Cerebrospinal Fluid Biomarkers of Synaptic Dysfunction are Altered in Parkinson's Disease and Related Disorders

BACKGROUND

Synaptic dysfunction and degeneration are central contributors to the pathogenesis and progression of parkinsonian disorders. Therefore, identification and validation of biomarkers reflecting pathological synaptic alterations are greatly needed and could be used in prognostic assessment and to monitor treatment effects.

OBJECTIVE

To explore candidate biomarkers of synaptic dysfunction in Parkinson's disease (PD) and related disorders.

METHODS

Mass spectrometry was used to quantify 15 synaptic proteins in two clinical cerebrospinal fluid (CSF) cohorts, including PD (n₁  = 51, n₂  = 101), corticobasal degeneration (CBD) (n₁  = 11, n₂  = 3), progressive supranuclear palsy (PSP) (n₁  = 22, n₂  = 21), multiple system atrophy (MSA) (n₁  = 31, n₂  = 26), and healthy control (HC) (n₁  = 48, n₂  = 30) participants, as well as Alzheimer's disease (AD) (n₂  = 23) patients in the second cohort.

RESULTS

Across both cohorts, lower levels of the neuronal pentraxins (NPTX; 1, 2, and receptor) were found in PD, MSA, and PSP, compared with HC. In MSA and PSP, lower neurogranin, AP2B1, and complexin-2 levels compared with HC were observed. In AD, levels of 14-3-3 zeta/delta, beta- and gamma-synuclein were higher compared with the parkinsonian disorders. Lower pentraxin levels in PD correlated with Mini-Mental State Exam scores and specific cognitive deficits (NPTX2; rho = 0.25-0.32, P < 0.05) and reduced dopaminergic pre-synaptic integrity as measured by DaTSCAN (NPTX2; rho = 0.29, P = 0.023). Additionally, lower levels were associated with the progression of postural imbalance and gait difficulty symptoms (All NPTX; β-estimate = -0.025 to -0.038, P < 0.05) and cognitive decline (NPTX2; β-estimate = 0.32, P = 0.021).

CONCLUSIONS

These novel findings show different alterations of synaptic proteins in parkinsonian disorders compared with AD and HC. The neuronal pentraxins may serve as prognostic CSF biomarkers for both cognitive and motor symptom progression in PD. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Luminance and Color Contrast Sensitivity and Vep Latency in Subjects with Normal and Defective Binocularity

Luminance contrast sinusoidal gratings (spatial frequencies 1, 2 and 4 cycles/degree) were compared with the corresponding color contrasting patterns (along the protan, deutan and tritan axes) to see whether they demonstrated normal binocular function in humans, and distinguished between normals and persons with defective binocularity. Contrast sensitivity and transient pattern VEP latency (on-responses) were measured in normals (n = 11, median age 36, range 12-46 years) and subjects with no stereopsis (n = 6, median age 13, range 8-38 years). The normal group had significantly higher contrast sensitivity with binocular stimulation for all patterns except tritan contrast gratings of 2 and 4 c/deg. The stereo-deficient group showed no higher binocular contrast sensitivity for any pattern. Differences between groups were significant with all gratings of 4 c/deg, and also with protan and deutan contrast gratings of 2 c/deg. In the normal group, binocular VEP latency was significantly shorter than the monocular with protan contrast gratings of 2 c/deg and tritan contrast gratings of 1 and 2 c/deg. Differences between the normal and the stereo-deficient groups were significant for all color contrast patterns of 2 c/deg; and tritan contrast gratings of 1 c/deg. We conclude that color contrast sensitivity and VEP measurements are potentially useful for demonstrating binocular function, and for separating normals from stereo-blind subjects. Color contrast patterns however are less effective than the corresponding luminance contrast patterns in evoking cortical potentials.

Symptom burden in stable COPD patients with moderate or severe airflow limitation

OBJECTIVES

To describe a multidimensional symptom profile in patients with stable chronic obstructive pulmonary disease (COPD) and determine whether symptom experience differed between patients with moderate or severe airflow limitations.

BACKGROUND

Patients with severe airflow limitation experience numerous symptoms, but little is known regarding patients with moderate airflow limitation.

METHODS

A multidimensional symptom profile (Memorial Symptom Assessment Scale) was assessed in 42 outpatients with moderate and 49 with severe airflow limitations.

RESULTS

The mean number of symptoms in the total sample was 7.9 (±4.3) with no difference between patients with moderate and severe airflow limitations. The most prevalent symptoms with the highest MSAS symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy in both groups.

CONCLUSIONS

Patients with moderate or severe airflow limitations experience multiple symptoms with high severity and distress. An assessment of their multidimensional symptom profile might contribute to better symptom management.

Screening for ocular dysfunction in children: approaching a common program

According to the general principles of screening, detection of visual impairment in children is worthwhile, since the condition is a serious health problem, reliable diagnostic tests are available and effective treatment is possible in most instances of ocular and visual dysfunction. However, an evaluation of the screening procedures has not been properly done and the cost-benefit of screening has not been studied. The aim of the present study is to perform a systematic analysis of the screening programs for detection of visual dysfunction. In the screening two parts can be separated, one that concerns the more serious ocular and visual conditions which have to be discovered by general survey methods very early in life, and one that involves detection of less serious conditions, mainly amblyopia, which can be diagnosed by testing for monocular reduction of visual acuity at about 3-4 years of age. The performance characteristics of the screening programs used in Sweden and Canada were evaluated and found to be very favourable. Based on the analysis and the evaluation, recommendations are made on programs for vision screening in children that could be applied more widely. The program could involve all or parts of the following: 1) A careful inspection of the eyes in the neonatal period and preferably also examination of the red reflex with the ophthalmoscope. 2) Children at high risk for ocular and visual disorder, i.e. those born prematurely before 32 weeks of age, or with genetic disease, hearing deficit and/or neurological and mental disorder, should be examined at the proper age by an ophthalmologist. 3) All staff at pediatric departments and child health care centers should be familiar with the visual development of the normal baby and should be alerted to the various symptoms and signs which first warn parents that there may be a visual defect. An inspection of the eyes to detect squint should be part of all pediatric examinations. 4) A screening test of monocular visual acuity in 4 year-old children can be reliably performed by non-ophthalmic personnel after proper training. The screening test should be repeated by school nurses during the first grade of school, and at regular intervals during the school years. 5) The children that screen positively should be seen by ophthalmologists, and in some cases by orthoptists, without undue delay for diagnosis and treatment.

Oxygen supplementation increases glucose tolerance during euglycaemic hyperinsulinaemic glucose clamp procedure in patients with severe COPD and chronic hypoxaemia

Investigations in chronic obstructive pulmonary disease (COPD) patients have shown impaired glucose tolerance in hypoxic COPD patients, compared with COPD patients with normal arterial blood gases. In healthy subjects, hypoxaemia or stay at altitude, have been shown to alter glucose metabolism. At altitude the effect seems to be dependent on duration of stay. A short stay is associated with insulin resistance, a longer stay gives rise to increased glucose uptake. The euglycaemic hyperinsulinaemic glucose clamp technique is a method to study glucose tolerance and enables determinations of glucose clearance in peripheral tissues. We investigated six COPD patients [forced expiratory volume in 1 s 0.7 +/- 0.2 l (mean +/- SD)] with chronic hypoxaemia (PaO(2) 7.9 +/- 0.6 kPa at rest, breathing air), with and without oxygen supplementation, using the glucose clamp technique. Net peripheral glucose uptake was 5.5 +/- 1.2 and 7.1 +/- 1.6 mg (kg*min)(-1) (+29%) breathing air and supplemental oxygen, respectively (P = 0.03). The tissue sensitivity to insulin increased 32% (P = 0.03) with oxygen supplementation. The results indicate that normalization of oxygen saturation in COPD patients with chronic hypoxaemia may have an immediate effect on glucose tolerance and tissue sensitivity to insulin in these patients.

Is vision screening in 3-year-old children feasible? Comparison between the Lea Symbol chart and the HVOT (LM) chart

PURPOSE

The aim of this prospective study was to compare visual screening at the age of 3 years with screening at 4 years using two different charts.

METHODS

A total of 478 3-year-old children were tested at four child health care centres (CHCCs). Of these children, 440 were tested again at the age of 4 years. A third group, a control group, consisting of 229 children, was examined only at the age of 4 years. All children were tested with both the HVOT chart and the Lea Symbol chart.

RESULTS

Testability rates for 3-year-olds were almost the same with the Lea Symbol chart and the HVOT chart (82.8% and 84.8%, respectively). The corresponding rates for the same children tested at 4 years of age were 96.5% and 97.0%, and for the 4-year-olds not previously tested 92.9% and 92.8%. The mean testing time was somewhat shorter for the Lea Symbol chart in all three groups, but the difference was not statistically significant. The difference in the assessment of visual acuity between the two charts was small and less than 1/10th of a line. The positive predictive value was lower at 3 years (58%) than has previously been found at 4 years (74.6%).

CONCLUSION

Three-year-old children co-operate well in visual acuity testing. However, the examination time is a little longer and the testability rate is about 10% lower than at 4 years. Both 3-year-old and 4-year-old children can be tested equally well with the HVOT and the Lea Symbol charts.

Evaluation of screening procedures for congenital cataracts

AIM

To evaluate the efficacy of two different Swedish screening procedures for early detection of congenital cataracts in comparison with no screening.

METHODS

Children born between January 1992 and December 1998 in Swedish regions with an established eye-screening routine procedure, diagnosed with congenital cataract, and operated on before 1 y of age, were included in a retrospective study. Age at referral and age at time of the operation were compared between regions using different screening procedures: screening in the maternity wards (Region 1), at the well-baby clinics (Region 2) and one region without any screening (Region 3).

RESULTS

Seventy-two children were included in the study. Concerning early diagnosis and surgery, Region 1 differed significantly from Regions 2 and 3, which were more similar and were combined for further analysis. The difference in detected cases was greatest at 21 d of age (55% vs 18%; p < 0.001), but persisted even at 100 d of age (78% vs 64%; p < 0.02). Region 1 screening resulted in more and earlier cases detected than the other two regions (22 vs 15 per 100,000 births). In 72% of all cases, surgery was performed in response to referrals from either the maternity wards (36%), or the well-baby clinics (36%). However, half of the cases from the well-baby clinics were detected too late, i.e. at > 100 d.

CONCLUSION

Eye screening in the maternity ward is preferable to well-baby clinic screening and to no screening at all, since it leads to early detection. Screening should also be performed routinely at well-baby clinics within the period when successful treatment is possible.

Visual screening of Swedish children: an ophthalmological evaluation

PURPOSE

This study describes the various ophthalmological conditions detected in the Swedish visual screening program for children.

METHODS

The study was longitudinal and retrospective. All children (3126) born in 1982 in three Swedish municipalities have been followed from birth to ten years of age. Visual acuity was examined at the ages of 4, 5.5, 7 and 10 years. Before the age of 4, a gross examination of the eyes was performed.

RESULTS

The prevalence of ametropia in the population was 7.7%, the prevalence of strabismus 3.1%, and the prevalence of organic lesions 0.6%. Seven children (0.2%) were visually handicapped (visual acuity </=0.3 in the better eye). Refractive errors and microtropias were mainly detected at the age of 4, when the first visual acuity test was performed, while manifest strabismus was in many cases detected before this age. With this screening and subsequent diagnosis and treatment, the prevalence of deep amblyopia (visual acuity </=0.3) has been reduced from 2% to 0.2%. With treatment, 47% of the amblyopic children achieved a visual acuity better than 0.7.

CONCLUSION

Visual screening is effective in detecting visual and ocular disorders. Most conditions are discovered before the age of 6. Compared to an unscreened population, the prevalence of amblyopia is greatly reduced.

Fourier analysis of steady-state visual evoked potentials in subjects with normal and defective stereo vision

The purpose of this work was to study the second harmonic in the steady state pattern visual evoked potential (ssVEP) to various stimulus frequencies in subjects with normal and defective binocularity. ssVEPs were elicited by 4 c/deg sinusoidal gratings, with temporal frequencies ranging from 5 to 20 Hz (exp. 1) and 15 to 27.5 Hz (exp. 2). Responses were Fourier analysed and power and phase of the second harmonic to stimulus frequency were measured. For power, binocular enhancement in a bimodal fashion was found both in normals and in subjects with defective binocularity. The power with binocular stimulation was significantly higher in the normal group in the high frequency domain. Latency, estimated from the phase-frequency function, was longer in the group with defective binocularity, but this was statistically significant only for the high frequency domain. The results suggest that a visual system with normal binocular function can follow a stimulus with high temporal frequency more accurately than a system with disturbed binocularity.

Human glutathione dependent prostaglandin E synthase: gene structure and regulation

A P1 clone containing the gene for human glutathione dependent PGE synthase (PGES) was isolated and characterized. The gene is divided into three exons, spans 14.8 kb and was localized to chromosome 9q34. 3. In A549 cells, the protein and activity levels of PGES were increased by interleukin-1beta. This increase was prevented by phenobarbital. Reporter constructs containing the 5'-flanking region of exon 1, which exhibited strong promoter activity, responded accordingly, except that interleukin-1beta induced a transient increase followed by a decrease. As cyclooxygenase 2 expression has been reported to respond in a similar fashion, a transcriptional regulatory basis for the observed co-regulation with PGES is implied. The strong down-regulation by phenobarbital raises important issues concerning its mechanisms of action.

Decay of the GRB 990123 optical afterglow: implications for the fireball model

Broad-band (ultraviolet to near-infrared) observations of the intense gamma ray burst GRB 990123 started approximately 8.5 hours after the event and continued until 18 February 1999. When combined with other data, in particular from the Robotic Telescope and Transient Source Experiment (ROTSE) and the Hubble Space Telescope (HST), evidence emerges for a smoothly declining light curve, suggesting some color dependence that could be related to a cooling break passing the ultraviolet-optical band at about 1 day after the high-energy event. The steeper decline rate seen after 1.5 to 2 days may be evidence for a collimated jet pointing toward the observer.

Domiciliary liquid oxygen versus concentrator treatment in chronic hypoxaemia: a cost-utility analysis

Whether long-term oxygen therapy (LTOT) improves quality of life in chronic hypoxaemia has been questioned. LTOT with an oxygen concentrator (C/C) and gas cylinders for ambulation is considered cumbersome compared to mobile liquid oxygen equipment (L). The hypothesis for this study was that LTOT with liquid oxygen treatment (L) improves patients' health-related quality of life, but that it is also more expensive compared to concentrator (C/C) treatment. A prospective, randomized multicentre trial comparing C/C with L for LTOT was conducted during a six-month period. Fifty-one patients (29 on L and 22 on C/C) with chronic hypoxaemia, regularly active outside the home, participated in the study initially. Costs for oxygen were obtained from the pharmacies. Patient diaries and telephone contacts with members of the healthcare sector were used to estimate costs. Health-related quality of life was measured by the Sickness Impact Profile (SIP) and the EuroQol, instruments at the start and after 6 months. The average total cost per patient for group C/C for the six-month period was US$1,310, and for group L it was US$4,950. Health-related quality of life measured by the SIP instrument showed significant differences in favour of group L in the categories/dimensions of physical function, body care, ambulation, social interaction and total SIP score. In conclusion, liquid-oxygen treatment was more expensive compared to concentrator treatment. However, treatment effects showed that liquid oxygen had a better impact on quality of life.

Screening for visual and ocular disorders in children, evaluation of the system in Sweden

The aim of this study was to evaluate the visual screening system in Sweden. We have made a retrospective investigation of the results of screening for ocular disease and visual impairment of all children born in 1982 in three Swedish communities. The records from screening examinations from 0 to 10 y and from diagnostic follow-up at the departments of ophthalmology that the children were referred to were inspected. The data were used to evaluate the efficiency of the Swedish visual screening system. The study included 3126 children. The attendance rate at the 4-y examination was better than 99%. The sensitivity of the 4- and 5.5-y screening examinations was on the average 92% and the specificity was 97%. The average number of false negative cases at 4 y was 5.6 in 1000 (0.56%). With this screening and subsequent diagnosis and treatment, the prevalence of amblyopia at different levels of visual acuity at the age of 10 y was: 0.06% with visual acuity < or = 0.1, 0.9% with visual acuity < or = 0.5 and 1.7% with visual acuity < or = 0.7. In spite of largely unchanged pressure of amblyogenic factors in the population, the prevalence of deep and moderate amblyopia has been markedly reduced by screening and early treatment.

Insulin resistance is not exhibited by advanced chronic obstructive pulmonary disease patients

We have previously reported increased blood glucose concentrations and skeletal muscle glycogen depletion in severe COPD patients with chronic respiratory failure. In order to see if insulin resistance exists in severe COPD, we investigated nine patients with advanced COPD with chronic hypoxaemia and seven healthy control subjects of similar age, using the euglycaemic hyperinsulinaemic glucose clamp technique. We could not demonstrate a subnormal intravenous glucose requirement in response to insulin when maintaining euglycaemia in the COPD patients with chronic hypoxaemia. This indicates that the net metabolism of glucose in COPD patients with chronic hypoxaemia is not resistant to insulin.

Long-term oxygen therapy may improve skeletal muscle metabolism in advanced chronic obstructive pulmonary disease patients with chronic hypoxaemia

Skeletal muscle metabolite depletion exists in advanced chronic obstructive pulmonary disease (COPD) patients with chronic hypoxaemia. The purpose of this study was to investigate if long-term oxygen therapy (LTOT) can improve skeletal muscle energy metabolism. Eight patients with advanced COPD, four with chronic hypoxaemia, were investigated using muscle biopsy specimens from the quadriceps femoris muscle applying the needle biopsy technique. The investigation was performed twice, before and after approximately 8 months of LTOT in the hypoxaemic patients. Eight healthy controls of similar age were also investigated. In the COPD patients, muscle glycogen, ATP and creatine phosphate (CrP) concentrations, were 42% (P < 0.01), 18% (P < 0.05) and 21% (P = n.s.) lower than in the healthy controls, respectively, while creatine (Cr) and lactate concentrations were 21% and 90% higher, respectively in the COPD patients compared to the healthy control subjects (P < 0.05). After LTOT, the 'energy index' CrP/(CrP + Cr) ratio increased by 0.12 in the LTOT patients but decreased by 0.12 in the control COPD patients (P < 0.05). The results indicate an improvement in skeletal muscle energy metabolism during LTOT in COPD patients with chronic hypoxaemia.

Fat metabolism and its response to infusion of insulin and glucose in patients with advanced chronic obstructive pulmonary disease

In order to investigate fat metabolism and the regulation of lipolysis and blood fuel metabolites by insulin, nine patients with chronic obstructive pulmonary disease (COPD) with chronic hypoxaemia and seven healthy control subjects of similar age were investigated by determination of the turnover rate of free fatty acids (TOR), using 1-14C-oleic acid as a tracer, and arterial concentrations of FFA, glycerol and 3-hydroxybutyrate. The measurements were performed in the basal state and during insulin and glucose infusion, aiming at euglycaemia at insulin levels of 50 and 100 mU l-1. The subjects' ages were 64 +/- 2.7 and 66 +/- 1.1 (mean +/- SEM) years in the COPD and control groups, respectively. TOR was 0.73 +/- 0.06 and 0.52 +/- 0.02 mmol min-1 (P < 0.05) in the basal state, 0.33 +/- 0.04 and 0.30 +/- 0.02 at an insulin level of 50 mU l-1 and 0.32 +/- 0.08 and 0.24 +/- 0.02 at an insulin level of 100 mU l-1, in the COPD and control groups, respectively. Arterial FFA concentration was 0.98 +/- 0.08 and 0.75 +/- 0.06 mmol l-1 (P < 0.05) in the basal state in the COPD and control groups, respectively. During the clamp, the decrease in FFA mirrored that in TOR. The results show that the state of lipolysis is increased in severe COPD patients with chronic hypoxaemia. Furthermore, the results suggest a reduced effect of insulin in lipolysis.

A computer and video display based system for training eccentric viewing in macular degeneration with an absolute central scotoma

A new approach designed to establish the most suitable area for eccentric viewing and to teach and train patients with severe age-related macular degeneration (AMD) to use the eccentric viewing technique is described. Using a computer and video display based system, as well as software written specifically for this purpose, we investigated and trained ten consecutive patients with AMD. The patients were 80.1 + or - 5.6 years old, on average. All of them had an absolute central scotoma. Mean visual acuity was 0.035 + or - 0.016. After 30 min of testing, instruction and reading on the screen, followed by 2.6 + or - 0.69 one-hour training sessions, on average, with the low vision therapist, reading newspaper and book texts with the aid of hyperoculars or aplanatic systems and a very short reading distance, the patients achieved a reading speed of 58.9 + or - 19.7 words/min, significantly (p<0.001) higher than the initial speed when reading on the screen, 11.5 + or - 4.5 words/min.

Metabolic enzyme activity in the quadriceps femoris muscle in patients with severe chronic obstructive pulmonary disease

Eighteen patients with severe COPD and seven healthy control subjects 64.0 +/- 2.2 and 66.8 +/- 1.4 yr of age, respectively (mean +/- SEM), were investigated. Arterial blood gas analysis, dynamic lung volumes, and muscle biopsy specimens from the quadriceps femoris muscle were performed. The muscle biopsies were analyzed for citrate synthase (CS), succinic acid dehydrogenase (SDH), 3-hydroxyacyl-CoA dehydrogenase (HAD), phosphofructokinase (PFK), and lactate dehydrogenase (LDH) activities and related to protein content. The PFK activity was higher in the COPD group than in the control group (+34%, p < 0.05). CS showed a group difference in the opposite direction (-29%, p < 0.05). LDH activity followed PFK and tended to be higher in the patient group (+27%, NS), whereas SDH (-31%, NS) and HAD (-28%, NS) mirrored the CS results. Muscle protein concentration tended to be lower in the COPD group (-14%, NS). There were no significant changes in enzyme activity after 7 mo of long-term oxygen therapy (n = 6). These results indicate adaptation in the form of augmented glycolysis (PFK), and decreased aerobic metabolism (CS) in the quadriceps femoris muscle in patients with advanced COPD.

Patient positioning for fractionated precision radiation treatment of targets in the head using fiducial markers

When irradiating targets in the brain, an accurately localised dose is often needed. One crucial moment to achieve this is the positioning of the patient. We have developed a positioning method where the patient is immobilised with a bite block and a head mould, and where the position of the target is determined by X-ray imaging of fiducial markers that are placed in the patient's skull. A method for computing the transformation needed to move the target from the observed to the prescribed position and orientation is described. This method uses the information from two orthogonal X-ray images and takes measurement errors and data from three or more markers into account. Results from using the method clinically in proton beam therapy are given.

The effect of spatial frequency and contrast on the latency in the visual evoked potential

The latency in the visual evoked potential was measured at spatial frequencies of 2-12 c/deg in 10 subjects. The contrast levels of the sinuosoidal grating patterns were set at 1.5, 1.75, 2.0, 2.25, 2.5, 2.75 and 3.0 log units above each subject's contrast sensitivity threshold. Two factors were shown to influence the latency: suprathreshold contrast and, to a lesser extent, spatial frequency. The visual evoked potential latencies at contrast sensitivity threshold were extrapolated. These threshold latencies showed considerable variation with spatial frequency and between subjects. Therefore, the visual evoked potential latency cannot be considered a useful tool for estimating the contrast sensitivity function.

[Endoprosthetic dilatation of the vena cava eliminates obstruction in superior vena cava syndrome]

A 62-year-old woman with superior vena cava obstruction (SVCO) secondary to small cell lung cancer was treated with expandable wire stents prior to chemotherapy and irradiation. The treatment resulted in immediate and complete remission of the SVCO symptoms.

The narrow proton beam therapy unit at the the Svedberg Laboratory in Uppsala

The synchrocyclotron at the The Svedberg Laboratory (TSL) in Uppsala is now reconstructed and can presently operate with fixed frequency and proton energies up to 100 MeV. A first treatment room with a narrow proton beam unit for therapy of eye tumours is now in operation. Therapy of eye melanomas started in April, 1989 and during 1989 and 1990, 19 patients were treated with 72 MeV protons. The narrow beam unit provides a fixed horizontal beam and the patient is treated in a seated position. The present paper describes mainly the technical aspects of the unit which so far has been used only for eye melanomas. In the future, modifications of the unit will allow therapy of intracranial targets when higher proton energies are available. In its final form, the proton therapy facility at TSL will harbour a second treatment unit. Here a rotating gantry for 200 MeV protons will provide a broad beam, which will enable treatment of tumours located anywhere in the body.

Skeletal muscle metabolites and fibre types in patients with advanced chronic obstructive pulmonary disease (COPD), with and without chronic respiratory failure

Eighteen patients with advanced COPD, 8 with chronic respiratory failure (RF) and 10 without (nonRF, NRF) were investigated using spirometry, arterial blood gas analysis and biopsies taken from the quadriceps femorls muscle. The biopsies were analysed for ATP, creatine phosphate (CrP), creatine (Cr), lactate and glycogen content. Muscle fibre composition was also studied. Low concentrations of ATP, glycogen and CrP were found in the RF patients. Significant correlations were found between muscle metabolites and arterial blood gas values with the strongest correlation between muscle glycogen and arterial PO2 (r = 0.70; p less than 0.001). A very low percentage of "oxidative" type I muscle fibres was found in both groups. Possible mechanisms causing depletion of muscle metabolites are discussed.

Skeletal muscle metabolites and fibre types in patients with advanced chronic obstructive pulmonary disease (COPD), with and without chronic respiratory failure

Eighteen patients with advanced COPD, 8 with chronic respiratory failure (RF) and 10 without (nonRF, NRF) were investigated using spirometry, arterial blood gas analysis and biopsies taken from the quadriceps femorls muscle. The biopsies were analysed for ATP, creatine phosphate (CrP), creatine (Cr), lactate and glycogen content. Muscle fibre composition was also studied. Low concentrations of ATP, glycogen and CrP were found in the RF patients. Significant correlations were found between muscle metabolites and arterial blood gas values with the strongest correlation between muscle glycogen and arterial PO2 (r = 0.70; p less than 0.001). A very low percentage of "oxidative" type I muscle fibres was found in both groups. Possible mechanisms causing depletion of muscle metabolites are discussed.

Binocular interaction in the VEP to grating stimulation. II. Spatial frequency effects

The size specificity of the binocular interaction in the VEP was investigated. VEPs elicited by sine wave gratings were recorded on 3 subjects, with the exception of one experiment where 6 subjects were tested. The recording technique made it possible to obtain responses from each eye, even during binocular stimulation. The VEP amplitude for each eye during monocular stimulation was compared with the response of the same eye during binocular stimulation. A low binocular/monocular ratio indicated a high binocular interaction. When each eye was stimulated by the same spatial frequency, the binocular interaction was highest in the spatial frequency band of 2-4 c/d. When each eye was stimulated by a different spatial frequency, the binocular interaction decreased as the frequencies were made progressively more unequal. The bandwidth at half amplitude was about 1 octave around the center frequency.

Binocular interaction in the VEP to grating stimulation. I. Orientational effects

The orientational effects of monocular stimulation with sinusoidal grating patterns were studied with transient VEP technique in 10 subjects with normal vision and binocular functions. No significant variation in amplitude with orientation was obtained. The latency for 45 degrees (oblique) orientation was slightly longer than the latency for other orientations. The orientational effects on binocular interaction in dichoptic stimulation were determined with sinusoidal grating patterns at a reversing rate of 1.9 and 2.1 Hz for each eye respectively. The binocular interaction was assessed as the binocular/monocular ratio of the VEP amplitude for each eye. There was a significantly reduced binocular interaction for dichoptically presented perpendicular gratings as compared to parallel gratings at the spatial frequencies of 2, 4 and 6 cycles/degree, when mean values of the whole group of subjects were statistically analysed. A broad orientation tuning of about 45 degree was found for the binocular interaction at 4 cycles/degree for the group as a whole, although tuning was hard to establish in the VEP of each individual. This compares well with other neurophysiological and electrophysiological data but is broader than the orientation tuning demonstrated psychophysically.

Preoperative radiation therapy of high malignancy grade soft tissue sarcoma. A preliminary investigation

Twenty-three patients with high malignancy grade soft tissue sarcoma received irradiation (about 40 Gy) followed by surgery. The follow-up time was 62 months or more in all patients. The local recurrence rate was 9 per cent (2/23). One of the patients was reoperated and is living free of disease, giving a local control rate of 95 per cent. Thirty per cent (7/23) of the cases developed distant metastases and died of the disease. Delayed wound healing was observed in 2 cases which was possibly due to the radiation therapy. Since surgery was regarded non-radical in 5 cases, the local control obtained by the combined radiation therapy and surgery is good and should be the subject for further investigations.

Visual evoked potentials to binocular stimulation with disparate patterns

Experiments with VEP to checkerboard stimulation in 4 subjects with normal stereoscopic vision showed that binocular interaction was the same for fused images and for linear pattern displacement induced by horizontal and vertical prisms, as long as the patterns were projected on the macular areas of both eyes. Also in a stereo-blind subject the impaired binocular VEP interaction remained unchanged during linear displacement of the patterns. Thus the previously reported differences in binocular VEP interaction between stereo-normal stereoblind subjects cannot be explained by binocular stimulation with unfused patterns in the latter group. With patterns displaced to different hemifields in the 2 eyes, no binocular interaction was recorded. Experiments with black-and-white gratings of different orientations to the 2 eyes showed that binocular VEP reactions remained the same even with patterns perpendicular to each other. However, the binocular interaction was disrupted when the subject viewed the perpendicular patterns through coloured filters.

Radiation effects on cultured human lymphoid cells. Analysis using the growth extrapolation method

The cloning efficiency of human normal and malignant lymphoid cells is usually low. Radiation effects in vitro on such cells can therefore not be analysed with conventional cloning. However, this problem can be circumscribed by using the growth extrapolation method. A panel of human leukemia-lymphoma cell-lines representing Epstein-Barr virus carrying lymphoblastoid cells of presumed nonneoplastic derivation and neoplastic T- and B-lymphocytes was used to test the efficiency of this method. The sensitivity to radiation could be determined for all these cell types. The growth extrapolation method gave generally the same result as conventional cloning demonstrated by comparison with one exceptional cell-line with capacity for cloning in agar. The sensitivity varied largely between the different cell types. A common feature was that none of the cell lines had a good capacity to accumulate sublethal radiation injury.

DNA and its synthesis in individual tumor cells from human upper respiratory tract squamous cell carcinomas

Measurements of cytophotometric Feulgen DNA content and incorporation of 3H-thymidine were made in individual tumor cells from 58 patients with squamous cell carcinomas of the head-neck region. These measurements were correlated with a point ranking system for pathological grading for these types of tumors. Two of the parameters of the grading system, mode of invasion and nuclear polymorphism which had been found to be important factors in prognosis in clinical studies were correlated to the objective cellular DNA measurements. In 40 carcinomas, 10 were found to have a predominantly diploid distribution of DNA values, while the remaining 30 tumor values were either multiples of diploid or were aneuploid. Generally, tumors with low point rankings for individual morphological parameters tended to have diploid DNA values. Those tumors with higher DNA values usually had larger point rankings and more advanced clinical stage. When tumor cells from biopsies of 39 patients were studied by 3H-thymidine incorporation, no relevant connections between the labeling index and cellular DNA amounts, malignancy grading, or clinical stage were found.

Possible tumour markers in patients with oesophagus cancer

Carcinoembryonic antigen (CEA), alpha-foetoprotein (AFP), and enzymes were determined in the blood of 59 patients with primary oesophagus carcinoma. Raised CEA values were encountered in 59% of the patients, and AFP above that of an age-matched control group in 33% of the patients. Values of CEA during progression were significantly higher than in regression of disease. Two patients had exceptionally high serum AFP, but in most cases AFP levels were not related to disease progress. CEA and AFP could appear in a discordant fashion. The combined assay did not improve diagnostic sensitivity.

Acute infections in interferon-treated patients with osteosarcoma: preliminary report of a comparative study

The incidence of acute infections in eight patients with osteosarcoma who are receiving interferon regularly is currently being compared with the incidence among their family members. Observations thus far indicate that the patients treated with interferon are less frequently and less severely ill than their untreated family contacts. The study is continuing, and the patients will also be observed after discontinuation of interferon treatment. Sera are regularly frozen for future viral serologic tests. The preliminary clinical data indicate that therapy with exogenous interferon may afford protection against common acute infections.

Aspiration biopsy of salivary gland tumors. VI. Morphologic studies on smears and histologic sections from mucoepidermoid carcinoma

The cytologic findings in fine-needle aspiration biopsy of 24 primary mucoepidermoid carcinomas of salivary glands are reviewed. The morphologic details which permit recognition of this tumor in smears of the aspirate are described.