Analysis of Data that is in the Form of Categories Part II: Beyond the 2*2 Contingency Table-Partitioning Chi-Square Tests

This article extends the analysis of 2*2 tables considered in the preceding paper of this three-part series. The methods described in the previous paper for analysis of frequency counts of categorical variables in 2*2 tables, including overall tests, partitioned tests, odds ratios, and estimation of required sample size, are applied to tables with multiple levels, such as those with more than two response factors and/or more than two levels for each factor.

Analyzing Data from Experiments in which the Outcome is Time to an Event

This is the third in a series of articles devoted to a simplified description of experimental design, statistical analysis, and interpretation. The present article deals with an overview of time to event methods, the importance of censored information, and the utilization of survival methods with three concrete examples. These methods can be used to design experiments with increased power to detect significant differences. Experiments planned with time to event methods usually have reduced sample size requirements.

Analysis of Data that is in the Form of Categories

This is the fifth installment in a series of articles devoted to a simplified description of statistical techniques. Here we are concerned with the analysis of nominal and ordinal categorical variables where the outcomes are counts or frequencies of events that are observed in an experiment. Examples are given for chi-square analysis of 2 * 2 tables, for the calculation and interpretation of odds ratios, and for the estimation of sample sizes in experiments where outcomes are categorical.

The Analysis of Variance (ANOVA)

This is the fourth in a series of articles devoted to a simplified description of experimental design, statistical analysis and interpretation. This article deals with a basic description of the analysis of variance (ANOVA) and its methods of computation and hypothesis testing. Examples are provided in which a one-way ANOVA is analyzed; methods for post-ANOVA pair-wise comparisons of treatment means are also discussed.

Variation in small bowel length: factor in achieving total enteroscopy?

BACKGROUND AND AIM

Estimation of small bowel length is of interest following the recent development of device-assisted enteroscopy. This new technology allows access to the deep small bowel, but rates of examination of the entire small bowel (total enteroscopy) differ between study populations. Variation in small bowel length could factor into this observed irregularity in total enteroscopy rates. Medical literature contains limited information regarding small bowel length in living patients and conflicting data regarding small bowel length and its relationship to height and weight. We carried out small bowel measurements on surgical patients to further define the total length of the small bowel and its relationship to height, weight and body mass index (BMI).

METHODS

Measurement of ileojejunal length on 91 surgical patients undergoing laparotomy for routine indications. Demographic data were collected for each subject, including height, weight and BMI.

RESULTS

Small bowel length was found to vary widely between individuals (average 998.52 cm, range 630-1510 cm). Linear regression analysis demonstrated a statistically significant relationship between small bowel length and height (regression coefficient = 0.0561, P-value = 0.0238). A linear relationship between small bowel length and weight or BMI was not observed.

CONCLUSIONS

Length of the small bowel in humans is pertinent to advances in deep enteroscopy and existing surgical applications such as intestinal bypass and prevention of short gut syndrome. If average small bowel length varies with height, total enteroscopy may be easier to achieve in patients who are short in stature.

Modulation of immune signaling, bacterial clearance, and corneal integrity by toll-like receptors during streptococcus pneumoniae keratitis

PURPOSE

Bacterial keratitis, without effective antimicrobial treatment, leads to poor patient prognosis. Even after bacterial clearance, the host inflammatory response can contribute to corneal damage. Though Streptococcus pneumoniae (pneumococcus) is a common cause of bacterial keratitis, the role of host innate immunity during pneumococcal keratitis is not well characterized. This study investigated the role of Toll-like receptors (TLRs) during pneumococcal keratitis.

MATERIALS AND METHODS

C57BL/6, as well as TLR2(-/-) and TLR4(-/-) mice, were infected with S. pneumoniae, and infected corneas were examined for 21 days. Quantitative real-time reverse-transcriptase polymerase chain reaction was performed using primers for genes involved in the inflammatory response and TLR signaling. Bacterial survival and leukocyte invasion were examined over a 72-h period.

RESULTS

The corneal expression of TLR2, TLR4, and other inflammatory genes was increased at 72 h post-infection (p.i.) compared to uninfected C57BL/6 scratch controls. TLR2(-/-) mice showed a significant increase in bacterial survival at 24 h p.i. likely due to decreased neutrophil infiltration; however, after Day 5 p.i. observed clinical scores of TLR2(-/-) and C57BL/6 mice were not significantly different. In contrast, permanent corneal damage was observed for TLR4(-/-) mice over 21 days. Initially, both TLR(-/-) mouse strains exhibited lower expression levels in many immune genes, but returned to similar or elevated levels compared to C57BL/6 mice by 72 h p.i.

CONCLUSIONS

TLR2 and TLR4 are involved in the response to pneumococcal keratitis and TLR2 may aid in bacterial clearance by recruitment of neutrophils to the cornea, whereas TLR4 may be necessary to modulate the immune response to limit cellular damage.

HSV-1 latent rabbits shed viral DNA into their saliva

Background

Rabbits latent with HSV-1 strain McKrae spontaneously shed infectious virus and viral DNA into their tears and develop recurrent herpetic-specific corneal lesions. The rabbit eye model has been used for many years to assess acute ocular infections and pathogenesis, antiviral efficacy, as well as latency, reactivation, and recurrent eye diseases. This study used real-time PCR to quantify HSV-1 DNA in the saliva and tears of rabbits latent with HSV-1 McKrae.

Methods

New Zealand white rabbits used were latent with HSV-1 strain McKrae and had no ocular or oral pathology. Scarified corneas were topically inoculated with HSV-1. Eye swabs and saliva were taken from post inoculation (PI) days 28 through 49 (22 consecutive days). Saliva samples were taken four times each day from each rabbit and the DNA extracted was pooled for each rabbit for each day; one swab was taken daily from each eye and DNA extracted. Real-time PCR was done on the purified DNA samples for quantification of HSV-1 DNA copy numbers. Data are presented as copy numbers for each individual sample, plus all the copy numbers designated as positive, for comparison between left eye (OS), right eye (OD), and saliva.

Results

The saliva and tears were taken from 9 rabbits and from 18 eyes and all tested positive at least once. Saliva was positive for HSV-1 DNA at 43.4% (86/198) and tears were positive at 28.0% (111/396). The saliva positives had 48 episodes and the tears had 75 episodes. The mean copy numbers ± the SEM for HSV-1 DNA in saliva were 3773 ± 2019 and 2294 ± 869 for tears (no statistical difference).

Conclusion

Rabbits latent with strain McKrae shed HSV-1 DNA into their saliva and tears. HSV-1 DNA shedding into the saliva was similar to humans. This is the first evidence that documents HSV-1 DNA in the saliva of latent rabbits.

Upregulation of mouse genes in HSV-1 latent TG after butyrate treatment implicates the multiple roles of the LAT-ICP0 locus

PURPOSE

To determine host response by gene expression in HSV-1 latent trigeminal ganglia (TG) after sodium butyrate (NaBu) treatment.

METHODS

Corneas of 6-week-old female BALB/c mice were scarified and inoculated with HSV-1 17Syn(+) (high phenotypic reactivator) or its mutant 17ΔPst(LAT(-)) (low phenotypic reactivator) at 10(4) plaque-forming units/eye. NaBu-induced viral reactivation was by intraperitoneal (IP) administration at postinfection (PI) day 28, followed by euthanasia after 1 hour. NaBu-treated, uninfected mice served as the control. The resultant labeled cRNA from TG isolated total RNA was hybridized to gene microarray chips containing 14,000 mouse genes. Quantitative real-time PCR was performed to confirm gene expression.

RESULTS

Differential induction of gene expression between 17Syn(+) and its mutant 17ΔPst(LAT(-)) was designated as NaBu-induced gene expression and yielded significant upregulation of 2- to 16-fold of 0.4% (56/14,000) host genes probed, comprising mainly nucleosome assembly and binding, central nervous system structural activity, hormonal activity, and signaling activity. Approximately 0.2% (24/14,000) of the host genes, mainly of the same functional categories were downregulated 3- to 11-fold. Immune activity was minor in comparison to our reports on gene expression during latency and heat stress induction. Euchromatin analysis revealed that the LAT-ICP0 locus is amenable to the effects of NaBu. Histone activity was detected by early transcription of histone cluster 2 H2be (Hist2h2be). CONCLUSIONS NaBu-induced reactivation of HSV-1 is twofold: drug action involving significant moderation of specific host epigenetic changes and failure to elicit or suppress immune activity at the early time point of 1 hour.

Clinical and antiviral efficacy of an ophthalmic formulation of dexamethasone povidone-iodine in a rabbit model of adenoviral keratoconjunctivitis

PURPOSE

To determine the efficacy of a new formulation of topical dexamethasone 0.1%/povidone-iodine 0.4% (FST-100) in reducing clinical symptoms and infectious viral titers in a rabbit model of adenoviral keratoconjunctivitis.

METHODS

Rabbit corneas were inoculated bilaterally with 2×10(6) plaque-forming-units (PFU) of adenovirus type 5 (Ad5) after corneal scarification. Animals were randomized 1:1:1:1 (five rabbits per group) to FST-100, 0.5% cidofovir, tobramycin/dexamethasone (Tobradex; Alcon Laboratories, Fort Worth, TX) ophthalmic suspension, and balanced salt solution (BSS; Alcon Laboratories). Treatment began 12 hours after viral inoculation and continued for 7 consecutive days. The eyes were clinically scored daily for scleral inflammation (injection), ocular neovascularization, eyelid inflammation (redness), friability of vasculature, inflammatory discharge (pus), and epiphora (excessive tearing). Eye swabs were collected daily before treatment for the duration of the study. Virus was eluted from the swabs and PFU determined by titration on human A549 cells, according to standard procedures.

RESULTS

The FST-100 treatment resulted in significantly lower clinical scores (P<0.05) than did the other treatments. The 0.5% cidofovir exhibited the most ocular toxicity compared with FST-100, tobramycin/dexamethasone, and balanced salt solution treatments. FST-100 and 0.5% cidofovir significantly (P<0.05) reduced viral titers compared with tobramycin/dexamethasone or balanced salt solution.

CONCLUSIONS

FST-100 was the most efficacious in minimizing the clinical symptoms of adenovirus infection in rabbit eyes. FST-100 and 0.5% cidofovir were both equally effective in reducing viral titers and decreasing the duration of viral shedding. By providing symptomatic relief in addition to reducing infectious virus titers, FST-100 should be a valuable addition to treatment of epidemic adenoviral keratoconjunctivitis.

Effect of high versus low oral doses of valacyclovir on herpes simplex virus-1 DNA shedding into tears of latently infected rabbits

PURPOSE

To assess the effect of high doses of valacyclovir (VCV) on HSV-1 DNA shedding into tears of latently infected rabbits.

METHODS

Three oral doses of VCV were tested. Corneas were inoculated with HSV-1, and latent infection was allowed to establish. Starting on postinoculation (PI) day 28, tear swabs were collected once daily for 6 consecutive days before treatment. The rabbits were placed in five balanced groups: group 1 had no treatment, group 2 received placebo, group 3 received 7 mg/kg VCV, group 4 received 70 mg/kg, and group 5 received 140 mg/kg. The treatment was administered by oral gavage twice daily, starting on PI day 36 and continuing for 14 days. The ocular swabs were collected beginning on PI day 40 and continuing for 10 days.

RESULTS

The mean copy number of HSV-1 DNA before treatment was 370+/-70, 569+/-273, 368+/-86, 408+/-108, and 396+/-91, and the mean HSV-1 DNA copy number after treatment was 232+/-183, 564+/-186, 518+/-122, 67+/-63, and 13+/-7 in groups 1 to 5, respectively.

CONCLUSIONS

There was no observable toxicity in any group. The 70- and 140-mg/kg doses of VCV significantly reduced the HSV-1 DNA copy number, compared with that of the other three groups. A daily dose of 500 mg (approximately 7 mg/kg) VCV in healthy human volunteers did not suppress HSV-1 DNA shedding in tears and saliva. Thus, higher doses of VCV may be necessary to reduce asymptomatic shedding in healthy human subjects.

Protein structure classification based on conserved hydrophobic residues

Protein folding is frequently guided by local residue interactions that form clusters in the protein core. The interactions between residue clusters serve as potential nucleation sites in the folding process. Evidence postulates that the residue interactions are governed by the hydrophobic propensities that the residues possess. An array of hydrophobicity scales has been developed to determine the hydrophobic propensities of residues under different environmental conditions. In this work, we propose a graph-theory-based data mining framework to extract and isolate protein structural features that sustain invariance in evolutionary-related proteins, through the integrated analysis of five well-known hydrophobicity scales over the 3D structure of proteins. We hypothesize that proteins of the same homology contain conserved hydrophobic residues and exhibit analogous residue interaction patterns in the folded state. The results obtained demonstrate that discriminatory residue interaction patterns shared among proteins of the same family can be employed for both the structural and the functional annotation of proteins. We obtained on the average 90 percent accuracy in protein classification with a significantly small feature vector compared to previous results in the area. This work presents an elaborate study, as well as validation evidence, to illustrate the efficacy of the method and the correctness of results reported.

A framework for detecting glaucomatous progression in the optic nerve head of an eye using proper orthogonal decomposition

Glaucoma is the second leading cause of blindness worldwide. Often, the optic nerve head (ONH) glaucomatous damage and ONH changes occur prior to visual field loss and are observable in vivo. Thus, digital image analysis is a promising choice for detecting the onset and/or progression of glaucoma. In this paper, we present a new framework for detecting glaucomatous changes in the ONH of an eye using the method of proper orthogonal decomposition (POD). A baseline topograph subspace was constructed for each eye to describe the structure of the ONH of the eye at a reference/baseline condition using POD. Any glaucomatous changes in the ONH of the eye present during a follow-up exam were estimated by comparing the follow-up ONH topography with its baseline topograph subspace representation. Image correspondence measures of L1-norm and L2 -norm, correlation, and image Euclidean distance (IMED) were used to quantify the ONH changes. An ONH topographic library built from the Louisiana State University Experimental Glaucoma study was used to evaluate the performance of the proposed method. The area under the receiver operating characteristic curves (AUCs) was used to compare the diagnostic performance of the POD-induced parameters with the parameters of the topographic change analysis (TCA) method. The IMED and L2-norm parameters in the POD framework provided the highest AUC of 0.94 at 10 degrees field of imaging and 0.91 at 15 degrees field of imaging compared to the TCA parameters with an AUC of 0.86 and 0.88, respectively. The proposed POD framework captures the instrument measurement variability and inherent structure variability and shows promise for improving our ability to detect glaucomatous change over time in glaucoma management.

A double-blind placebo-controlled study to evaluate valacyclovir alone and with aspirin for asymptomatic HSV-1 DNA shedding in human tears and saliva

PURPOSE

To test the effect of valacyclovir alone and with aspirin on the asymptomatic shedding of HSV-1 DNA in tears and saliva of healthy individuals. METHOD. The subjects (n = 45) were randomized into three groups without regard to age, sex, or race. Group 1 (n = 14) received the placebo, group 2 (n = 15) received a dose of 500 mg valacyclovir once daily, and group 3 (n = 16) received a dose of 500 mg valacyclovir once daily and 350 mg aspirin twice daily for 30 days. Ocular and oral swabs were collected twice daily for 30 days. DNA was extracted from all swabs and HSV-1 DNA copy numbers were determined. Statistical analysis was performed to compare the DNA copy numbers of the three groups.

RESULTS

There was no significant difference in the HSV-1 DNA copy numbers in the tears or saliva among any of the three treatment groups. The mean copy numbers +/- SE of mean (SEM) of HSV-1 DNA in tears were 340 +/- 35, 1074 +/- 320, and 630 +/- 51 for groups 1, 2, and 3, and in saliva were 238 +/- 35, 963 +/- 462, and 493 +/- 25, respectively, for groups 1, 2, and 3.

CONCLUSIONS

No correlation was found between HSV-1 shedding and valacyclovir and valacyclovir with aspirin treatment. The HSV-1 DNA copy number was not reduced by treatment with 500 mg of valacyclovir daily or with a combination of daily valacyclovir (500 mg) plus twice-daily doses of aspirin (350 mg) over 30 days.

Apolipoprotein E Modulates Establishment of HSV-1 Latency and Survival in a Mouse Ocular Model

PURPOSE

To evaluate and compare the neuroinvasiveness and neurovirulence after ocular HSV-1 infection in ApoE knockout (ApoE-/-) and control C57BL/6 (ApoE+/+) mice.

METHODS

Age-matched (14 weeks of age) C57BL/6J (ApoE+/+) female mice and female ApoE knockout (ApoE-/-) mice were inoculated by corneal scarification with HSV-1 strain 17Syn+. Analysis of HSV-1 replication in the mouse cornea was assessed through infectious virus assays of ocular (tear film) swabs at 1 to 5 days postinoculation (PI), slit-lamp examination (SLE) of corneas at PI days 1 to 7, and survival of infected mice. The contribution of apoE to the efficient establishment of latency was measured by real-time PCR quantitation of the latent viral genome in the trigeminal ganglia (TG) of infected mice.

RESULTS

These studies showed that HSV-1 strain 17Syn+ replicates efficiently in the eyes, regardless of the host ApoE genotype. Neither the scoring of corneal pathology via SLE nor the infectious virus assay of the tear film resulted in any statistical differences between ApoE knockout (-/-) mice or the C57BL/6 (ApoE+/+) mice. In mice latently infected with HSV-1, our real-time PCR data showed significantly lower viral copy numbers of HSV-1 DNA in ApoE knockout (ApoE-/-) mice compared with C57BL/6 (ApoE+/+) mice. C57BL/6 (ApoE+/+) mice are more susceptible to the neurovirulence of HSV-1 strain 17Syn+ than female ApoE knockout (-/-) mice, as demonstrated by the fact that 50% (7/14) of the female C57BL/6 (ApoE+/+) mice inoculated with 17Syn+ died, as opposed to none (0/14) of the age- and sex-matched ApoE knockout mice.

CONCLUSIONS

These data indicate that age (14 weeks) and sex-matched (female) wild mice with an ApoE null background (ApoE-/-) are more resistant and less efficient in the establishment of latency compared with ApoE+/+ mice in the C57BL/6 background.

Molecular and cellular responses of the corneal epithelium to wound healing

The corneal epithelium responds rapidly to injury, repairing defects with a layer of cells that covers the denuded corneal surface and prevents infection and loss of vision. After a wound, reorganization of the remaining epithelial cells occurs over several hours, resulting in the formation of a migratory leading edge. However, expression of genes such as c-fos occurs within minutes of wounding. This early expression may be important for directing epithelial reorganization and the later mitotic burst. Our results show that receptors for epidermal growth factor are upregulated in the migratory cell population. Proliferation through a mitotic burst was observed in cells surrounding the original wound margin after 36 hours. The interaction between gene expression and cell surface receptors for growth factors and cell proliferation suggests that wound healing occurs in a complex, but tightly controlled process in the corneal epithelium.

WITHDRAWN: Synergistic interaction of aciclovir and a helicase-primase inhibitor, BAY 57-1293, against herpes simplex virus type 1

This article has been withdrawn at the request of the author(s). The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Effective treatment of ocular HSK with a human apolipoprotein E mimetic peptide in a mouse eye model

PURPOSE

To evaluate efficacy of the small apolipoprotein E (apoE) mimetic dimer peptide (apoEdp) in the treatment of herpetic stromal keratitis in a mouse ocular model and determine its therapeutic effects against HSV-1-induced inflammatory cytokines.

METHODS

Female C57Bl/6 mice were corneally infected with HSV-1 strain KOS-GFP; topical treatment was initiated 24 hours after infection and continued for 10 consecutive days. Treatment groups were 1% apoEdp, 1% trifluorothymidine (TFT), and phosphate-buffered saline (PBS). The incidence and severity of stromal keratitis were monitored by slit lamp examination in a masked fashion. Infectious HSV-1 titer in eye swabs and alteration in inflammatory cytokines were determined in the early postinfection period by real-time RT-PCR.

RESULTS

One percent apoEdp treatment, which significantly reduced the incidence and severity of HSK, was equal to the effect of 1% TFT; both groups had significantly lower incidence and severity than the placebo treatment group. The in vivo mouse ocular model results of apoEdp therapy correlated with accelerated clearance of virus from eye swabs. Topical 1% apoEdp treatment in mice significantly downregulated gene expression of mouse proinflammatory cytokines.

CONCLUSIONS

These results suggest that topical treatment with apoE peptide has efficacy against HSK through anti-HSV-1 and anti-inflammatory activities.

Effect of human apolipoprotein E genotype on the pathogenesis of experimental ocular HSV-1

The isoform-specific role of human apolipoprotein E (apoE) has been assessed in a mouse model of ocular herpes. Female, age-matched transgenic mice knocked-in for the human allele apoE3 or apoE4 and their parent C57Bl/6 mice were inoculated corneally with HSV-1 strain KOS. Ocular HSV-1 pathogenesis was monitored through viral replication and clinical progression of stromal opacity and neovascularization by slit-lamp examination. Establishment of latency was determined by analysis of HSV-1 DNA (copy number) by specific real-time PCR in the cornea, trigeminal ganglia (TG), and brain. Representative groups of transgenic mice were sacrificed for the analysis of gene expression of vascular endothelial growth factor (VEGF) by reverse-transcription PCR, and apoE expression by Western blot analysis. At 6days post-infection (P.I.), the ocular infectious HSV-1 titer was significantly higher (p<0.05) in apoE4 mice compared with apoE3 and C57Bl/6 mice. Corneal neovascularization in apoE4 mice was significantly higher (p<0.05) than apoE3 and C57Bl/6 mice. The onset of corneal opacity in apoE4 mice was accelerated during days 9-11 P.I.; however, no significant difference in severity was seen on P.I. days 15 and beyond. At 28 days P.I., infected mice of all genotypes had no significant differences in copy numbers (range 0-15) of HSV-1 DNA in their corneas, indicating that HSV-1 DNA copy numbers in cornea are independent of apoE isoform regulation. At 28 days P.I., both apoE4 and C57Bl/6 mice had a significantly higher (p=0.001) number of copies of HSV-1 DNA in TG compared with apoE3. ApoE4 mice also had significantly higher (p=0.001) copies of HSV-1 DNA in their TGs compared with C57Bl/6 mice. In brain, both apoE4 and C57Bl/6 mice had significantly higher numbers (p<or=0.03) of copies of HSV-1 DNA compared with apoE3 mice. However, the number of HSV-1 DNA copies in the brain of C57Bl/6 mice was not significantly different than that of apoE4 (p=0.1). Comparative molecular analysis between apoE3 and apoE4 mice on selected days between 7 and 28 P.I., inclusive, revealed that the corneas of apoE4 mice expressed VEGF. None of the corneas in the apoE3 mice expressed VEGF during this time. Western blot analysis showed proteolytic cleavage of the apoE protein in the corneas of the apoE4 mice. Through days 14-28 P.I., a approximately 29 kDa C-terminal truncated apoE fragment was present in the corneas of apoE4 mice, but not in apoE3 mice. ApoE4 is a risk factor for ocular herpes, in part, through increased replication of virus in the eye, an earlier onset in clinical opacity, significantly higher neovascularization, and increased HSV-1 DNA load in TG and brain than that of apoE3. Increased pathogenesis of ocular herpes in apoE4 mice was also mediated, in part through up-regulated expression of VEGF and apoE proteolysis in the cornea. This is the first report linking a human gene, apoE4, as a risk factor for ocular herpes pathogenesis in a transgenic mouse model.

Efficacy of a helicase-primase inhibitor in animal models of ocular herpes simplex virus type 1 infection

PURPOSE

The aim of this study was to evaluate the effect of BAY 57-1293, a helicase-primase inhibitor, on herpes simplex virus type 1 (HSV-1) reactivation in mice and its efficacy on established disease in rabbits.

METHODS

BALB/c mice latent for McKrae-strain HSV-1 were reactivated via heat stress, treated with BAY 57-1293, and their corneas were swabbed for virus or the trigeminal ganglia (TG) obtained for quantification of viral DNA. New Zealand white rabbits were infected and treated topically or orally in comparison with trifluridine or valacyclovir.

RESULTS

Oral BAY 57-1293 suppressed reactivation in HSV-1-infected mice and reduced the viral load in TG up to four orders of magnitude. In the rabbits, the therapeutic efficacies of topical BAY 57-1293 and trifluridine were similar. Once-daily oral BAY 57-1293 was significantly more effective than valacyclovir and as effective as twice a day topical trifluridine.

CONCLUSIONS

BAY 57-1293 may be more effective than valacyclovir, without the cytotoxicity or potential healing retardation seen with trifluridine. Oral BAY 57-1293 may be a substitute for eye drops as an effective treatment for herpetic keratitis and might be useful in treating stromal keratitis and iritis, as well as preventing recurrences of ocular herpes.

Are release recommendations for NGRI acquittees informed by relevant data?

We conducted a retrospective review of factors involved in clinical recommendations for release of patients adjudicated not guilty by reason of insanity (NGRI). Medical records from 91 patients in a maximum security forensic hospital who participated in a formal hearing process to determine suitability for release were reviewed. The purpose of the study was twofold: (1) to examine the process involved in day to day clinical decision-making regarding release from a maximum security forensic hospital and (2) to determine what factors in a patient's clinical and legal history were related to recommendation decisions. Multivariate statistical methods revealed that among the clinical, demographic, and legal information available to clinicians at the time a formal release recommendation was made two factors emerged that were significantly related to release recommendations: PCL-R score and the age at which the patient committed his first criminal offense. Patients with high levels of psychopathy and those who engaged in criminal behavior at a younger age were less likely to be recommended for release from a maximum security forensic hospital.

Long-term study of accommodative esotropia

PURPOSE

This study aimed, using a large sample size, to determine the long-term results of standard treatment of accommodative esotropia and identify predictors of outcome while minimizing bias in data collection and analysis.

METHODS

Data from all the files of a large, long-established pediatric ophthalmology practice were collected and analyzed using a masked protocol. The study included every esotropic patient who had been prescribed glasses. Criteria for patient inclusion were designed to conform to earlier studies by the authors.

RESULTS

The database totaled 1307 patients, of who 354 met inclusion criteria. A greater difference between near and distance esodeviation (AC/A relationship) correlated with a higher rate of deterioration of accommodative esotropia control (P < 0.0001). Deterioration also positively correlated with earlier age of onset (P < 0.0001), inferior oblique overaction (P = 0.0005), and amblyopia (P < 0.005).

CONCLUSIONS

This study demonstrates that a high AC/A relationship increases the likelihood of deterioration of accommodative esotropia, supporting the earlier studies, as well as the accuracy of this database. It also represents a new model for the utilization of clinical trials' bias-reduction principals in the analysis of retrospective data.

Can a herpes simplex virus type 1 neuroinvasive score be correlated to other risk factors in Alzheimer's disease?

Herpes simplex virus type 1 (HSV-1) is latent in the nervous system of most humans. Ball [Can J Neurol Sci 9 (1982) 303] first suggested the hypothesis that HSV-1 could be involved in the pathogenesis of Alzheimer's Disease (AD) by noting that regions of the brain particularly and earliest affected in AD were the same as those most damaged during HSV encephalitis. Data from Itzhaki's research suggests that HSV-1 in the brain and the carriage of an apolipoprotein E allele 4 (ApoE e4) together confer risk for AD [J Pathol 97 (2002) 395], [Mol Chem Neuropathol 28 (1996) 135], [Alzheimer's Rep 1 (1998) 173], [Biochem Soc Trans 26 (1998) 273]. Of the two other studies based on Itzhaki's findings, one showed similar results [Lancet 349 (1997) 1102], and the other showed a similar trend [Lancet 351 (1998) 1330], [Lancet 352 (1998) 1312]. To further examine the role of HSV-1 in the etiology of AD, we have formulated a Neuroinvasive Score that quantifies the presence and viral load of HSV-1 in eight brain regions. These regions are: entorhinal cortex, hippocampus, pons, cerebellum, and neocortex (temporal, parietal, occipital, and frontal). We hypothesize that the Neuroinvasive Score that encompasses the presence, amount, and extent of HSV-1 spreading (neuroinvasiveness), will correlate with the genetic risk factor, ApoE e4, in the assessment of autopsy samples from AD patients. If the neuroinvasive score can be directly correlated to the different stages of AD (mild, moderate, severe), this will strengthen the hypothesis that HSV-1 is involved in AD and that ApoE e4 also confers risk for the development and progression of AD.

HSV-1 DNA in tears and saliva of normal adults

PURPOSE

To assess the frequency of shedding of herpes simplex virus type 1 (HSV-1) DNA in tears and saliva of asymptomatic individuals.

METHODS

Fifty subjects without signs of ocular herpetic disease participated. Serum samples from all subjects were tested for HSV IgG antibodies by enzyme-linked immunosorbent assay (ELISA) and for HSV-1 by neutralization assay. HSV-1 DNA copy number and frequency of shedding were determined by real-time polymerase chain reaction (PCR) analysis of tear and saliva samples collected twice daily for 30 consecutive days.

RESULTS

Thirty-seven (74%) of the 50 subjects were positive for HSV IgG by ELISA. The percentages of positive eye and mouth swabs were approximately equivalent: 33.5% (941/2806) and 37.5% (1020/2723), respectively. However, the percentage of samples with high HSV-1 genome copy numbers was greater in saliva than in tears, which may have been a result of the sample volume collected. Shedding frequency in tears was nearly the same in men (347/1003; 34.6%) and women (594/1705; 34.8%); in saliva, men had a higher frequency of shedding (457/1009; 45.3% vs. 563/1703; 33.1%, men versus women). Overall, 49 (98%) of 50 subjects shed HSV-1 DNA at least once during the course of the 30-day study.

CONCLUSIONS

The percentage of asymptomatic subjects who intermittently shed HSV-1 DNA in tears or saliva was higher than the percentage of subjects with positive ELISA or neutralization antibodies to HSV. Because most HSV transmission occurs during asymptomatic shedding, further knowledge of the prevalence of HSV-1 DNA in tears and saliva is warranted to control its spread. Shedding is simple to study, and its suppression may be an efficient way to evaluate new antivirals in humans.

COMPARISON OF RETINAL OUTCOMES AFTER SCLERAL BUCKLE OR LENS-SPARING VITRECTOMY FOR STAGE 4 RETINOPATHY OF PREMATURITY

PURPOSE

To compare anatomic outcomes after lens-sparing vitrectomy (LSV) or scleral buckle (SB) for stage 4 retinopathy of prematurity (ROP).

METHODS

Nonrandomized, retrospective study of infants consecutively treated for stage 4 ROP by LSV or SB. Outcomes were retinal attachment at 1 month of initial surgery and at the end of follow-up (6 months) and number of procedures to achieve retinal attachment. Exact chi2 methods determined significance, and student's t-test compared mean postmenstrual age and birthweight between the groups.

RESULTS

After one procedure, LSV (72%) was associated with retinal attachment more often than was SB (31%). At the end of follow-up, after one or more procedures, there was no difference in retinal reattachment rate between LSV or SB as the first procedure. There were no differences between the surgical groups by mean postmenstrual age and birthweight or severity of ROP determined by zone, clock hours of ridge elevation, or quadrants of plus disease.

CONCLUSION

This study supports the hypothesis that vitrectomy by LSV stops progressive stage 4 ROP. As an initial procedure, LSV was associated with retinal attachment more often than SB. Future prospective studies can determine the effects of LSV and SB on visual development in progressive stage 4 ROP.

Bupropion (Zyban, Wellbutrin) inhibits nicotine-induced viral reactivation in herpes simplex virus type 1 latent rabbits

We reported that nicotine applied via a transdermal patch (21 mg/day) induced viral reactivation and ocular shedding in herpes simplex virus type 1 (HSV-1) latent rabbits. One possible mechanism of action involves the release of catecholamines and other similar agents, triggering HSV reactivation. Bupropion (Zyban, Wellbutrin), a non-nicotine aid to smoking cessation, inhibits neuronal uptake of norepinephrine, serotonin, and dopamine. To determine whether bupropion inhibits HSV reactivation, rabbits latent with HSV-1 were grouped (at least 10 rabbits/group) and treated as follows: nicotine patch (transdermal delivery) and bupropion [Zyban sustained-release tablets (150 mg) twice a day (oral)], nicotine patch only, Zyban tablets only [twice a day (oral)], nicotine patch with oral placebo [twice a day (oral)], or no drug treatment. Eyes were swabbed for 22 consecutive days. The appearance of HSV-1 in the tear film was significantly less frequent in the bupropion-treated rabbits, in terms of positive rabbits/total rabbits, positive eyes/total eyes, and positive swabs/total swabs. Nicotine-treated rabbits had 78/440 (17.7%) positive/total swabs, and nicotine/placebo-treated rabbits had 149/792 (18.8%) positive/total swabs, whereas bupropion-treated rabbits had 23/440 (5.2%), and nicotine/bupropion-treated rabbits had 47/792 (5.9%) positive/total swabs. Thus, bupropion significantly reduces nicotine-induced HSV reactivation in latent rabbits.

Anterior scleral canal geometry in pressurised (IOP 10) and non-pressurised (IOP 0) normal monkey eyes

AIMS

To characterise lamina cribrosa and anterior scleral canal wall architecture in pressurised (IOP 10 mm Hg) and non-pressurised (IOP 0 mm Hg) normal monkey eyes.

METHODS

Eight normal eyes from eight monkeys were enucleated before sacrifice and the optic nerve heads (ONH) trephined and immersion fixed in glutaraldehyde (IOP 0). Nine normal eyes from nine monkeys were perfusion fixed in situ with paraformaldehyde at IOP 10 mm Hg (IOP 10), and the ONHs trephined and stored in glutaraldehyde. Each ONH specimen was embedded in glycol methacrylate and cut into vertical or horizontal, 4 micro m thick, serial sections. Within digitised images of every sixth section, anterior laminar position and laminar thickness were measured at nine evenly spaced locations across the scleral canal opening. Additionally, scleral canal diameters at Bruch's membrane (SCD-B) and at the anterior laminar insertion (SCD-ALI) were measured within the 15 middle section images of each vertically sectioned ONH.

RESULTS

Anterior laminar position was significantly more anterior (nearer Bruch's membrane) in the IOP 10 eyes, compared with the IOP 0 eyes (116 (+/-95% CI; 2) micro m v 184 (2) micro m, respectively). Also in the IOP 10 eyes, the lamina cribrosa was thinner (195 (2) micro m v 264 (2) micro m) and the scleral canal diameter was larger (SCD-B: 1751 (23) micro m v 1591 (19) micro m; SCD-ALI: 1961 (21) micro m v 1717 (17) micro m), compared with the IOP 0 eyes.

CONCLUSION

The anterior scleral canal wall is expanded and the lamina cribrosa is thinned and more tautly stretched within pressurised (perfusion fixed at IOP 10) young monkey eyes, compared with non-pressurised (immersion fixed at IOP 0) young monkey eyes. The constricted scleral canal and the relaxed and thickened lamina in the non-pressurised eyes may represent phenomena that contribute to optic disc swelling in hypotonous eyes.

Coordinate activation of HIF-1 and NF-kappaB DNA binding and COX-2 and VEGF expression in retinal cells by hypoxia

PURPOSE

Proinflammatory signaling mechanisms are implicated in the induction of retinal neovascularization (NV) during ischemic retinopathies. This study examined transcription factor (TF) AP-1, HIF-1, and NF-kappaB DNA-binding in relation to cyclooxygenase (COX)-2 and VEGF RNA and protein levels in hypoxia-triggered monkey choroidal retinal (RF/6A) endothelial cells. Effects of the carboxamide CGP43182 were tested on COX-2 and VEGF activation and prostaglandin (PG)E(2) release.

METHODS

RF/6A cells were subjected to hypoxia for 1 and 3 hours, at which times RNA and proteins were isolated. Potential AP-1, hypoxia-inducible factor (HIF)-1 and NF-kappaB DNA-binding sites were identified using DNA sequence search algorithms and were analyzed using gel-shift assay. COX-2 and VEGF RNA, protein, and PGE(2) levels were quantified by RT-PCR, Western analysis, and enzyme immunoassay, respectively. Tubular morphogenesis was analyzed with phase-contrast imaging microscopy.

RESULTS

Nuclear AP-1, HIF-1 and NF-kappaB promoter DNA binding increased 1.5-, 4-, and 3-fold, respectively, after 1 hour of hypoxia. COX-2 RNA was elevated five- and fourfold after 1 and 3 hours of hypoxia, respectively. VEGF RNA and protein abundance lagged behind COX-2 induction but were each increased two- to threefold 3 hours after hypoxia. CGP43182 was found to inhibit NF-kappaB DNA binding, COX-2 and VEGF gene expression, PGE(2) release, and hypoxia-induced tubular morphogenesis.

CONCLUSIONS

Maximum HIF-1 and NF-kappaB DNA binding immediately before COX-2 expression suggests that these TFs are important regulators of COX-2 induction in hypoxic RF/6A cells. IL-1beta emulated AP-1, HIF-1, and NF-kappaB DNA binding during hypoxia and may be a novel cytokine trigger for NV. CGP43182 appears to be an effective inhibitor of NV. VEGF expression appears to be regulated through dual interdependent mechanisms involving HIF-1 directly and indirectly through NF-kappaB-mediated COX-2 expression and PGE(2) production.

Long-term vision results measured with Teller Acuity Cards and a new Light Perception/Projection Scale after management of late stages of retinopathy of prematurity

OBJECTIVES

To report visual acuity (VA) measured by Teller Acuity Cards (TACs) and a new Light Perception/Projection (LPP) Scale in infants with regressed or treated stage 3, 4, or 5 retinopathy of prematurity (ROP), and to compare VA in eyes that underwent successful vitreoretinal surgery for stage 5 ROP with eyes with persistent retinal detachment.

METHODS

Nineteen infants (35 eyes) underwent VA testing using TACs and the LPP scale. The correlation between the methods was determined. Comparisons in VA scores were made in eyes by stage of ROP at the first examination and retinal status at the end of follow-up and between eyes with successful surgical reattachment and persistent retinal detachment.

RESULTS

Scores obtained with the LPP scale and TACs were highly correlated (Spearman rank-order correlation coefficient, 0.92; P<.001). Visual acuity was better in eyes with retinal attachment at the end of follow-up than in eyes with retinal detachment whether the ROP stage at first examination was 4A (n = 6), 4B (n = 16), or 5 (n = 6). In eyes that progressed to stage 5 ROP and had successful surgical retinal reattachment (n = 16), both methods of measurement yielded better visual function than in eyes with persistent retinal detachment. The LPP scale provided scores for eyes without quantifiable grating acuity determined with TAC.

CONCLUSIONS

The LPP scale scores were correlated with TAC scores in infants with stages 3, 4, and 5 ROP. Surgical retinal reattachment in stage 5 ROP resulted in better visual function. The LPP scale may be useful in measuring low vision in infants without quantifiable grating acuity and with later stages of ROP.

Analyzing data in which the outcome is time to an event part II: The presence of multiple covariates

In this article, the second of a series on the analysis of time to event data, we address the case in which multiple predictors (covariates) that may influence the time to an event are taken into account. The hazard function is introduced, and is given in a form useful for assessing the impact of multiple covariates on time to an event. Methods for the assessment of model fitting are also discussed and an example with cancer survival as outcome with the presence or absence of multiple genes as covariates is presented.

Deformation of the lamina cribrosa and anterior scleral canal wall in early experimental glaucoma

PURPOSE

To test the hypothesis that pathophysiologic deformation of the lamina cribrosa and anterior scleral canal wall underlies the onset of confocal scanning laser tomography (CSLT)-detected optic nerve head (ONH) surface change in early experimental glaucoma.

METHODS

Both eyes of four normal (two normal eyes) monkeys and four with early glaucoma (one eye with laser-induced IOP elevation, observed until the onset of CSLT-detected ONH surface change) were enucleated immediately after death and immersion fixed at IOP 0 mm Hg. In an additional four normal monkeys and five with early glaucoma, both eyes were cannulated, and IOP set to 10 mm Hg in one normal eye and either 30 or 45 mm Hg in the other (normal or early-glaucoma) eye. After 15 to 80 minutes of acute IOP elevation, these nine monkeys were perfusion-fixed. Within images of serial sagittal sections of the ONH tissues in all 17 monkeys, anterior lamina cribrosa position, laminar thickness, and scleral canal diameter were measured. For each parameter, differences between the two eyes of each monkey and between treatment groups were assessed by ANOVA.

RESULTS

Within the eyes of the eight monkeys with IOP 0 mm Hg, the lamina cribrosa was posteriorly displaced and thicker and the scleral canal was enlarged at Bruch's membrane and at the anterior laminar insertion in the early-glaucoma eyes compared with the contralateral normal eyes (plastic deformation). Within the high-IOP normal eyes, the lamina cribrosa was posteriorly displaced compared with that in the low-IOP normal eyes, but there were no significant differences in laminar thickness or scleral canal diameter (normal compliance). Within the high-IOP early-glaucoma eyes, the lamina cribrosa was posteriorly displaced and thicker and the scleral canal enlarged, compared with both low-IOP normal eyes and high-IOP normal eyes (hypercompliant deformation). Differences in laminar position between the high-IOP early-glaucoma eyes and the contralateral low-IOP normal eyes (hypercompliant plus plastic deformation) were more than eight times greater than the differences between the high-IOP normal eyes and the contralateral low-IOP normal eyes (normal compliance).

CONCLUSIONS

Both plastic (permanent) and hypercompliant deformation of the lamina cribrosa and anterior scleral canal wall are present in young adult monkey eyes with early experimental glaucoma. These findings suggest that damage to the ONH connective tissues occurs early in the monkey model of experimental glaucoma.

Long-term study of accommodative esotropia

PURPOSE

Previous studies of accommodative esotropia have been hampered by bias-prone methods of data collection and analysis and by small sample size. The studies have conflicting conclusions, causing uncertain results. This study aims to determine long-term results of standard treatment of accommodative esotropia and identify predictors of outcome, while minimizing bias in data collection and analysis, using the largest possible sample size.

METHODS

A research assistant collected data from all files of a large, long-established pediatric ophthalmology practice (M.M.P.). The assistant was given standardized collection forms that allowed inclusion of all patient data points over all visits. The assistant was masked as to study goals. She was instructed to include any patient with esotropia who had been prescribed glasses during treatment. Descriptive terms were converted to code numbers. A second, similarly masked research assistant entered data into a computerized database. Criteria for patient inclusion were designed to conform to earlier studies by I.H.L. and M.M.P. and were implemented by computer.

RESULTS

The database totaled 1,307 patients (747,717 data points). Of these, 354 qualified for this analysis. A greater difference between near and distance esodeviation (AC/A relationship) correlated with a higher rate of deterioration of accommodative esotropia control (P<.0001). Deterioration also positively correlated with earlier age at onset, inferior oblique overaction, and amblyopia.

CONCLUSIONS

This study agrees with our previous findings that a high AC/A relationship increases the likelihood of deterioration of accommodative esotropia, thus confirming the integrity of the database. This unique, unbiased dataset will be used for future analyses of esotropia.

Using dependency/association rules to find indications for computed tomography in a head trauma dataset

Analysis of a clinical head trauma dataset was aided by the use of a new, binary-based data mining technique, termed Boolean analyzer (BA), which finds dependency/association rules. With initial guidance from a domain user or domain expert, the BA algorithm is given one or more metrics to partition the entire dataset. The weighted rules are in the form of Boolean expressions. To augment the analysis of the rules produced, we applied a probabilistic interestingness measure (PIM) to order the generated rules based on event dependency, where events are combinations of primed and unprimed variables. Interpretation of the dependency rules generated on the clinical head trauma data resulted in a set of criteria that identified minor head trauma patients needing computed tomography (CT) scans. The BA criteria contained fewer variables than were found using recursive partitioning of Chi-square values (five variables versus seven variables, respectively). The BA five-variable criteria set was more sensitive but less specific than the seven-variable Chi-square criteria set. We believe that the BA method has broad applicability in the medical domain, and hope that this paper will stimulate other creative applications of the technique.

Peripapillary scleral thickness in perfusion-fixed normal monkey eyes

PURPOSE

To characterize the thickness of the peripapillary sclera in perfusion-fixed normal monkey eyes so as to build accurate computational models of intraocular pressure (IOP)-related stress and strain within these tissues.

METHODS

Nine rhesus monkeys were perfusion fixed, each with one normal eye set to an IOP of 10 mm Hg by manometer. A 6-mm-diameter specimen containing the optic nerve head and peripapillary sclera was trephined from each scleral shell and cut into 4-microm serial sagittal sections across the scleral canal opening, either horizontally (four eyes) or vertically (five eyes). The thickness of the peripapillary sclera was measured on every 24th section at 100-microm intervals from the posterior scleral canal opening (PSCO) to the peripheral edge of the specimen. The data were pooled by quadrant (superior, inferior, nasal, and temporal), regions within each quadrant, and distance from the PSCO, overall and for individual eyes, and subjected to analysis of variance.

RESULTS

In terms of distance from the PSCO, the peripapillary sclera was thinnest nearest the PSCO (201 microm, nasal; 201 microm, temporal; 240 microm, inferior; 249 microm, superior), thickened progressively to a maximum in the midperiphery approximately 600 to 1000 microm from the PSCO (326 microm, nasal; 415 microm, superior; 420 microm, temporal; 422 microm, inferior), and thinned again peripherally in all quadrants. The peripapillary sclera was thinner in the nasal quadrant when compared with the other quadrants superiorly, inferiorly, and temporally (central region means of 291 microm, nasal; 369 microm, superior; 372 microm, inferior; and 369 microm, temporal; P < 0.0001).

CONCLUSIONS

In the normal monkey eye, peripapillary scleral thickness varies significantly with distance from the posterior scleral canal opening and is thinner in the nasal quadrant than in the other quadrants. These differences are substantial and are likely to affect the magnitude of IOP-related stress and strain within these tissues for a given level of IOP.

Effect of immunosuppression on gene expression in the HSV-1 latently infected mouse trigeminal ganglion

PURPOSE

To determine alterations in expression of genes in herpes simples virus (HSV)-1 latently infected mouse trigeminal ganglia (TGs), after treatment with cyclophosphamide and dexamethasone.

METHODS

Scarified corneas of female BALB/c mice were inoculated with HSV-1 strain McKrae. Four weeks after inoculation, cyclophosphamide and dexamethasone were intravenously injected to induce HSV-1 reactivation. Uninfected mice were also treated with the immunosuppressants. Four groups of animals were studied: uninfected, not treated; uninfected, drug treated; latently infected, not treated; and latently infected, drug treated. PolyA+ mRNA from the TGs of each group was reverse transcribed, labeled with 32P, incubated on a 1185-gene array membrane, and analyzed by phosphorimaging. As a comparison and to confirm microarray results, semiquantitative RT-PCR was also performed for selected genes.

RESULTS

The immunosuppressive drugs significantly increased expression of two genes (calpactin 1 light chain and guanine nucleotide-binding protein alpha-stimulating polypeptide [GNAS]) in the ganglia of uninfected mice compared with those in untreated uninfected mice. Ten genes were shown to be significantly increased in the latent TGs of mice treated with immunosuppressants compared with latently infected untreated mice. These genes were prostaglandin E2 receptor EP4 subtype (PTGER4), insulin promoter factor 1 (IPF1), glutathione S-transferase mu2, cyclin D2, peripherin, plasma glutathione peroxidase, methyl CpG-binding protein 2, retinal S-antigen, ErbB2 proto-oncogene, and GNAS. Eight genes were shown to be significantly decreased in the HSV-1 latent TGs treated with the drugs, compared with untreated latently infected mice. These genes were peripheral myelin protein 22, decorin, transcription factor AP-1, dystroglycan 1, myelin protein zero, mitogen-activated protein kinase 3, prothymosin beta 4, and brain lipid-binding protein. The results obtained by semiquantitative RT-PCR were similar to those obtained by microarray analysis.

CONCLUSIONS

Those genes with expression altered by immunosuppressive drug treatment may play an important role in ocular HSV-1 recurrence. Changes in expression of genes in the prostaglandin pathway, a transcription factor, and an enzyme in the cell cycle are considered especially important in HSV-1 reactivation by immunosuppression and are reviewed.

Corneal pathogenesis of Staphylococcus aureus strain Newman

PURPOSE

To determine the pathogenic role of gamma- and alpha-toxin in a rabbit model of Staphylococcus aureus keratitis.

METHODS

S. aureus strains Newman (expressing gamma-toxin), Newman Delta(hlg) (deficient in gamma-toxin), Newman Delta(hlg)/pCU1 hlg(+) (chromosomal gamma-toxin-deficient mutant rescued by a plasmid encoding gamma-toxin), and Newman Delta(hla) (alpha-toxin-deficient) were intrastromally injected into rabbit corneas. Eyes were scored by slit lamp examination (SLE), and bacterial colony-forming units (CFU) per cornea were determined at 15, 20, and 25 hours after infection. Histologic examination of corneas was performed. Rabbits were immunized against alpha-toxin and subsequently challenged with S. aureus strain Newman. Western blot analyses of culture supernatants were performed to detect alpha-toxin production.

RESULTS

All strains grew equivalently, producing approximately 7 log CFU per cornea at 25 hours after infection. SLE scores at 20 and 25 hours after infection revealed that strains Newman Delta(hlg) and Newman Delta(hla), although virulent, caused significantly less ocular damage and inflammation than their parent or the gamma-toxin genetically rescued strain (P <or= 0.0006). Histologic and SLEs revealed that all strains except Newman Delta(hla) produced corneal erosions. Rabbits immunized actively or passively to alpha-toxin had reduced SLE scores (P <or= 0.0003 and P <or= 0.0033, respectively) and no epithelial erosions when infected with strain Newman. Western blot analysis demonstrated that strains Newman and Newman Delta(hlg), but not Newman Delta(hla), produced alpha-toxin.

CONCLUSIONS

These results illustrate that the virulence of strain Newman involves both alpha- and gamma-toxin, with alpha-toxin mediating corneal epithelial erosions. An additional uncharacterized toxin could also be active in damaging the cornea.

Clinician change detection viewing longitudinal stereophotographs compared to confocal scanning laser tomography in the LSU Experimental Glaucoma (LEG) Study

PURPOSE

To compare optic nerve head (ONH) surface change detection by confocal scanning laser tomography (CSLT) within the LSU Experimental Glaucoma (LEG) study to expert clinicians viewing the LEG stereophotographs.

DESIGN

Experimental study.

PARTICIPANTS

Four fellowship-trained glaucoma specialists.

METHODS

In the LEG study, six 15 CSLT images (TopSS, Laser Diagnostics Technologies, San Diego, CA) and four 2x optic disc stereophotographs were obtained from both eyes of 12 monkeys on 3 separate days and then every 2 weeks after laser to one eye (study eye) to elevate intraocular pressure. ONH surface change detection within the CSLT images is described in our companion report. In this report, the preliminary study compared change detection by the CSLT multivariate strategy with that of a single clinician viewing stereophotograph pairs on three separate occasions as the "gold standard." The main study compared change detection by three additional clinicians viewing a subset of LEG stereophotograph pairs on three separate occasions with that of the CSLT multivariate strategy as the "gold standard." Clinician change detection was assessed for partial (two of three occasions) or complete (three of three occasions) agreement. Three comparison groups within the main study are emphasized: 44 group A comparisons assessed false-positive change detection (specificity); 38 group B comparisons assessed change detection within 38 instances (11 onset and 27 progression events) of CSLT-detected study eye change; and 30 group C comparisons assessed change detection within 30 instances in which the CSLT failed to detect change in study eyes.

MAIN OUTCOME MEASURES

Clinician change detection within each comparison with either partial or complete agreement.

RESULTS

Within the main study, intrareading (-.29 to 0.67) and interreading (0.24--0.56) session agreement for each clinician was slight to moderate by kappa test. Good specificity (less than 10% false-positive change detection) was achieved within the 44 group A comparisons by two of the three clinicians, but only when the more stringent criterion (change detection on three of three occasions) was applied. Of the 38 group B comparisons (in which the CSLT detected change), the two clinicians who achieved good specificity in group A failed to detect change in 25 and 16 instances, respectively, using the more stringent (three of three) criterion. Similarly, of the 30 group C comparisons (in which the CSLT failed to detect change), these two clinicians detected change in three and seven instances, respectively, but in only one comparison did they both detect change.

CONCLUSIONS

This study provides the first direct evidence that an existing CSLT may reasonably meet or exceed the ONH surface change detection performance of fellowship-trained glaucoma specialists in at least those eyes with good CSLT reproducibility.

Change detection in regional and volumetric disc parameters using longitudinal confocal scanning laser tomography

PURPOSE

To develop a clinically specific strategy for optic nerve head (ONH) surface change detection within longitudinally acquired confocal scanning laser tomographic (CSLT) images.

DESIGN

Experimental study.

PARTICIPANTS AND/OR CONTROLS

Twelve monkeys, each with one glaucomatous and one contralateral normal eye.

MAIN OUTCOME MEASURES

Detection of ONH surface change within the CSLT images of each monkey's glaucomatous eye.

METHODS

Six 10 and six 15 CSLT images and four stereo optic disc photographs were obtained from both eyes of 12 monkeys on 3 separate days (imaging sessions) and then every 2 weeks after laser to one eye (study eye) to elevate intraocular pressure. For each set of 10 and 15 images per eye (and for each of the 7-25 imaging sessions per monkey), 37 CSLT parameters were calculated. Univariate change required an individual parameter to change in excess of its analysis of variance-determined minimum detectable change (MDC) value. Multivariate change required groups of three parameters, considered together, to demonstrate significant change as determined by a multivariate analysis of variance. The rate of false-positive change detection for each individual parameter and for a group of three-parameter combinations was determined using both a one-in-a-row strategy (change at a single session) and a two-in-a-row strategy (change at two successive sessions) within the postlaser images of the 12 unchanging contralateral normal eyes. Change detection within the study eye images was then assessed for only those individual parameters and three-parameter combinations that were clinically specific (i.e., showed less than 10% false-positive change detection in the normal eyes).

RESULTS

A total of 36 prelaser (three per monkey) imaging sessions and 158 postlaser (4-22/monkey) imaging sessions was performed. Clinically specific change detection (low rate of false positives) was achieved only with the two-in-a-row strategy. Overall, multivariate ONH surface change detection performed best; the best-performing three-parameter combination detected only 8 change events (4 onset and 4 progression) in 139 imaging sessions within the postlaser imaging sessions of the contralateral normal eyes and a total of 47 change events (11 onset and 36 progression) within the postlaser imaging sessions of the 12 study eyes. Counterintuitive (anterior) change occurred in most parameters within the late postlaser imaging sessions of the study eyes followed to end-stage damage.

CONCLUSIONS

Clinically specific detection of the onset and progression of glaucomatous ONH surface change is possible within longitudinally acquired CSLT images.

Gene expression analyzed by microarrays in HSV-1 latent mouse trigeminal ganglion following heat stress

An understanding of the cellular genes whose expression is altered during HSV reactivation will enable us to better understand host responses and biochemical pathways involved in the process. Furthermore, this knowledge could allow us to develop gene-targeted inhibitors to prevent viral reactivation. Mice latent with HSV-1 strain McKrae and uninfected control mice were subjected to hyperthermic stress (43 degrees C for 10 min) and their trigeminal ganglia (TG) collected 1 h later. Two additional groups included HSV-1 latently infected and uninfected mice not subjected to hyperthermic stress. Poly A+ mRNA was enriched from total mouse TG RNA and reverse transcribed using MMLV RT. Radioactively labeled cDNAs were analyzed by microarray analysis. A stress/toxicology array of 149 mouse genes on a nylon membrane was used. The labeled cDNAs prepared from latently infected, stressed mice demonstrated 3-fold or greater increases in certain mRNA-early response genes (ERGs) compared to cDNAs from uninfected, stressed control mice. The ERG mRNAs that showed increases included two heat shock proteins (HSP60 and HSP40), a basic transcription factor (BTF T62), a DNA repair enzyme, two kinases [MAP kinase and a stress-induced protein kinase (SADK)], an oxidative stress-induced protein, a manganese superoxide dismutase precursor-2 (SOD-2), and cyclooxygenase 2 (COX-2). The gene expression in unstressed, infected TGs was similar to the gene expression in unstressed, uninfected controls. These results suggest that there is a significant difference in the ERG expression profile in latently infected TGs undergoing stress-induced reactivation compared to uninfected TGs.

Posterior scleral thickness in perfusion-fixed normal and early-glaucoma monkey eyes

PURPOSE

To characterize posterior scleral thickness in the normal monkey eye and to assess the effects of acute (15- to 80-minute) and short-term chronic (3- to 7-week) intraocular pressure (IOP) elevations.

METHODS

Both eyes of four normal monkeys (both eyes normal) and four monkeys with early glaucoma (one eye normal and one eye with induced chronic elevation of IOP) were cannulated. In each monkey, IOP was set to 10 mm Hg in the normal eye and 30 or 45 mm Hg in the contralateral eye (normal or early glaucoma) for 15 to 80 minutes. All eight monkeys were perfusion fixed, yielding eight low IOP-normal eyes, four high IOP-normal eyes, and four high IOP-early glaucoma eyes. Posterior scleral thickness was measured histomorphometrically at 15 measurement points within each eye, and the data were grouped by region: foveal, midposterior, posterior-equatorial, and equatorial.

RESULTS

Overall, posterior scleral thickness was significantly different in the various regions and among the treatment groups (P < 0.0001). In the low IOP-normal eyes, the posterior sclera was thickest in the foveal region (307 microm) and thinner in the midposterior (199 microm), posterior-equatorial (133 microm), and equatorial (179 microm) regions. In the high IOP-normal and high IOP-early glaucoma eyes, the posterior sclera was thinner both overall and within specific regions, compared with the low IOP-normal eyes.

CONCLUSIONS

The posterior sclera in the perfusion-fixed normal monkey eye thins progressively from the fovea to the equator and is thinnest just posterior to the equator. Acute and short-term chronic IOP elevations cause regional thinning within the posterior sclera of some monkey eyes, which significantly increases stresses in the scleral wall.

(+/-)-3-(3-oxocyclohexyl)propionic acid: dual conformational selection and hydrogen bonding in an epsilon-keto acid

The asymmetric unit of the title compound, C9H14O3, consists of two molecules having conformations that differ by a rotation of 111.7 (5) degrees about the equatorial substituent bond, so that the side chains of the two species extend away from the ring in different directions. Each conformer forms centrosymmetric hydrogen-bonded acid-to-acid dimers with its own enantiomer [O...O = 2.681 (3) and 2.698 (4) A]. There is an intermolecular C-H...O close contact involving the ketone group of one of the conformers.

Optic disc surface compliance testing using confocal scanning laser tomography in the normal monkey eye

PURPOSE

To determine the effect of acute, experimentally increased intraocular pressure on deformation of the surface of the optic nerve head (optic nerve head surface compliance testing) in normal monkey eyes using confocal scanning laser tomography.

METHODS

A total of 156 compliance tests were performed on 48 normal eyes of 30 monkeys in three separate studies. Compliance testing involved obtaining confocal scanning laser tomographic images using a 10 degrees and/or 15 degrees and/or 20 degrees scan angle at various times after intraocular pressure was raised from 10 to 30 or 45 mm Hg. At each point, six images were analyzed to provide a value for a parameter, called mean position of the disc, which was used to express the amount of deformation the surface of the optic nerve head had undergone at that point. Statistical analysis (ANOVA) was performed to evaluate differences in the amounts of deformation in individual eyes at different intraocular pressures and at different compliance testing sessions (studies 1 and 2) and in the two eyes of individual monkeys under the same conditions (study 3).

RESULTS

The majority of eyes showed posterior deformation of the surface of the optic nerve head ranging from 15 to 86 microm as early as 10 minutes after intraocular pressure was increased from 10 to 30 mm Hg. When pressure was increased from 30 to 45 mm Hg in a subset of these eyes, most showed additional deformation. Of the 12 eyes for which both 15 degrees and 20 degrees images were obtained at the same compliance test, 7 showed larger amounts of deformation in the 20 degrees images. Of the 18 monkeys tested in both eyes, 12 showed some differences and 4 showed substantial differences between the two eyes.

CONCLUSIONS

In the normal monkey eye, the surface of the optic nerve head deforms rapidly (in as few as 10 minutes) in response to increased intraocular pressure. The amount of deformation varies between subjects and even within the two eyes of individual monkeys. Increasing the scan angle from 15 degrees to 20 degrees frequently increases the amount of deformation detected, suggesting that the peripapillary sclera and the optic nerve head may be involved in the deformation in some eyes.

(-)-Dioxosantadienic acid: hydrogen-bonding patterns in a bicyclic sesquiterpenoid keto acid and its monohydrate

The anhydrous form, (I), of the title compound, (-)-2-(1,2,3,4,4a,7-hexahydro-4a,8-dimethyl-1,7-dioxo-2-naphthyl)propionic acid, C(15)H(18)O(4), derived from a naturally occurring sesquiterpenoid, has two molecules in the asymmetric unit, (I) and (I'), differing in the conformations of the saturated ring and the carboxyl group. The compound aggregates as carboxyl-to-ketone hydrogen-bonding catemers [O.O = 2.776 (3) and 2.775 (3) A]. Two crystallographically independent sets of single-strand hydrogen-bonding helices with opposite end-to-end orientation pass through the cell in the b direction, one consisting exclusively of molecules of (I) and the other entirely of (I'). Three C-H.O=C close contacts are found in (I). The monohydrate, C(15)H(18)O(4).H(2)O, (II), with two molecules of (I) plus two water molecules in its asymmetric unit, forms a complex three-dimensional hydrogen-bonding network including acid-to-water, water-to-acid, water-to-ketone, water-to-water and acid-to-acid hydrogen bonds, plus three C-H.O=C close contacts. In both (I) and (II), only the ketone remote from the acid is involved in hydrogen bonding.

(-)-gibberic acid: hydrogen-bonding pattern of the monohydrate of a non-racemic tetracyclic delta-keto acid derivative of gibberellin A3

In the the title compound, 1,7-dimethyl-8-oxo-4balpha,7alpha-gibba-1,3,4a(10a)-triene-10beta-carboxylic acid monohydrate, C18H20O3*H2O, the water of hydration accepts a hydrogen bond from the carboxyl and donates hydrogen bonds to the carboxyl carbonyl and the ketone in two different screw-related neighbors, which are mutually translational, yielding a complex three-dimensional hydrogen-bonding array.

A cAMP response element within the latency-associated transcript promoter of HSV-1 facilitates induced ocular reactivation in a mouse hyperthermia model

Herpes simplex virus type 1 (HSV-1) recombinant strain 17CRE contains a site-directed mutation in the 7-bp CRE consensus sequence located 38 nucleotides upstream of the transcription start site. Scarified mouse corneas received inoculations of 17syn+ (parent), 17CRE, and rescue 17CREr. Slit lamp examination of herpetic lesions and tear film swabs containing infectious virus showed that 17CRE had the same acute phenotype as 17syn+ and 17CREr. At 4 weeks, when the corneas had healed and latency was established, mice received hyperthermic shock. Eye swabs taken 24 h after hyperthermia showed that 17CRE reactivated significantly less than 17syn+ and 17CREr, while no significant differences were found in HSV-1 DNA genome copy numbers and latent virus in the trigeminal ganglia. These results are evidence that this CRE site in the LAT promoter facilitates ocular HSV-1 reactivation in mice.