Role for OCT in detecting hemi-macular ganglion cell layer thinning in patients with multiple sclerosis and related demyelinating diseases

OBJECTIVE

Investigations have found associations of homonymous thinning of the macular ganglion cell/ inner-plexiform layer (GCIPL) with demyelinating lesions in the post-chiasmal visual pathway among patients with multiple sclerosis (MS). Retinal thinning may also occur through retrograde trans-synaptic degeneration, a process by which lesions in post-geniculate visual pathway structures lead to thinning of the GCIPL across thalamic synapses. The purpose of our study was to determine the frequency of homonymous hemimacular thinning that occurs in association with post-chiasmal visual pathway demyelinating lesions in patients with MS and other demyelinating diseases.

METHODS

Adult patients with demyelinating diseases (MS, neuromyelitis optica spectrum disorder [NMOSD], myelin oligodendrocyte glycoprotein antibody disease (anti-MOG)) who were participants in an ongoing observational study of visual pathway structure and function were analyzed for the presence of hemimacular GCIPL thinning on OCT scans. Brain MRI scans were examined for the presence of post-geniculate visual pathway demyelinating lesions.

RESULTS

Among 135 participants in the visual pathway study, 5 patients (3.7%) had homonymous hemimacular GCIPL thinning. Eleven patients (8.1%) had a whole+half pattern of GCIPL thinning, characterized by hemimacular thinning in one eye and circumferential macular thinning in the contralateral eye. All but one patient with homonymous hemimacular thinning had demyelinating lesions in the post-geniculate visual pathway; however, these lesions were located in both cerebral hemispheres.

CONCLUSION

Homonymous hemimacular thinning in the GCIPL by OCT is associated with post-chiasmal visual pathway demyelinating lesions but it appears to be a relatively uncommon contributor to GCIPL loss. Patients with this pattern of GCIPL often fail to complain of hemifield visual loss. Future studies with prospective and detailed MR imaging may be able to more closely associate demyelinating lesions in anatomically appropriate regions of the post-chiasmal visual pathways with homonymous hemimacular thinning.

Analysis of e-waste recycling behavior based on survey at a Midwestern US University

The United States lacks a set of unified electronic waste recycling laws, contributing in part to the observed low rate of e-waste recycling behaviors among consumers. Individual factors of consumers contributing to the low recycling rates are not well understood. The objective of this study was to evaluate consumer behaviors, including barriers, surrounding e-waste recycling at a large Midwestern university in the United States. A survey was administered to faculty, graduate students, undergraduate students, and staff to determine their personal recycling habits, knowledge, and beliefs. The results indicate that free access to disposal, lack of consumer knowledge about products and disposal sites, and access to a recycling facility within a reasonable distance are all important factors in consumer decisions. Policy-makers and waste management professionals should focus on promotion of e-waste recycling behaviors through increased access to free or low-cost recycling as well as through the creation of recycling incentives.

Risk Factors and Services to Reduce Child Sexual Abuse Recurrence

Child sexual abuse (CSA) is associated with a range of negative consequences for victims that are compounded when it recurs. We used the National Child Abuse and Neglect Data System to study a cohort of 42,036 children in 45 U.S. states with sexual abuse reports first confirmed by child protective services (CPS) during 2010 in order to identify children with increased risk for recurrence. A small proportion (3.6%) had a second confirmed sexual abuse report through 2015. In multivariate models, female gender, family hearing and vision problems, other child maltreatment, and other family violence were associated with increased risk of recurrence, while younger children, Hispanic families, and those with substance abuse tended to have less risk. One fourth of recurrence involved the same offender, usually a parent or caretaker. One fourth of cases were referred for any CPS services, which were more likely to be provided for families with poverty, drug or alcohol problems, or other violence. Only substance abuse services significantly reduced recurrence in multivariable models. Those trying to reduce CSA recurrence should recognize that certain case characteristics are associated with greater recurrence, and most CPS services do not significantly reduce CSA recurrence.

Inhibition of 2-AG hydrolysis differentially regulates blood brain barrier permeability after injury

Background

Acute neurological insults caused by infection, systemic inflammation, ischemia, or traumatic injury are often associated with breakdown of the blood-brain barrier (BBB) followed by infiltration of peripheral immune cells, cytotoxic proteins, and water. BBB breakdown and extravasation of these peripheral components into the brain parenchyma result in inflammation, oxidative stress, edema, excitotoxicity, and neurodegeneration. These downstream consequences of BBB dysfunction can drive pathophysiological processes and play a substantial role in the morbidity and mortality of acute and chronic neurological insults, and contribute to long-term sequelae. Preserving or rescuing BBB integrity and homeostasis therefore represents a translational research area of high therapeutic potential.

Methods

Induction of general and localized BBB disruption in mice was carried out using systemic administration of LPS and focal photothrombotic ischemic insult, respectively, in the presence and absence of the monoacylglycerol lipase (MAGL) inhibitor, CPD-4645. The effects of CPD-4645 treatment were assessed by gene expression analysis performed on neurovascular-enriched brain fractions, cytokine and inflammatory mediator measurement, and functional assessment of BBB permeability. The mechanism of action of CPD-4645 was studied pharmacologically using inverse agonists/antagonists of the cannabinoid receptors CB1 and CB2.

Results

Here, we demonstrate that the neurovasculature exhibits a unique transcriptional signature following inflammatory insults, and pharmacological inhibition of MAGL using a newly characterized inhibitor rescues the transcriptional profile of brain vasculature and restores its functional homeostasis. This pronounced effect of MAGL inhibition on blood-brain barrier permeability is evident following both systemic inflammatory and localized ischemic insults. Mechanistically, the protective effects of the MAGL inhibitor are partially mediated by cannabinoid receptor signaling in the ischemic brain insult.

Conclusions

Our results support considering MAGL inhibitors as potential therapeutics for BBB dysfunction and cerebral edema associated with inflammatory brain insults.

Electronic supplementary material

The online version of this article (10.1186/s12974-018-1166-9) contains supplementary material, which is available to authorized users.

Kidney vasculogenesis and angiogenesis: role of vascular endothelial growth factor

Vascular Endothelial Growth Factor (VEGF) plays a crucial role in the establishment of the vascular tree pattern. New vessels can be formed by two different ways; in the development of kidney both vasculogenesis and angiogenesis participate to microvessel assembly. VEGF and its receptor (VEGF-R) are co-expressed during kidney organogenesis and stimulate renal blood vessels development, induce and maintain the fenestrated phenotype in endothelium and regulate vascular permeability. VEGF and many other growth factors participate to the development of embryonic glomerular microvasculature. We believe that therapeutical use of VEGF or anti-VEGF antibodies may be performed in the treatment of many disorders.

The infrequent association of synchronous renal and colonic malignancies

The coexistence of both kidney and colon primary malignancies is a rare condition. We report the case of a 75-year-old woman who presented with bilateral pulmonary nodules at chest X-ray and stratigraphy. Total-body CT scan showed multiple, apparently metastatic, bilateral pulmonary lesions, a diffusely dysomogeneous neoformation in the lower pole of the right kidney and a gross neoformation in the ascending colon. A right nephrectomy and a right hemicolectomy were performed and histology showed two primary neoplasms: clear cell renal carcinoma and undifferentiated adenocarcinoma of the colon.

Pathophysiology, clinical features and management of hepatorenal syndrome

Hepatorenal syndrome (HRS) is a form of functional renal failure occurring in patients with advanced liver disease. Hypoperfusion of the kidney, due to renal vasoconstriction, is the main feature of HRS. Conversely, the extrarenal circulation is characterized by low systemic resistance, especially occurring in splanchnic vessels, and arterial hypotension. It has been postulated that renal vasoconstriction is induced either by a hepatorenal reflex related to the diseased liver or by arterial vasodilation and the subsequent baroreceptor-mediator activation of systemic vasoconstrictor factors. The diagnosis of HRS requires the exclusion of other causes of renal failure in patients with liver disease. On the basis of clinical and prognostic differences, two types of HRS have been defined. The prognosis of HRS is poor and, to date, the only effective treatment is the liver transplantation.

The use of indomethacin to treat acute rises of intracranial pressure and improve global cerebral perfusion in a child with head trauma

BACKGROUND

The use of vasoconstrictors (e.g. dihydroergotamine, indomethacin) for the treatment of increased intracranial pressure (ICP) secondary to brain trauma is controversial. In particular, it has been suggested that vasoconstrictors be employed only for intracranial hypertension secondary to hyperemia, when venous jugular bulb saturation (SjO2) is > 75%.

METHOD

We administered indomethacin as a bolus i.v. (5-10 mg) on 18 occasions to a multiple-injured 3-year-old child with acute rises of ICP secondary to severe brain trauma (GCS score 7) determining a large hypodensity area in and swelling of the right hemisphere.

RESULTS

Before indomethacin administration the average of mean ICP was 68.1 +/- 10.8 (SD) mm Hg (range 47-84) and the cerebral perfusion pressure (CCP) was 38.4 +/- 10.4 mm Hg (range 30-65). In response to indomethacin, ICP dropped in a few seconds to 22.7 +/- 5.6 and CCP increased to 82.4 +/- 6.1 mm Hg (P < 0.001), while the mean arterial pressure remained unchanged. On 6 occasions SjO2 was also evaluated immediately before and 5 and 10 min after indomethacin administration. Before indomethacin administration, SjO2 values were within the normal range on 2 occasions and abnormally low on four. SjO2 increased from the mean value of 45.6 +/- 15.7 to 59.8 +/- 8.9 (after 5 min) and 60.6 +/- 12.4% (after 10 min) (P < 0.01 versus pre-indomethacin). At the same time the cerebral venous pH increased from 7.43 +/- 0.01 to 7.45 +/- 0.01 (P = 0.01). These findinge suggest that the global cerebral perfusion was improved. Eighteen days after injury the child was awake and was discharged from the ICU.

CONCLUSION

To our knowledge, increase of SjO2 in response to indomethacin has not been previously reported. Although great caution is necessary in the use of indomethacin for the treatment of ICP, these findings suggest that indomethacin can be useful for the treatment of acute rises of ICP compromising severely the CCP, even if SjO2 is normal or abnormally low. Under these circumstances, indomethacin can improve the global cerebral perfusion.