PD-L1. This result was consistent across different methods to measure T cell stimulation (proliferation, IFN-γ secretion), various stimulatory antigens (viral and bacterial peptide pool, specific viral antigen, specific tumor antigen), and seen for both CD4⁺ and CD8⁺ T cells. Only under conditions with a weak antigenic stimulus, particularly when combining antigen presentation by peripheral blood mononuclear cells with low concentrations of peptides, we observed the highest T cell stimulation with dual blockade of LAG-3 and PD-1 blockade. We conclude that priming of novel immune responses can be strongly enhanced by blockade of LAG-3 or dual blockade of LAG-3 and PD-1, depending on the strength of the antigenic stimulus.

Photopigment basis for dichromatic color vision in the horse

Horses, like other ungulates, are active in the day, at dusk, dawn, and night; and, they have eyes designed to have both high sensitivity for vision in dim light and good visual acuity under higher light levels (Walls, 1942). Typically, daytime activity is associated with the presence of multiple cone classes and color-vision capacity (Jacobs, 1993). Previous studies in other ungulates, such as pigs, goats, cows, sheep and deer, have shown that they have two spectrally different cone types, and hence, at least the photopigment basis for dichromatic color vision (Neitz & Jacobs, 1989; Jacobs, Deegan II, Neitz, Murphy, Miller, & Marchinton, 1994; Jacobs, Deegan II, & Neitz, 1998). Here, electroretinogram flicker photometry was used to measure the spectral sensitivities of the cones in the domestic horse (Equus caballus). Two distinct spectral mechanisms were identified and are consistent with the presence of a short-wavelength-sensitive (S) and a middle-to-long-wavelength-sensitive (M/L) cone. The spectral sensitivity of the S cone was estimated to have a peak of 428 nm, while the M/L cone had a peak of 539 nm. These two cone types would provide the basis for dichromatic color vision consistent with recent results from behavioral testing of horses (Macuda & Timney, 1999; Macuda & Timney, 2000; Timney & Macuda, 2001). The spectral peak of the M/L cone photopigment measured here, in vivo, is similar to that obtained when the gene was sequenced, cloned, and expressed in vitro (Yokoyama & Radlwimmer, 1999). Of the ungulates that have been studied to date, all have the photopigment basis for dichromatic color vision; however, they differ considerably from one another in the spectral tuning of their cone pigments. These differences may represent adaptations to the different visual requirements of different species.

Local cellular sources of apolipoprotein E in the human retina and retinal pigmented epithelium: implications for the process of drusen formation

PURPOSE

The inheritance of specific apolipoprotein E allelles has been linked to atherosclerosis, Alzheimer disease, and, most recently, to the incidence of age-related macular degeneration. Apolipoprotein E is a common component of the extracellular plaques and deposits characteristic of these disorders, including drusen, which are a hallmark of age-related macular degeneration. Accordingly, we assessed the potential biosynthetic contribution of local ocular cell types to the apolipoprotein E found in drusen.

METHODS

We measured apolipoprotein E mRNA levels in human donor tissues using a quantitative assay of apolipoprotein E transcription, and we localized apolipoprotein E protein to specific cell types and compartments in the neural retina, retinal pigmented epithelium, and choroid using laser scanning confocal immunofluorescence microscopy.

RESULTS

Apolipoprotein E immunoreactivity is associated with photoreceptor outer segments, the retinal ganglion cell layer, the retinal pigmented epithelium basal cytoplasm and basal lamina, and with both collagenous layers of Bruch membrane. Apolipoprotein E appears to be a ubiquitous component of drusen, irrespective of clinical phenotype. It also accumulates in the cytoplasm of a subpopulation of retinal pigmented epithelial cells, many of which overlie or flank drusen. Mean levels of apolipoprotein E mRNA in the adult human retina are 45% and 150% of the levels measured in liver and adult brain, the two most abundant biosynthetic sources of apolipoprotein E. Apolipoprotein E mRNA levels are highest in the inner retina, and lowest in the outer retina where photoreceptors predominate. Significant levels of apolipoprotein E mRNA are also present in the retinal pigmented epithelium/choroid complex and in cultured human retinal pigmented epithelial cells.

CONCLUSIONS

Apolipoprotein E protein is strategically located at the same anatomic locus where drusen are situated, and the retinal pigmented epithelium is the most likely local biosynthetic source of apolipoprotein E at that location. Age-related alteration of lipoprotein biosynthesis and/or processing at the level of the retinal pigmented epithelium and/or Bruch membrane may be a significant contributing factor in drusen formation and age-related macular degeneration pathogenesis.

The uncommon retina of the common house mouse

Unlike most mammals, most cones in house mouse retina express two opsins, one sensitive to UV-light, and another sensitive to middle-wavelengths. Is the mouse unique, having a single cone type that normally expresses two opsins? Or is the mouse a typical mammal having two cone types, but a species wide mutation results in co-expression of two opsins?

Differential recovery of retinal function after mitochondrial inhibition by methanol intoxication

PURPOSE

The authors' laboratory has previously documented formate-induced retinal toxicity in a rodent model of methanol intoxication. These studies determined functional, bioenergetic, and structural recovery of the retina after methanol intoxication.

METHODS

Rats were intoxicated with methanol, and retinal function was assessed by electroretinography 72 hours after the initial dose of methanol and after a 72-hour recovery period. Retinal energy metabolites, glutathione (GSH) concentrations, and histology were determined at the same time points.

RESULTS

Both rod-dominated and UV-cone-mediated electroretinogram responses were profoundly attenuated in methanol-intoxicated rats. In rats allowed to recover from methanol intoxication, there was significant, although incomplete, recovery of rod-dominated retinal function. However, there was no demonstrable improvement in UV-cone-mediated responses. Retinal adenosine triphosphate (ATP), adenosine diphosphate (ADP), and GSH concentrations were significantly reduced after intoxication. Although retinal energy metabolites returned to control values after the recovery period, retinal GSH remained significantly depleted. Histopathologic changes were apparent in the photoreceptors after methanol intoxication, with evidence of inner segment swelling and mitochondrial disruption. In animals allowed to recover from methanol intoxication, there was no evidence of histopathology at the light microscopic level; however, ultrastructural studies revealed subtle photoreceptor mitochondrial alterations.

CONCLUSIONS

These findings support the hypothesis that formate inhibits retinal mitochondrial function and increases oxidative stress. They also provide evidence for a differential sensitivity of photoreceptors to the cytotoxic actions of formic acid, with a partial recovery of rod-dominated responses and no recovery of UV-cone-mediated responses.

Molecular genetics of color vision and color vision defects

Color is an extremely important component of the information that we gather with our eyes. Most of us use color so automatically that we fail to appreciate how important it is in our daily activities. It serves as a nonlinguistic code that gives us instant information about the world around us. From observing color, for example, we can find the bee sting on an infant's arm even before it begins to swell by looking for the little spot where the infant's skin is red. We know when fruit is ripe; the ripe banana is yellow not green. We know when meat is cooked because it is no longer red. When watching a football game, we can instantly keep track of the players on opposing teams from the colors of their uniforms. Using color, we know from a distance which car is ours in the parking lot--it is the blue one--and whether we will need to stop at the distant traffic light, even at night, when we cannot see the relative positions of red and green lights.

Cone pigment gene expression in individual photoreceptors and the chromatic topography of the retina

Human trichromatic vision is based on three classes of cones: L, M, and S (long-, middle-, and short-wavelength sensitive, respectively). Individuals can have more than one M and/or more than one L pigment gene on the X chromosome along with an S pigment gene on chromosome 7. In some people the X-linked pigment gene array can include polymorphic variants that encode multiple, spectrally distinct cone photopigment subtypes. A single-cell, polymerase chain reaction approach was used to examine visual pigment gene expression in individual human cone cells and identify them as L or M. The ratio of L:M pigment gene expression was assayed in homogenized retinal tissues taken from the same eyes. Results indicate that there is a close correspondence between the cone ratio determined from counting single cells and the L:M pigment mRNA ratio estimated from homogenized pieces of retina. The results also show that the different pigment genes in one array are often expressed at very different levels, giving rise to unequal numbers of L and M cones. Expression of only one photopigment gene was detected in each cone cell. However, individual males can have more than the classically described three spectrally distinct cone types in their retinas.

Flicker-photometric electroretinogram estimates of L:M cone photoreceptor ratio in men with photopigment spectra derived from genetics

Relative proportions of long-wavelength-sensitive (L) to middle-wavelength-sensitive (M) cones were estimated by use of the flicker-photometric electroretinogram (ERG). It has been demonstrated that a major source of error in estimates of cone proportions from spectral luminosity functions is the known variation in the lambda(max) of the photopigments [Vision Res. 38, 1961 (1998)]. To correct for these errors, estimates of cone proportions were derived by use of individualized L-cone spectral sensitivity curves deduced from photopigment gene sequences from each subject. For some individuals this correction made a large difference in the estimated cone proportions compared with the value obtained when a fixed standard L cone was assumed. The largest discrepancy occurred in a man estimated to have 62% L cones (L:M ratio 1.6:1) when a standard L pigment was assumed but a value of 80% L cones (L:M ratio 4:1) when his individualized L-cone spectrum was used. From repeated measurements made with the ERG, it was determined that individual estimates of the relative L-to-M cone contributions, expressed as %L cones, are usually reliable within approximately 2%. The average L:M ratio for 15 male subjects was estimated at 2:1 (67% L cones). Previously, a large range of individual variability was reported for L:M ratios obtained from photometry. An unresolved issue concerns how much of the range might be attributed to error. Here efforts have been taken to markedly reduce measurement error. Nonetheless, a large range of individual differences persists. Estimated L:M ratios for individuals ranged from 0.6:1 to 12:1 (40% L to 92% L).

Functional consequences of the relative numbers of L and M cones

Direct imaging of the retina by adaptive optics allows assessment of the relative number of long-wavelength-sensitive (L) and middle-wavelength-sensitive (M) cones in living human eyes. We examine the functional consequences of variation in the relative numbers of L and M cones (L/M cone ratio) for two observers whose ratios were measured by direct imaging. The L/M cone ratio for the two observers varied considerably, taking on values of 1.15 and 3.79. Two sets of functional data were collected: spectral sensitivity measured with the flicker electroretinogram (ERG) and the wavelength of unique yellow. A genetic analysis was used to determine L and M cone spectra appropriate for each observer. Rayleigh matches confirmed the use of these spectra. We determined the relative strength of L and M cone contributions to ERG spectral sensitivity by fitting the data with a weighted sum of L and M cone spectra. The relative strengths so determined (1.06 and 3.38) were close to the cone ratios established by direct imaging. Thus variation in L/M cone ratio is preserved at the sites tapped by the flicker ERG. The wavelength of unique yellow varied only slightly between the two observers (576.8 and 574.7 nm). This small variation indicates that neural factors play an important role in stabilizing unique yellow against variation in the L/M cone ratio.

Vitronectin gene expression in the adult human retina

PURPOSE

To determine whether vitronectin (Vn), a plasma protein and extracellular matrix molecule that is also a prominent constituent of drusen, is synthesized by cells in the adult human retina.

METHODS

The distribution of Vn in the normal adult human retina was examined using antibodies to circulating plasma Vn and to the multimeric, heparin-binding form that is most prevalent in extravascular tissues. Evidence of Vn transcription by retinal cells was analyzed by in situ hybridization and also by reverse transcription of total RNA derived from dissociated human or mouse photoreceptors followed by amplification using polymerase chain reaction (RT-PCR).

RESULTS

Cytoplasmic immunoreactivity for plasma Vn or multimeric Vn was detected in photoreceptors, in a subpopulation of neurons situated in the inner retina, and in vitreous hyalocytes. Extracellular labeling was limited primarily to Bruch's membrane and the retinal vasculature. At the transcriptional level, Vn mRNA was localized to both photoreceptors and ganglion cells by in situ hybridization. The in situ findings were corroborated by RT-PCR using total RNA from dissociated mouse or human photoreceptor cells.

CONCLUSIONS

The results constitute the first evidence for Vn gene expression by adult neurons in the mammalian central nervous system. The identification of the photoreceptors as a cellular source of Vn suggests that these cells have the potential to make a biosynthetic contribution to the Vn that is found in drusen.

Trichromatic color vision with only two spectrally distinct photopigments

Protanomaly is a common, X-linked abnormality of color vision. Like people with normal color vision, protanomalous observers are trichromatic, but their ability to discriminate colors in the red-green part of the spectrum is reduced because the photopigments that mediate discrimination in this range are abnormally similar. Whereas normal subjects have pigments whose wavelengths of peak sensitivity differ by about 30 nm, the peak wavelengths for protanomalous observers are thought to differ by only a few nanometers. We found, however, that although this difference occurred in some protanomalous subjects, others had pigments whose peak wavelengths were identical. Genetic and psychophysical results from the latter class indicated that limited red-green discrimination can be achieved with pigments that have the same peak wavelength sensitivity and that differ only in optical density. A single amino acid substitution was correlated with trichromacy in these subjects, suggesting that differences in pigment sequence may regulate the optical density of the cone.

Formate-induced inhibition of photoreceptor function in methanol intoxication

Formic acid is the toxic metabolite responsible for the retinal and optic nerve toxicity produced in methanol intoxication. Previous studies in our laboratory have documented formate-induced retinal dysfunction and histopathology in a rodent model of methanol intoxication. The present studies define the time and concentration dependence of formate-induced retinal toxicity in methanol-intoxicated rats. Retinal function was assessed 24, 48, and 72 h after the initial dose of methanol by flicker electroretinographic measurements. Retinal histopathology was assessed at the same time intervals. Rod- and cone-mediated electroretinogram (ERG) responses were attenuated in a formate concentration- and time-dependent manner, and both retinal sensitivity and maximal responsiveness to light were diminished. Attenuation of UV-cone-mediated responses was temporally delayed in comparison to the functional deficits observed in the 15 Hz/510 nm responses, which have a rod-mediated component and occurred at significantly higher formate concentrations. Both 15 Hz/510 nm and UV-cone-mediated ERG responses were undetectable by 72 h; however, if light intensity was increased, a retinal ERG response could be recorded, indicating that photoreceptor function was profoundly attenuated, but not abolished, under these intoxication conditions. Functional changes preceded structural alterations. Histopathological changes were most pronounced in the outer retina with evidence of inner segment swelling, photoreceptor mitochondrial disruption, and the appearance of fragmented photoreceptor nuclei in the outer nuclear layer. The nature of both the functional and structural alterations observed are consistent with formate-induced inhibition of mitochondrial energy production, resulting in photoreceptor dysfunction and pathology.

Spectra of human L cones

Variations in the amino acid sequences of the human cone opsins give rise to spectrally variant subtypes of L and M cone pigments even in the population with normal color vision. In vitro mutagenesis studies have shown that a limited number of amino acid substitutions produce shifts in the wavelength sensitivity. Presented here are results comparing electrophysiological measurements of single human cones with the expressed cone pigment gene sequences from the same retina. In a sample of eight long-wavelength sensitive cone (L cone) spectra obtained from five donors the precise spectral sensitivities, measured in situ, of the two most commonly occurring spectral variants were determined. The peak sensitivity of the Lser180 cone was 563 nm while that of the Lala180 cone was 559 nm.

Molecular genetic detection of female carriers of protan defects

Females heterozygous for congenital colour vision defects are of interest because they are believed to have cone photoreceptor ratios and cone photopigments that differ from normal. We describe a molecular genetic method to identify protan carriers that involves characterizing the genes that occur in the most upstream position in each of the X-chromosome photopigment gene arrays.

M- and L-cones in early infancy: III. Comparison of genotypic and phenotypic markers of color vision in infants and adults

Genetic analyses were performed on five male children (approximately 3 years), two suspect color-normals and three suspects for congenital color vision deficiencies. These classifications were based on visually-evoked potential (VEP) responses to M- and L-cone-isolating stimuli obtained in a previous study when each subject was either 4- or 8-weeks old. The present analyses were performed in a blind study to characterize the genotypes of these subjects. Four male adults with various color vision phenotypes were also tested as a control. DNA was isolated using a non-invasive technique followed by polymerase chain reaction (PCR) amplification and restriction enzyme analysis to examine the genomic DNA of each subject. The genetic analyses confirmed the VEP identification of two color defective infants, and were consistent with the diagnosis of two other infants as color normal. A third infant was predicted by VEP analysis to have a protan defect, but he did not have a gene array typically found in protan observers.