Infant and Parent Outcomes Related to NICU-Based Co-occupational Engagement

Neonatal intensive care unit (NICU) co-occupations may impact parent-infant outcomes. The main objective of this study was to explore relationships between parent and infant outcomes based on whether sensory-based interventions (co-occupations) occurred most often between parent-infant dyads or provider/volunteer-infant dyads. Thirty-five families received the Supporting and Enhancing NICU Sensory Experiences (SENSE) program, which includes education defining specific amounts of sensory exposures for infants to receive each day of NICU hospitalization (with a preference for parent delivery). Infant sensory experiences in the NICU were logged, and dyads were grouped based on who conducted most of the sensory interventions with the infant in the NICU into a Parent-Infant Co-occupation group or Other Administered group. The Parent-Infant Co-occupation group had infants with less lethargy on the NICU Network Neurobehavioral Scale (p = .04), and parents with lower scores on the Parental Stress Scale (p = .003) and State-Trait Anxiety Inventory-state (p = .047). Parent-infant engagement in co-occupations was related to parental mental health and infant neurobehavior.

Parent-infant interaction in the NICU: Challenges in measurement

BACKGROUND

Parent-infant interaction is poorly understood among high-risk dyads in NICU settings. No parent-infant interaction measures are specifically designed for preterm infants within the NICU nor account for the education NICU parents receive to tailor their interactions based on the infant's cues.

AIM

To improve our understanding of a measure of parent-infant interaction in the NICU, we investigated relationships between parent-infant interaction scores on the Nursing Child Assessment Feeding Scale (NCAFS) and 1) socio-demographic and medical factors, 2) parent mental health and confidence, and 3) enhanced parental education (delivered as part of the Supporting and Enhancing NICU Sensory Experiences program) on tailoring interactions based on the infant's cues.

METHOD

Twenty-six preterm infants (born ≤32 weeks) had a video recorded oral feeding conducted by a parent in the NICU when the infant was 34-48 weeks postmenstrual age. A certified evaluator scored parent-infant interaction from the videos using the NCAFS.

RESULTS

Seventeen (65 %) parent-infant dyads scored below the 10th percentile on the total NCAFS score. Despite it being well-understood that parent-infant interaction is related to sociodemographic factors and parental mental health, there were no relationships between these factors and NCAFS scores in this study. Dyads who received enhanced parent education (n = 15) had lower NCAFS scores than dyads receiving usual care (n = 11) (p = 0.01).

CONCLUSION

It remains unclear if the standard measure of parent-infant interaction, NCAFS, captured positive and negative interactions in context of assessment of a high-risk dyad within the NICU setting. The utility of the NCAFS with preterm infants in the NICU was not supported by this study.

AB0411 COGNITIVE IMPAIRMENT IN PRIMARY SJÖGREN’S SYNDROME: A CASE-CONTROL STUDY

Background:

Neurological symptoms are common in primary Sjögren’s syndrome (pSS) with a prevalence of 8.5 to 70%, focusing on cognitive impairment, information in pSS is scarce.

Many neuropsychological tests are used to diagnose cognitive impairment. The Montreal Cognitive Assessment (MoCA) is a validated, practical, and reliable instrument for screening mild cognitive impairment.

Objectives:

To evaluate the prevalence of cognitive impairment with the MoCA test in pSS and compare it with controls.

Methods:

Patients of a rheumatology clinic in Northeastern Mexico were recruited, who met the pSS AECG 2002 or ACR-EULAR 2016 classification criteria. Controls, matched by demographic characteristics were included for comparison. All subjects took the MoCA. The test has a range of 0-30 points, the highest score reflects better cognitive function, and explores 6 cognitive domains (Table 2).

Table 1.

Demographic and clinical characteristics

≤ 9 years of education≥10 years of educationGroupNmean, SD1Min-maxp-valuenmean, SD1Min-maxp-valueMoCA totalpSS1725.65 (2.17)20 - 290.2484626.67 (2.27)20 - 300.3Control1424.36 (3.85)17 - 303627.22 (2.24)21 - 30VisuospatialpSS173.76 (0.9)1 - 50.505464.17 (1.03)2 - 50.056Control144.07 (1.59)0 - 5364.58 (0.87)2 - 5NamingpSS172.82 (0.39)2 - 30.831462.96 (0.2)2 - 30.711Control142.79 (0.57)1 - 3362.97 (0.16)2 - 3Deyaled recallpSS173.06 (1.34)1 - 50.251463.48 (1.31)0 - 50.921Control142.43 (1.65)0 - 5363.44 (1.68)0 - 5AttentionpSS175 (0.79)3 - 60.041465.37 (0.77)4 - 60.285Control144.29 (1.06)3 - 6365.53 (0.56)4 - 6AbstractionpSS171.71(0.68)0 - 20.464461.89 (0.31)1 - 20.79Control141.86 (0.36)1 - 2362 (0.23)1 - 3OrientationpSS176 (0)6 - 60.999465.93 (0.25)5 - 60.083Control146 (0)6 - 6366 (0)6 - 6LanguagepSS172.41(0.71)1 - 30.741462.61 (0.57)1 - 30.878Control142.5 (0.76)1 - 3362.58 (0.84)0 - 3

1SD: Standard deviation

We defined mild cognitive impairment as a score <26 and moderate-severe cognitive impairment as a score <24 as previously determined in Mexican population.

Results:

Demographic and clinical characteristics are described in Table 1. Mild cognitive impairment was present in 13 (25.4%) in pSS group versus 14 (27%) in control group. Moderate-severe cognitive impairment was present in 9 (17%) of pSS group versus 8 (15%) in control (p> 0.05).

Table 2.

MoCA subtest analysis by years of education in pSS and control group.

CharacteristicspSSn=51Controln=51Age, Mean (SD)56 (10.4)54 (14)SexFemale n (%)47 (92.15)48 (94)Male n (%)4 (7.85)3 (7.3)Disease duration (years), mean (SD)6.38 (6.15)ESSPRI mean (SD)4.94 (2.28)Years of education, median (q25-q75)13 (10-17)12 (10-15)Employment, mean (%)19 (37)29 (56)

Results of the individual domains and comparison between groups are shown in Table 2. Attention was lower in the pSS group with ≤9 years of education compared to the control group (p <0.05).

Conclusion:

We did not found a difference in the prevalence of cognitive impairment, either mild or moderate-severe, in pSS subjects with low disease duration versus controls by MoCA. We found a lower attention score in the pSS group with less than 10 of years of education.

The combination of neuropsychological examining and imaging techniques, such as SPECT or brain MRI, seem a more sensitive way to detect cognitive impairment in earlier stages.

References:

[1]Manzo, C., Martinez-Suarez, E., Kechida, M., Isetta, M. and Serra-Mestres, J. (2019). Cognitive Function in Primary Sjögren’s Syndrome: A Systematic Review. Brain Sciences, 9(4), p.85.

[2]Aguilar-Navarro S, Mimenza-Alvarado A, Palacios-García A, Samudio-Cruz A, Gutiérrez-Gutiérrez L, Ávila-Funes J. Validez y confiabilidad del MoCA (Montreal Cognitive Assessment) para el tamizaje del deterioro cognoscitivo en méxico. Revista Colombiana de Psiquiatría. 2018;47(4):237-243.

Disclosure of Interests:

None declared

AB0410 COGNITIVE DYSFUNCTION IN PRIMARY SJÖGREN’S SYNDROME AND SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Primary Sjögren’s syndrome (pSS) and systemic lupus erythematosus (SLE) share several clinical manifestations including neurological involvement. Cognitive dysfunction is a common neuropsychiatric manifestation in both, but evaluation and diagnosis is often challenging and delayed. The Automated Neuropsychological Assessment Metrics (ANAM) is a computerized cognitive screening tool that does not need specialized personnel to apply and is less time consuming than other tests.

Objectives:

Assess cognitive function of SLE and pSS patients with a computer-based tool (ANAM) in a single rheumatology clinic, compare its performance, and record their clinical and demographic characteristics

Methods:

We recruited patients from the rheumatology clinic of the UANL University Hospital who met the pSS 2002 AECG or ACR-EULAR 2016 classification criteria and SLE patients fulfilling SLICC 2012 criteria. We defined mild cognitive impairment as 1 to 1.9 SD below controls, and moderate-severe cognitive impairment as 2 SD or more below the comparison group (subjects matched by age, sex, ethnicity and educational level by the ANAM program) as previously employed in SLE.

Percentages were used for categorical variables and means (±SD) for numerical ones. To observe differences between groups, chi square and Student´s t were used,p<0.05 was considered significant.

Results:

A significant difference was observed in the total ANAM score between SLE and pSS patients (Table 1). In SLE, the most affected domains were simple reaction time, code substitution and delayed memory; in pSS patients, the most affected domains were inhibition and spatial work memory (Table 2).

Table 1.

Differences in ANAM performance between pSS and SLE.

VariablepSSmean, (SD)SLEmean, (SD)pFemale, %92.293.50.77Age (years)56.25 (10.45)31.99 (13.17)0.001Disease duration (years)6.38 (6.15)5.61 (6.1)0.492ANAM total score-1.43 (0.85)-1.87 (0.96)0.008Simple reaction time25.554.50.001Simple reaction time score148.39 (32.44)144.13 (52.37)0.571Code substitution (Learning)13.79.10.411Code substitution (Learning) score33.39 (8.42)38.61 (14.23)0.001Procedural reaction time-Attention15.727.30.125Procedural reaction time-Attention score70.29 (12.11)73.17 (17.68)0.277Mathematical processing11.8130.838Mathematical processing score17.92 (11.07)15.57 (6.63)0.177Matching to sample-spatial work memory21.67.80.025Matching to sample-spatial work memory score20.08 (7.66)22.26 (8.72)0.139Code substitution-delayed memory15.77.80.161Code substitution-delayed memory score26 (11.57)33.69 (18.99)0.005Simple reaction time21.632.90.165Simple reaction time score148.88 (24.82)166.29 (38.87)0.004Go/No-Go, Inhibition21.65.20.005Go/No-Go, Inhibition score3.41 (1.573.27 (1.68)0.635

Conclusion:

Cognitive impairment was common in both diseases but the cognitive domains affected were different. Rheumatologists should be aware of these differences when evaluating cognitive dysfunction in SLE and pSS patients.

References:

[1]Kurtuluş F, Çay H, Parlak E, Yaman A. Montreal cognitive assessment in primary sjogren’s syndrome. A brief screening tool. Neurosciences. 2019;24(3):199-206.

[2]Tayer-Shifman O, Green R, Beaton D, Ruttan L, Wither J, Tartaglia M et al. Validity evidence supports the use of automated neuropsychological assessment metrics as a screening tool for cognitive impairment in lupus. Arthritis Care & Research. 2019;.

Disclosure of Interests:

None declared

THU0125 IMPACT OF DISEASE ACTIVITY IN THE LEFT VENTRICULAR SYSTOLIC MYOCARDIAL FUNCTION OF PATIENTS WITH RHEUMATOID ARTHRITIS: A CASE-CONTROL STUDY

Background:

Patients with Rheumatoid Arthritis (RA) have higher incidence of cardiovascular diseases (CVD) compared to general population. There is controversy about the impact of RA disease activity on left ventricular systolic function (LVSF)1. LVSF may be assessed by conventional methods like left ventricular ejection fraction (LVEF) and myocardial shortening or by novel techniques evaluating myocardial strain such as speckle tracking echocardiography (STE).

Objectives:

To assess the impact of RA disease activity on LVSF using ejection fraction and myocardial strain by STE.

Methods:

Observational, cross-sectional study. RA patients aged 40-75 years that fulfilled the 2010 ACR/EULAR classification criteria and matched controls were included. Patients with a poor US window, history of previous CVD (ischemic heart disease, cerebrovascular accident or peripheral arterial disease) and pregnancy were excluded. Individuals were evaluated using two-dimensional speckle tracking echocardiography performed and reviewed by 2 certified echocardiographers. LVEF and myocardial strains (circumferential, longitudinal and radial) were measured; differences were solved by consensus. Descriptive analysis was done with measures of central tendency and dispersion. Student-t and Mann-Whitney U tests were used for comparisons.

Results:

A total of 140 subjects were included. Demographic and clinical characteristics are shown in Table 1. RA patients were divided in 2 groups, according to disease activity by DAS 28-CRP (remission or low activity and moderate or high activity). Echocardiographic comparisons between RA and controls and between the 2 groups in which RA patients were divided by disease activity are shown in Table 2. The LVEF was lower in RA subjects compared with controls (p=0.022), however LVEF was normal (> 52% in men and >54% in women) in both groups. There was a significant difference in the circumferential strain (CS) between RA patients based on the disease activity by DAS 28-CRP (p=0.006).

Table 1.

Demographic and clinical characteristics.

RA(n= 70)Control(n= 70)PFemale, n (%)67 (95.7)69 (98.6)NSAge, mean ± SD52,4±6,752,0±6,1NSType 2 Diabetes Mellitus, n (%)9 (12.9)7 (10)NSHypertension, n (%)14 (20)16 (22.9)NSDyslipidemia, n (%)16 (22.9)17 (24.3)NSActive smoking, n (%)11 (10.9)8 (16.3)NSDisease duration, years,median (q25 –q75)8.0(3.0-15.0)--DAS-28-PCR, median (q25 –q75)3.2(2.1-3.9)--Table 2.

Echocardiographic findings

LVEFPCSPRA, mean ± SD63.0±4.30.022-16.4±4.5NSControls, mean ± SD64.7±3.8-16.2±4.1LVEFPCSPRemission or low disease activity, median (q25 –q75)64.0(60.0-66.0)NS-15.1(-17.2- -12.2)0.006Moderate and high diseases activity, median (q25 –q75)63.0(60.0-66.0)-18.1(-22.0- -13.9)

LVEF= Left ventricular ejection fraction

CS= Circumferential strain

Conclusion:

The decrease in the circumferential strain depends on the disease activity. Myocardial strain by speckle tracking echocardiography may detect early myocardial dysfunction in RA. It is important for the rheumatologist to establish an appropriate treatment in order to achieve the disease remission or a low disease activity, as there is an impact of the disease activity on the myocardial function.

References:

[1]Hanvivadhanakul, P., Buakhamsri, A. Disease activity is associated with LV dysfunction in rheumatoid arthritis patients without clinical cardiovascular disease.Adv Rheumatol59, 56 (2019).https://doi.org/10.1186/s42358-019-0100-x

Disclosure of Interests:

None declared

Enhancing sensory experiences for very preterm infants in the NICU: an integrative review

OBJECTIVE

Very preterm infants hospitalized in the neonatal intensive care unit (NICU) experience alterations in sensory experiences. Defining types, timing and frequency of sensory-based interventions that optimize outcomes can inform environmental modifications. The objective of this study was to conduct an integrative review on sensory-based interventions used with very preterm infants in the NICU to improve infant and parent outcomes.

STUDY DESIGN

The data sources include MEDLINE, CINAHL, Cochrane Library and Google Scholar. Studies were identified that used sensory-based interventions in the NICU with preterm infants born ⩽32 weeks gestation, were published in a peer-reviewed journal between 1995 and 2015, and measured outcomes related to infant and parent outcomes. Studies were extracted from electronic databases and hand-searched from identified reference lists.

RESULTS

Eighty-eight articles were identified (31 tactile, 12 auditory, 3 visual, 2 kinesthetic, 2 gustatory/olfactory and 37 multimodal). There was evidence to support the use of kangaroo care, music and language exposure, and multimodal interventions starting at 25 to 28 weeks postmenstrual age. These interventions were related to better infant development and lower maternal stress, but not all findings were consistent. Limitations included lack of consistent outcome measures, study quality and gaps in the literature.

CONCLUSIONS

Most research identified interventions that were done for short periods of time. It is unclear what the potential is for improving outcomes if positive sensory exposures occur consistently throughout NICU hospitalization. Until more research defines appropriate sensory-based interventions to use with infants born very preterm in the NICU, information from this review can be combined with expert opinion and parent/family values to determine best practice.

A Direct Neurokinin B Projection from the Arcuate Nucleus Regulates Magnocellular Vasopressin Cells of the Supraoptic Nucleus

Central administration of neurokinin B (NKB) agonists stimulates immediate early gene expression in the hypothalamus and increases the secretion of vasopressin from the posterior pituitary through a mechanism that depends on the activation of neurokinin receptor 3 receptors (NK3R). The present study reports that, in the rat, immunoreactivity for NK3R is expressed in magnocellular vasopressin and oxytocin neurones in the supraoptic nucleus (SON) and paraventricular nucleus (PVN) of the hypothalamus, and that NKB immunoreactivity is expressed in fibres in close juxtaposition with vasopressin neurones at both of these sites. Retrograde tracing in the rat shows that some NKB-expressing neurones in the arcuate nucleus project to the SON and, in mice, using an anterograde tracing approach, it is found that kisspeptin-expressing neurones of the arcuate nucleus, which are known to co-express NKB, project to the SON and PVN. Finally, i.c.v. injection of the NK3R agonist senktide is shown to potently increase the electrical activity of vasopressin neurones in the SON in vivo with no significant effect detected on oxytocin neurones. The results suggest that NKB-containing neurones in the arcuate nucleus regulate the secretion of vasopressin from magnocellular neurones in rodents, and the possible significance of this is discussed.

Skin test-positive immediate hypersensitivity reaction to iodinated contrast media: the role of controlled challenge testing

BACKGROUND

Immediate hypersensitivity reactions (IHR) to iodinated contrast media (ICM) have traditionally been considered nonallergic; however, the increasingly frequent reporting of positive skin test and basophil activation test results suggests a specific allergic mechanism in some patients. Skin tests have been proposed as a useful tool for diagnosis, although their sensitivity and predictive values remain to be determined. The role of controlled challenge testing has not been assessed.

OBJECTIVE

We aimed to evaluate the role of controlled challenge testing in skin test-positive IHR to ICM.

PATIENTS AND METHODS

We evaluated 106 patients with IHR to ICM by performing skin tests with the agent that caused the reaction. Patients with a positive result were selected. Skin tests were extended to a series of 8 ICMs; 5 patients underwent controlled challenge test with an alternative skin test-negative ICM; a further 2 patients underwent computed tomography with an alternative skin test-negative ICM. No premedication was administered.

RESULTS

Intradermal test results were positive to the ICM that caused the reaction in 11 out of 106 patients (10.4%). Five of the 11 patients tolerated a controlled challenge test with an alternative skin test-negative ICM. The 2 patients who underwent computed tomography with an alternative skin test-negative ICM tolerated the medium.

CONCLUSIONS

Skin tests are useful for the diagnostic workup in patients with an allergic IHR to ICM. Since ICM cannot be avoided in many patients because they are irreplaceable in some diagnostic or therapeutic techniques, an alternative safe ICM should be investigated for future procedures. We propose the use of controlled challenge tests based on skin test results to address this need in skin test-positive reactions in order to identify an alternative non-cross-reactive ICM.

Cellular distribution, regulated expression, and functional role of the anorexigenic peptide, NUCB2/nesfatin-1, in the testis

Nesfatin-1, product of the precursor NEFA/nucleobindin2 (NUCB2), was initially identified as anorectic hypothalamic neuropeptide, acting in a leptin-independent manner. In addition to its central role in the control of energy homeostasis, evidence has mounted recently that nesfatin-1 is also produced in peripheral metabolic tissues, such as pancreas, adipose, and gut. Moreover, nesfatin-1 has been shown to participate in the control of body functions gated by whole-body energy homeostasis, including puberty onset. Yet, whether, as is the case for other metabolic neuropeptides, NUCB2/nesfatin-1 participates in the direct control of gonadal function remains unexplored. We document here for the first time the expression of NUCB2 mRNA in rat, mouse, and human testes, where NUCB2/nesfatin-1 protein was identified in interstitial mature Leydig cells. Yet in rats, NUCB2/nesfatin-1 became expressed in Sertoli cells upon Leydig cell elimination and was also detected in Leydig cell progenitors. Although NUCB2 mRNA levels did not overtly change in rat testis during pubertal maturation and after short-term fasting, NUCB2/nesfatin-1 content significantly increased along the puberty-to-adult transition and was markedly suppressed after fasting. In addition, testicular NUCB2/nesfatin-1 expression was up-regulated by pituitary LH, because hypophysectomy decreased, whereas human choriogonadotropin (super-agonist of LH receptors) replacement enhanced, NUCB2/nesfatin-1 mRNA and peptide levels. Finally, nesfatin-1 increased human choriogonadotropin-stimulated testosterone secretion by rat testicular explants ex vivo. Our data are the first to disclose the presence and functional role of NUCB2/nesfatin-1 in the testis, where its expression is regulated by developmental, metabolic, and hormonal cues as well as by Leydig cell-derived factors. Our observations expand the reproductive dimension of nesfatin-1, which may operate directly at the testicular level to link energy homeostasis, puberty onset, and gonadal function.

Direct breast-feeding in the neonatal intensive care unit: is it important?

OBJECTIVE

Rates of breast milk feeding at hospital discharge are low in premature infants due to the many associated challenges. Although there are many benefits associated with breast milk, the effects of direct breast-feeding in the neonatal intensive care unit (NICU) have not been identified. The purpose of this study was to investigate the relationship between direct breast-feeding (infant sucking directly from the breast) and duration and success with breast milk feedings until discharge in premature infants.

STUDY DESIGN

This retrospective cohort was conducted on 66 very-low birth weight infants whose mothers initiated breast milk feedings in the NICU. Chart review revealed documented type (breast milk with or without fortifiers or type of infant formula), volume and mode (nasogastric tube, breast or bottle) of all gastric feeds for each day of NICU hospitalization. From this documentation, whether the mother initiated breast milk feedings, the number of times the mother put the infant to breast, the gestational age of the first direct breast-feeding, whether the first oral feeding was at the breast, the duration of breast milk feedings and whether breast milk feedings continued until NICU discharge were determined. Associations between breast-feeding participatory factors and breast milk feeding outcomes were investigated using linear and logistic regression.

RESULT

Positive associations were found between breast milk feedings at discharge and mothers putting their infants directly to breast in the NICU (P=0.0005). The duration of breast milk feedings was associated with: mothers putting their infants directly to breast (P=0.0110), whether the first oral sucking feeding was at the breast (P=0.0108) and the gestational age of the first breast-feeding attempt (P<0.0001).

CONCLUSION

Breast milk feedings are encouraged in most NICU's, but direct breast-feeding is often overlooked as an important area of research in the tightly controlled environment of the NICU. This study demonstrates a link between direct breast-feeding behaviors in the NICU and success with provision of milk at discharge, as well as how early participation can be an important factor in the breast-feeding process for mothers of NICU infants. More research on the effects of direct breast-feeding is warranted.

Characterization of the inhibitory roles of RFRP3, the mammalian ortholog of GnIH, in the control of gonadotropin secretion in the rat: in vivo and in vitro studies

RF-amide related peptides (RFRP), as putative mammalian orthologs of the avian gonadotropin-inhibitory hormone (GnIH), have been proposed as key regulators of gonadotropin secretion in higher vertebrates. Yet considerable debate has arisen recently on their physiological relevance and potential mechanisms and sites of action. Present studies were undertaken to further characterize the effects of RFRP on LH and FSH secretion by a combination of in vivo and in vitro approaches in male and female rats. Initial screening via intracerebroventricular (icv) administration of different analogs of RFRP1 (RFRP1-12 and RFRP1-20) and RFRP3 (RFRP3-8 and RFRP3-17), as well as the related neuropeptide FF (NPFF8), to gonadectomized (GNX) female rats evidenced significant, albeit modest, inhibitory effects on LH secretion only for RFRP3-8 and RFRP3-17, which were detectable at the high dose rage (1 nmol for RFRP3-8, 5 nmol for RFRP3-17). This moderate inhibitory action was also documented after icv administration of RFRP3-8 to intact and GNX male rats. In addition, systemic (intravenous) administration of RFRP3-8 decreased the circulating levels of both gonadotropins in GNX male rats. Likewise, RFRP3-8 inhibited basal and GnRH-stimulated LH secretion by pituitaries from GNX males in vitro. This inhibitory effect was blocked by the antagonist of RFRP receptors, RF9. In summary, our results support a putative inhibitory role of RFRP3 as ortholog of GnIH in the regulation of gonadotropin secretion in mammals, which appears to involve direct pituitary actions as well as potential central (hypothalamic) effects.

Acute inflammation reduces kisspeptin immunoreactivity at the arcuate nucleus and decreases responsiveness to kisspeptin independently of its anorectic effects

Severe inflammatory challenges are frequently coupled to decreased food intake and disruption of reproductive function, the latter via deregulation of different signaling pathways that impinge onto GnRH neurons. Recently, the hypothalamic Kiss1 system, a major gatekeeper of GnRH function, was suggested as potential target for transmitting immune-mediated repression of the gonadotropic axis during acute inflammation, and yet key facets of such a phenomenon remain ill defined. Using lipopolysaccharide S (LPS)-treated male rats as model of inflammation, we document herein the pattern of hypothalamic kisspeptin immunoreactivity (IR) and hormonal responses to kisspeptin during the acute inflammatory phase. LPS injections induced a dramatic but transient drop of serum LH and testosterone levels. Suppression of gonadotropic function was associated with a significant decrease in kisspeptin-IR in the arcuate nucleus (ARC) that was not observed under conditions of metabolic stress induced by 48-h fasting. In addition, absolute responses to kisspeptin-10 (Kp-10), in terms of LH and testosterone secretion, were significantly attenuated in LPS-treated males that also displayed a decrease in food intake and body weight. Yet pair-fed males did not show similar alterations in LH and testosterone secretory responses to Kp-10, whose magnitude was preserved, if not augmented, during food restriction. In summary, our data document the impact of acute inflammation on kisspeptin content at the ARC as key center for the neuroendocrine control of reproduction. Our results also suggest that suppressed gonadotropic function following inflammatory challenges might involve a reduction in absolute responsiveness to kisspeptin that is independent of the anorectic effects of inflammation.

Characterization of the potent gonadotropin-releasing activity of RF9, a selective antagonist of RF-amide-related peptides and neuropeptide FF receptors: physiological and pharmacological implications

Identification of RF-amide-related peptides (RFRP), as putative mammalian orthologs of the avian gonadotropin-inhibitory hormone, has drawn considerable interest on its potential effects and mechanisms of action in the control of gonadotropin secretion in higher vertebrates. Yet, these analyses have so far relied mostly on indirect approaches, while direct assessment of their physiological roles has been hampered by the lack of suitable antagonists. RF9 was recently reported as a selective and potent antagonist of the receptors for RFRP (RFRPR) and the related neuropeptides, neuropeptide FF (NPFF) and neuropeptide AF (NPFF receptor). We show here that RF9 possesses very strong gonadotropin-releasing activities in vivo. Central administration of RF9 evoked a dose-dependent increase of LH and FSH levels in adult male and female rats. Similarly, male and female mice responded to intracerebroventricular injection of RF9 with robust LH secretory bursts. In rats, administration of RF9 further augmented the gonadotropin-releasing effects of kisspeptin, and its stimulatory effects were detected despite the prevailing suppression of gonadotropin secretion by testosterone or estradiol. In fact, blockade of estrogen receptor-alpha partially attenuated gonadotropin responses to RF9. Finally, systemic administration of RF9 modestly stimulated LH secretion in vivo, although no direct effects in terms of gonadotropin secretion were detected at the pituitary in vitro. Altogether, these data are the first to disclose the potent gonadotropin-releasing activity of RF9, a selective antagonist of RFRP (and NPFF) receptors. Our findings support a putative role of the RFRP/gonadotropin-inhibitory hormone system in the central control of gonadotropin secretion in mammals and have interesting implications concerning the potential therapeutic indications and pharmacological effects of RF9.

Critical roles of kisspeptins in female puberty and preovulatory gonadotropin surges as revealed by a novel antagonist

Kisspeptins (Kp) have recently emerged as master regulators of the reproductive axis and among the most potent elicitors of GnRH-gonadotropin secretion. Despite their paramount importance in reproductive physiology and their potential therapeutic implications, development of Kp antagonists has remained elusive, and only recently has the first compound with the ability to block Kp actions in vitro and in vivo, namely p234, been reported. However, previous in vivo studies all used acute central injections, whereas characterization of the effects of the antagonist after continuous or systemic administration, which poses pharmacological challenges, is still pending. We report herein a comprehensive series of analyses on the impact of continuous intracerebroventricular infusion of p234 on puberty onset and the preovulatory surge of gonadotropins in the female rat. In addition, the effects of systemic (ip) administration of a tagged p234-penetratin, with a predicted higher permeability at the blood-brain barrier, on Kp-10 induced gonadotropin secretion were evaluated. Central infusion of p234 to pubertal females delayed vaginal opening and decreased uterine and ovarian weights at the expected time of puberty, without affecting body weight. Likewise, chronic intracerebroventricular administration of p234 for 4 d prevented the preovulatory surges of LH and FSH. In addition, systemic (ip) administration of p234-penetratin significantly attenuated acute LH and FSH responses to Kp-10, either after intracerebroventricular or ip injection of Kp. Our data document the validity of p234 for antagonizing Kp actions in vivo and provide direct experimental evidence for the important role of Kp signaling in the key events of female reproduction, such as puberty onset and the preovulatory surge of gonadotropins.

The mammalian target of rapamycin as novel central regulator of puberty onset via modulation of hypothalamic Kiss1 system

The mammalian target of rapamycin (mTOR) is a serine/threonine kinase that operates as sensor of cellular energy status and effector for its coupling to cell growth and proliferation. At the hypothalamic arcuate nucleus, mTOR signaling has been recently proposed as transducer for leptin effects on energy homeostasis and food intake. However, whether central mTOR also participates in metabolic regulation of fertility remains unexplored. We provide herein evidence for the involvement of mTOR in the control of puberty onset and LH secretion, likely via modulation of hypothalamic expression of Kiss1. Acute activation of mTOR by l-leucine stimulated LH secretion in pubertal female rats, whereas chronic l-leucine infusion partially rescued the state of hypogonadotropism induced by food restriction. Conversely, blockade of central mTOR signaling by rapamycin caused inhibition of the gonadotropic axis at puberty, with significantly delayed vaginal opening, decreased LH and estradiol levels, and ovarian and uterine atrophy. Inactivation of mTOR also blunted the positive effects of leptin on puberty onset in food-restricted females. Yet the GnRH/LH system retained their ability to respond to ovariectomy and kisspeptin-10 after sustained blockade of mTOR, ruling out the possibility of unspecific disruption of GnRH function by rapamycin. Finally, mTOR inactivation evoked a significant decrease of Kiss1 expression at the hypothalamus, with dramatic suppression of Kiss1 mRNA levels at the arcuate nucleus. Altogether our results unveil the role of central mTOR signaling in the control of puberty onset and gonadotropin secretion, a phenomenon that involves the regulation of Kiss1 and may contribute to the functional coupling between energy balance and gonadal activation and function.

Persistent impairment of hypothalamic KiSS-1 system after exposures to estrogenic compounds at critical periods of brain sex differentiation

Attainment of reproductive capacity at puberty relies on a complex series of maturational events that include sexual differentiation of the brain; a hormonally driven phenomenon that takes place at early stages of development (critical period). Alterations of sex steroid milieu during such critical period disrupt pubertal maturation and gonadotropic function later in life, through mechanisms that remain partially unknown. Kisspeptins, products of the KiSS-1 gene acting via G protein-coupled receptor 54, have recently emerged as essential gatekeepers of puberty onset and reproductive function. By using rat models of neonatal administration of estrogenic compounds, we provide herein compelling evidence for the functional impairment of the hypothalamic KiSS-1 system at the time preceding puberty after early inappropriate exposures during brain sex differentiation. Neonatal injection of estradiol benzoate to male and female rats resulted in a dose-dependent decrease in hypothalamic KiSS-1 mRNA levels at the prepubertal stage, linked to lowering of serum LH concentrations. Yet, despite persistently decreased basal gonadotropin levels in estrogenized animals, intracerebral injection of kisspeptin evoked potent LH and FSH secretory responses, similar in magnitude to those of control animals. Estrogenized rats also showed defective levels of hypothalamic KiSS-1 mRNA and circulating gonadotropins in response to gonadectomy, whereas exogenous kisspeptin was capable to enhance further LH and FSH secretion in this model. Finally, protocols of neonatal exposure to high doses of an environmentally relevant estrogen, bisphenol-A, mimicked the effects of estradiol benzoate in terms of hypothalamic expression of KiSS-1 gene at the prepubertal period. Altogether, our data document the sensitivity of the hypothalamic KiSS-1 system to alterations in sex steroid milieu during critical periods of brain sex differentiation, and suggest that lowering of endogenous kisspeptin tone induced by early exposures to xeno-estrogens might be mechanistically relevant for disruption of gonadotropin secretion and puberty onset later in life.

Alterations in hypothalamic KiSS-1 system in experimental diabetes: early changes and functional consequences

Using long-term streptozotocin (STZ)-treated male rats, we recently proposed that defective function of hypothalamic KiSS-1 system is mechanistically relevant for central hypogonadotropism of uncontrolled diabetes. However, the temporal pattern of such defects and its potential contribution to disturbed gonadotropin secretion in the diabetic female remain so far unexplored. To cover these issues, expression analyses and hormonal tests were conducted in diabetic male (1 wk after STZ; short term) and female (4 wk after STZ; long term) rats. Short-term diabetic males had lower basal testosterone levels and decreased gonadotropin responses to orchidectomy (ORX), which associated with significantly attenuated post-ORX rises of hypothalamic KiSS-1 mRNA. Yet kisspeptin administration to diabetic males was able to acutely elicit supramaximal LH and testosterone responses and normalize post-ORX gonadotropin secretion. Long-term diabetic females showed persistent anestrus and significantly decreased basal gonadotropin levels as well as blunted LH responses to ovariectomy; changes that were linked to lowering of basal and postovariectomy expression of hypothalamic KiSS-1 mRNA. Moreover, despite prevailing gonadotropin suppression, LH responses to acute kisspeptin administration were fully preserved, and even enhanced after its repeated injection, in diabetic females. In sum, our present findings further define the temporal course and mechanistic relevance of altered hypothalamic KiSS-1 system in the hypogonadotropic state of uncontrolled diabetes. Furthermore, our data provide the basis for the potential therapeutic intervention of the KiSS-1 system as adjuvant in the management of disturbed gonadotropin secretion of type 1 diabetes in the female.

Novel expression and direct effects of adiponectin in the rat testis

Adiponectin is an adipocyte hormone, with relevant roles in lipid metabolism and glucose homeostasis, recently involved in the control of different endocrine organs, such as the placenta, pituitary and, likely, the ovary. However, whether as described previously for other adipokines, such as leptin and resistin, adiponectin is expressed and/or conducts biological actions in the male gonad remains unexplored. In this study, we provide compelling evidence for the expression, putative hormonal regulation, and direct effects of adiponectin in the rat testis. Testicular expression of adiponectin was demonstrated along postnatal development, with a distinctive pattern of RNA transcripts and discernible protein levels that appeared mostly located at interstitial Leydig cells. Testicular levels of adiponectin mRNA were marginally regulated by pituitary gonadotropins but overtly modulated by metabolic signals, such as glucocorticoids, thyroxine, and peroxisome proliferator-activated receptor-gamma, whose effects were partially different from those on circulating levels of adiponectin. In addition, expression of the genes encoding adiponectin receptor (AdipoR)-1 and AdipoR2 was detected in the rat testis, with developmental changes and gonadotropin regulation for AdipoR2 mRNA, and prominent levels of AdipoR1 in seminiferous tubules. Moreover, recombinant adiponectin significantly inhibited basal and human choriogonadotropin-stimulated testosterone secretion ex vivo, whereas it failed to change relative levels of several Sertoli cell-expressed mRNAs, such as stem cell factor and anti-Müllerian hormone. In summary, our data are the first to document the expression, regulation and functional role of adiponectin in the rat testis. Taken together with its recently reported expression in the ovary and its effects on LH secretion and ovarian steroidogenesis, these results further substantiate a multifaceted role of adiponectin in the control of the reproductive axis, which might operate as endocrine integrator linking metabolism and gonadal function.

Desensitization of gonadotropin responses to kisspeptin in the female rat: analyses of LH and FSH secretion at different developmental and metabolic states

Kisspeptins have emerged as potent elicitors of gonadotropin secretion and, therefore, putative targets for pharmacological intervention. In this context, desensitization of gonadotropin responses to continuous administration of kisspeptins has begun to be characterized, but information so far available is mostly restricted to LH responses in males, whereas the similar phenomenon in females, of obvious therapeutic interest, remains virtually unexplored. We report herein LH and FSH responses to continuous intracerebral administration of kisspeptin in female rats at different developmental and metabolic states. Infusion of kisspeptin-10 to adult female rats induced a transient elevation in serum LH concentrations, followed by a precipitous drop and normalization of LH levels thereafter. Elevation of LH after kisspeptin infusion was prolonged in underfed animals; a phenomenon mimicked by leptin administration. Conversely, FSH levels were persistently heightened along continuous kisspeptin infusion, but duration of this response was shortened by undernutrition. In pubertal females, LH and FSH levels remained elevated at the end of a 7-day infusion of kisspeptin; responses whose magnitude was augmented by subnutrition but not mimicked by leptin. In all settings, terminal gonadotropin-releasing hormone responses were fully preserved, suggesting that eventual desensitization must occur upstream from the pituitary. In summary, our current data document the pharmacological consequences of continuous administration of kisspeptin to female rats, with remarkable differences being detected between LH and FSH responses, in different developmental and metabolic states. These observations of potential pharmacological interest might help also to delineate the physiological roles of kisspeptins in the dynamic regulation of gonadotropin secretion in the female.

Neuromedin s as novel putative regulator of luteinizing hormone secretion

Neuromedin S (NMS), a 36 amino acid peptide structurally related to neuromedin U, was recently identified in rat brain as ligand for the G protein-coupled receptor FM4/TGR-1, also termed neuromedin U receptor type-2 (NMU2R). Central expression of NMS appears restricted to the suprachiasmatic nucleus, and NMS has been involved in the regulation of dark-light rhythms and suppression of food intake. Reproduction is known to be tightly regulated by metabolic and photoperiodic cues. Yet the potential contribution of NMS to the control of reproductive axis remains unexplored. We report herein analyses of hypothalamic expression of NMS and NMU2R genes, as well as LH responses to NMS, in different developmental and functional states of the female rat. Expression of NMS and NMU2R genes was detected at the hypothalamus along postnatal development, with significant fluctuations of their relative levels (maximum at prepubertal stage and adulthood). In adult females, hypothalamic expression of NMS (which was confined to suprachiasmatic nucleus) and NMU2R significantly varied during the estrous cycle (maximum at proestrus) and was lowered after ovariectomy and enhanced after progesterone supplementation. Central administration of NMS evoked modest LH secretory responses in pubertal and cyclic females at diestrus, whereas exaggerated LH secretory bursts were elicited by NMS at estrus and after short-term fasting. Conversely, NMS significantly decreased elevated LH concentrations of ovariectomized rats. In summary, we provide herein novel evidence for the ability of NMS to modulate LH secretion in the female rat. Moreover, hypothalamic expression of NMS and NMU2R genes appeared dependent on the functional state of the female reproductive axis. Our data are the first to disclose the potential implication of NMS in the regulation of gonadotropic axis, a function that may contribute to the integration of circadian rhythms, energy balance, and reproduction.

Effects of galanin-like peptide on luteinizing hormone secretion in the rat: sexually dimorphic responses and enhanced sensitivity at male puberty

Reproductive function is exquisitely sensitive to adequacy of nutrition and fuel reserves, through mechanisms that are yet to be completely elucidated. Galanin-like peptide (GALP) has recently emerged as another neuropeptide link that couples reproduction and metabolism. However, although the effects of GALP on luteinizing hormone (LH) secretion have been studied, no systematic investigation on how these responses might differ along sexual maturation and between sexes has been reported. Moreover, the influence of metabolic status and potential interplay with other relevant neurotransmitters controlling LH secretion remain ill defined. These facets of GALP physiology were addressed herein. Intracerebral injection of GALP to male rats induced a dose-dependent increase in serum LH levels, the magnitude of which was significantly greater in pubertal than in adult males. In contrast, negligible LH responses to GALP were detected in pubertal or adult female rats at diestrus. Neonatal androgen treatment to females failed to "masculinize" the pattern of LH response to GALP. In addition, metabolic stress by short-term fasting did not prevent but rather amplified LH responses to GALP in pubertal males, whereas these responses were abrogated by pharmacological inhibition of nitric oxide synthesis. We conclude that the ability of GALP to evoke LH secretion is sexually differentiated, with maximal responses at male puberty, a phenomenon which was not reverted by manipulation of sex steroid milieu during the critical neonatal period and was sensitive to metabolic stress. This state of LH hyperresponsiveness may prove relevant for the mechanisms relaying metabolic status to the reproductive axis in male puberty.

Stimulatory effect of PYY-(3-36) on gonadotropin secretion is potentiated in fasted rats

Development and normal function of the reproductive axis requires a precise degree of body energy stores. Polypeptide YY-(3-36) [PYY-(3-36)] is a gastrointestinal secreted molecule recently shown to be involved in the control of food intake with agonistic activity on neuropeptide Y (NPY) receptor subtypes Y2 and Y5. Notably, PYY-(3-36) has been recently demonstrated as putative regulator of gonadotropin secretion in the rat. However, the "reproductive" facet of this factor remains to be fully elucidated. In this context, we report herein our analyses of the influence of the nutritional status on the effects of PYY-(3-36) upon GnRH and gonadotropin secretion. The major findings of our study are 1) the stimulatory effect of central administration of PYY-(3-36) on LH secretion was significantly enhanced after fasting and blocked by a GnRH antagonist; 2) besides central effects, PYY-(3-36) elicited LH and FSH secretion directly at the pituitary level, a response that is also augmented by fasting; 3) PYY-(3-36) inhibited GnRH secretion by hypothalamic fragments from male rats fed ad libitum, whereas a significant stimulatory effect was observed after fasting; and 4) the increase in the gonadotropin responsiveness to PYY-(3-36) in fasting was not associated with changes in the expression of Y2 and Y5 receptor genes at hypothalamus and/or pituitary. In conclusion, our study extends our previous observations suggesting a relevant, mostly stimulatory, role of PYY-(3-36) in the control of gonadotropin secretion. Strikingly, such an effect was significantly enhanced by fasting. Considering the proposed decrease in PYY-(3-36) levels after fasting, the possibility that reduced PYY-(3-36) secretion might contribute to defective function of the gonadotropic axis after food deprivation merits further investigation.

Pattern of orexin expression and direct biological actions of orexin-a in rat testis

Orexins, hypothalamic neuropeptides initially involved in the control of food intake and sleep-wake cycle, have recently emerged as pleiotropic regulators of different biological systems, including the reproductive axis. Besides central actions, peripheral expression and functions of orexins have been reported, and prepro-orexin and orexin type-1 receptor mRNAs have been detected in the testis. However, the pattern of expression and biological actions of orexin in the male gonad remain mostly unexplored. In this study, we report analyses on testicular prepro-orexin mRNA expression and orexin-A immunoreactivity in different experimental settings, and on direct effects of orexin-A on seminiferous tubule functions. Expression of prepro-orexin mRNA was demonstrated in the rat testis at different stages of postnatal development, with negligible levels at early juvenile period and maximum values in adulthood. Likewise, orexin-A immunoreactivity was demonstrated along postnatal maturation, with strong peptide signal in Leydig cells and spermatocytes at specific stages of meiosis. Testicular expression of prepro-orexin mRNA appeared hormonally regulated; its levels decreased after hypophysectomy and increased after gonadotropin replacement and ghrelin stimulation. Finally, orexin-A suppressed the expression of key Sertoli cell genes, such as Müllerian-inhibiting substance and stem cell factor, and inhibited DNA synthesis in specific stages of the seminiferous epithelium. In conclusion, we provide evidence for the regulated expression of orexin in the rat testis and its potential involvement in the control of seminiferous tubule functions. Together with our recent results on the expression of orexin type-1 receptor in the rat testis, our data further document a novel testicular site of action of orexins in the control of male reproductive axis.

Microbial characterization of organic carrier colonization during a model biofiltration experiment

AIMS

Dynamic microbial characterization of the colonization of organic carrier during a model biofiltration experiment using methanol as air pollutant.

METHODS AND RESULTS

A model biofilter was used in order to characterize the micro-organisms involved in the colonization of a model organic carrier. The model system consisted of closed vial as biofilter, peanut shells as lignocellulosic carrier and methanol as air pollutant. The micro-organisms involved in biofiltration were identified and characterized for their lignocellulolytic and methylotrophic activities. Fungi presented a higher lignocellulolytic activity than bacteria. A steady-state was reached after 15 to 20 days.

CONCLUSIONS

The consortium naturally associated to peanut shells is limited to few aerobic bacteria and lignocellulolytic fungi. This consortium was able to degrade methanol without external nutrient supply.

SIGNIFICANCE AND IMPACT OF THE STUDY

To our knowledge, this is the first paper that focuses on carrier degradation processes and the micro-organisms involved during the start-up period of a biofiltration process.

Orexin 1 receptor messenger ribonucleic acid expression and stimulation of testosterone secretion by orexin-A in rat testis

Orexins are hypothalamic neuropeptides primarily involved in the regulation of food intake and arousal states. In addition, a role for orexins as central neuroendocrine modulators of reproductive function has recently emerged. Prepro-orexin and orexin type-1 receptor mRNAs have been detected in the rat testis. This raises the possibility of additional peripheral actions of orexins in the control of reproductive axis, which remains so far unexplored. To analyze the biological effects and mechanisms of action of orexins in the male gonad, we evaluated testicular expression of orexin receptor 1 (OX(1)R) and orexin receptor 2 (OX(2)R) mRNAs in different experimental settings and the effect of orexin-A on testicular testosterone (T) secretion. Persistent expression of OX(1)R mRNA was demonstrated in the rat testis throughout postnatal development. In contrast, OX(2)R transcript was not detected at any developmental stage. Expression of OX(1)R mRNA persisted after selective elimination of mature Leydig cells and was detected in isolated seminiferous tubules at defined stages of the seminiferous epithelial cycle. In addition, testicular OX(1)R mRNA expression appeared to be under hormonal regulation; it was reduced by long-term hypophysectomy and partially restored by FSH replacement, whereas down-regulation was observed after exposure to increasing doses of the ligand in vitro. Moreover, OX(1)R mRNA expression was sensitive to neonatal imprinting by estrogen. Finally, orexin-A, in a dose-dependent manner, significantly increased basal, but not human choriogonadotropin-stimulated, T secretion in vitro. A similar stimulatory effect was observed in vivo after intratesticular administration of orexin-A. In conclusion, our present results provide the first evidence for the regulated expression of OX(1)R mRNA and functional role of orexin-A in the rat testis. Overall, our data are suggestive of a novel site of action of orexins in the control of male reproductive axis.

Diffuse lamellar keratitis: incidence, associations, outcomes, and a new classification system

PURPOSE

To evaluate the incidence, associations, and visual outcomes in patients with diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK).

SETTING

University-based refractive surgery center, Boston, Massachusetts, USA.

METHODS

This retrospective review comprised 2711 eyes that had LASIK between September 1996 and September 1999. All eyes that developed DLK after LASIK were included. They were divided into type I DLK (center sparing) or type II DLK (center involved) and then subdivided into A (sporadic-DLK not diagnosed in other patients treated on the same day) or B (cluster-other patients identified with DLK). Type IA corresponded to center sparing, sporadic; type IB, center sparing, cluster; type IIA, center involved, sporadic; and type IIB, center involved, cluster. The main outcome measures were incidence of DLK after LASIK, time to diagnosis, time to resolution, and changes in best spectacle-corrected visual acuity (BSCVA). Unpaired t tests were used for statistical analyses.

RESULTS

Thirty-six eyes (1.3%) developed DLK. Type I occurred in 58.3% of cases (type IA, n = 18; type IB, n = 3) and type II, in 41.7% (type IIA, n = 10; type IIB, n = 5). The mean time to diagnosis was not statistically significantly different between type I (1.8 days) and type II (1.1 days). Fourteen eyes (38.9%) developed DLK after an epithelial defect, representing an odds ratio of 13 times. The association with an epithelial defect was statistically significantly greater with type I (11/21 eyes, 52.4%) than with type II (3/15 eyes, 20.0%; P =.05). The mean time to resolution was 3.5 days in type I (type IA = 3.6 days; type IB = 2.7 days). This was significantly shorter than in type II, which had a mean time to resolution of 12.1 days (type IIA = 9.3 days; type IIB = 10.2 days) (P =.001). Loss of 2 or more lines of BSCVA occurred in 2 of 5 patients with type IIB and in no patients with types IA, IB, or IIA.

CONCLUSIONS

Epithelial defects after LASIK increased the risk of DLK occurrence, especially type I. Type II DLK was associated with a prolonged time to resolution and carried a significantly higher risk of BSCVA loss than type I.

Establishment of a rabbit model of extrascleral extension of ocular melanoma

PURPOSE

To establish an animal model of extrascleral extension of choroidal melanoma.

METHODS

Pigmented choroidal tumors were established in nine New Zealand albino rabbit eyes using B16F10 melanoma cell line. The sclerotomy site was not closed in the subgroup of six rabbits where extrascleral extension was desired. For the control group, the sclerotomy site was sutured with 8-0 nylon. Animals were treated with daily injections of cyclosporine and followed by serial fundus examinations, color Doppler imaging, and fundus photography. All tumor-bearing eyes were enucleated at the end of the follow-up period and examined for extrascleral extension.

RESULTS

Extrascleral extension of choroidal melanoma occurred in all six animals with open sclerotomy sites. No extrascleral extension was observed in the control group. Color Doppler imaging identified extrascleral extension which was confirmed on gross histology.

CONCLUSIONS

Our animal model of extrascleral extension of choroidal melanoma requires minimal surgery to establish, and is reproducible and easy to follow with standard diagnostic equipment.

Anticholinergic bronchodilators in combination

Chronic obstructive pulmonary disease (COPD), which affects approximately 14 million Americans, is the fourth leading cause of death in the United States and is responsible for an estimated US$6.5 billion in direct and indirect costs per year [1,2]. Its usual course is a slow deterioration of lung function and progressive breathlessness with activities. The age-adjusted death rate for COPD rose 71% from 1967 to 1987, and the 10 year mortality rate is about 50%. Bronchodilators form one of the mainstays of therapy in COPD patients. The judicious use of these agents increases airflow and reduces dyspnea in patients with COPD. Patients often experience a reduction in symptoms and improvement in their quality of life. There are several classes of bronchodilators available for the treatment of COPD, each with specific clinical benefits: anticholinergics, short-acting beta 2 agonists, combination anticholinergic and short-acting beta 2 agonist, long-acting beta 2 agonists and methylxanthines. This chapter reviews the use of an anticholinergic (ipratropium bromide) concomitantly with other bronchodilators, focusing on patients with COPD.

[Fatty acids composition and proximate of 7 fish species of Isla de Pascua]

During the last years the study of fatty acids belonging to omega 3 family in marine foods has been emphasized due to their beneficial effects on cardiovascular diseases, which are the main cause of death in occidental countries, as described by literature. In order to obtain more information about the fatty acid composition of the main marine species fat constituent, usually consumed by Eastern Island population, seven fish species were analyzed: Maito (Acanthurus leucopareius), Matuko (Bodianus vulpinus), Marau (Myripristis tiki), Nanue (Kiphosus bigibus). Moki (Mori and Marari, Anampses caeruleopunctatus), Puia (Girellops nebulosus) and Raea (Cheilodactilus plessisi). Fatty acid profile and proximate analysis were determined for each species. According to its fat content, Nanue and Marari showed the highest lipid percentage, with values of 2.8 and 3.6% respectively. Fatty acid profile expressed as methyl esters percentage indicated that the most important group was that of the saturated fatty acids (SFA 35.1-54%), followed by the polyunsaturated fatty acids group (PUFA, 22-42.5%). Palmitic acid was the most important between saturated fatty acids, while oleic acid was the main fatty acid between the monounsaturated group. In omega-3 family fatty acids, eicosapentaenoic acid (EPA, C20:5w3) and docosahexaenoic acid (DHA, C22:6w3) were the most important, with values in a range between 2.0-12% and 1.8-18.3%, respectively. Omega-6 family showed a higher content in arachidonic acid (AA, C20:4w6) with values between 1.9 and 10%. Considering the fatty acid composition and the fat content, Marari was the highest in w-3 and w-6 fatty acid contribution, with values of 850 and 240 mg per one hundred grams of edible portion respectively.

Hypertrophic discoid lupus erythematosus of the conjunctiva

PURPOSE

To report the ophthalmic manifestations of hypertrophic discoid lupus erythematosus of the conjunctiva.

METHOD

Case report and review of biopsy results.

RESULTS

A 58-year-old woman with a history of chronic blepharoconjunctivitis presented with an unusual raised conjunctival lesion. Previous biopsy slides were reviewed and interpreted as diagnostic of discoid lupus erythematosus, hypertrophic or verrucous type. Both blepharoconjunctivitis and the raised conjunctival lesion resolved with hydroxychloroquine therapy.

CONCLUSIONS

A raised conjunctival mass in the context of refractory blepharoconjunctivitis should elicit suspicion for discoid lupus erythematosus. The hypertrophic variant of this disease can affect the conjunctiva.

Posttransplantation lymphoproliferative disorder in the knee

Lymphoproliferative disorders with primary presentation in a joint are extremely rare. Posttransplantation lymphoproliferative disorders are commonly extranodal at presentation but rarely involve joint structures. The authors describe a fatal case of posttransplantation lymphoproliferative disorder presenting in the knee of a 39-year-old woman who had undergone renal transplantation many years before.

Late Onset of Haze Associated with Viral Keratoconjunctivitis Following Photorefractive Keratectomy

BACKGROUND

To report a newly recognized cause of late onset of corneal haze following photorefractive keratectomy (PRK).

METHODS

A 35-year old woman who underwent uneventful PRK and subsequently developed viral keratoconjunctivitis 1 year after treatment.

RESULTS

During resolution of the viral keratoconjunctivitis, the patient developed extensive central corneal subepithelial infiltrates and anterior stromal fibrosis in the PRK ablation zone. More than 1 year after the initial infection, the central subepithelial fibrosis persisted, complicated by myopic regression, central steep island on videokeratography, and loss of five lines of spectacle-corrected visual acuity. By the end of the second year after the infection, visual acuity had improved with disappearance of the central steep island on videokeratography. However, the myopic regression and subepithelial fibrosis remained.

CONCLUSION

Patients who undergo PRK may be at greater risk of visual loss following viral keratoconjunctivitis secondary to persistent subepithelial infiltrates and/or stromal fibrosis within the PRK treatment zone.

A study of topical nonsteroidal anti-inflammatory drops and no pressure patching in the treatment of corneal abrasions. Corneal Abrasion Patching Study Group

OBJECTIVE

To evaluate the effectiveness of an ophthalmic nonsteroidal anti-inflammatory drug (NSAID) in the treatment of noninfected, non-contact lens-related, traumatic corneal abrasions and no pressure patch.

DESIGN

A single-center, randomized, double-masked, placebo-controlled study.

PARTICIPANTS

One hundred patients with noninfected, non-contact lens-related, traumatic or foreign body removal-related corneal abrasions less than 36 hours in duration.

INTERVENTION

All patients received a cycloplegic drop and erythromycin or polymyxin B (Polysporin Ophthalmic Ointment, Burroughs Wellcome, Research Triangle Park, NC). Patients were then randomized to receive either ketorolac tromethamine 0.5% ophthalmic solution or control vehicle drops.

MAIN OUTCOME MEASURES

The main outcome measures were six subjective symptoms monitored daily, evaluation of corneal abrasion, and determination of adverse events. Long-term complications were determined 3 to 8 months after randomization.

RESULTS

Twelve patients were excluded from the study. One day after randomization, patients receiving ketorolac tromethamine 0.5% ophthalmic solution noted significantly decreased levels of pain (P < 0.002), photophobia (P < 0.009), and foreign body sensation (P < 0.003) as compared with the control vehicle group. In addition, the time to resumption of normal activities was shorter in the group who received ketorolac tromethamine 0.5% ophthalmic solution (P < 0.001). There was no statistical difference in the amount of tearing, healing time, acuity changes, or complication rates between the two groups.

CONCLUSIONS

Ketorolac tromethamine 0.5% ophthalmic solution provides increased patient comfort without clinical adverse effects when used as adjunctive therapy in the treatment of noninfected, non-contact lens-related, traumatic corneal abrasions.

Magnetic resonance imaging of cyclodialysis clefts

BACKGROUND

Our purpose was to determine whether cyclodialysis clefts can be imaged with magnetic resonance imaging (MRI).

METHODS

Surgical cyclodialysis clefts extending approximately 3 clock hours were created in four New Zealand white rabbits. Eyes were scanned with an ocular MRI coil. Images obtained after intravenous gadolinium, topical godalinium, and gadolinium injected into the cleft were compared to images obtained without contrast. Two human eyes were also scanned for cyclodialysis clefts with MRI.

RESULTS

Direct injection of gadolinium into the suprachoroid space yielded definitive localization and delineation of the cyclodialysis cleft. Cyclodialysis clefts could also be imaged following enhancement with topical or intravenous gadolinium. Without contrast medium, the clefts could not be clearly identified in rabbits. In a patient with hypotony and choroidal effusion following cataract surgery, a cyclodialysis cleft and enhancement of the suprachoroidal space were found with intravenous administration of gadolinium. MRI from a patient with a trabeculo-suprachoroidal shunt also demonstrated gadolinium enhancement of the suprachoroidal space.

CONCLUSION

Cyclodialysis clefts can be imaged using gadolinium-enhanced MRI in rabbits and humans.

Ciliary body neurilemoma. Unusual clinical findings intimating the diagnosis

BACKGROUND

Neurilemomas (schwannomas) rarely occur intraocularly. When present, they pose a diagnostic dilemma for the physician and often are mistaken as a malignant lesion, resulting in enucleation.

METHODS

The authors report the clinical findings of a 46-year-old man with a slowly progressive growing mass of the anterior chamber, associated with glaucoma and the development of cataract. To further delineate the tumor's features, ancillary techniques, including ultrasonography, computed tomography, and magnetic resonance imaging, were conducted. A definitive anterior chamber biopsy of the tumor was performed with histologic examination and electron microscopy.

RESULTS

Ultrasonography, high-resolution computed tomography and magnetic resonance imaging showed a well-delineated mass of the inferior ciliary body involving nearly 5 clock hours of the angle. Two clinical features that suggested a longstanding tumor were brilliant transillumination of the mass (leading to the impression of a "cystic mass," not corroborated by ultrasonography) and retrodisplacement of the involved iris root. The histology, and particularly the electron microscopic features, confirmed the diagnosis of a neurilemoma, a benign tumor of the anterior segment.

CONCLUSION

Intraocular neurilemomas are extremely rare tumors. Few are well documented with modern ancillary techniques. Clinical findings in conjunction with radiographic and ultrasonic features may support the diagnosis of a benign tumor. For this patient, confirmation via biopsy permitted combined cataract and glaucoma surgery to rehabilitate the eye, which retains 20/20 visual acuity 3 years after the procedure.

Rapid karyotyping in ectopic pregnancies

The aim of this study was to determine the feasibility of karyotyping ectopic Fallopian tube pregnancies utilizing dividing cytotrophoblast cells. Villi from 78 ectopic conceptuses were processed by the direct chromosome technique and cytogenetic diagnosis was successful in 60 cases (76.9 per cent). The amount of villi obtained, as well as villus morphology, was correlated with cytogenetic success rate. Histological examination of the Fallopian tube was also carried out. A total of 47 cases were chromosomally abnormal (78.3 per cent), which is the highest frequency of cytogenetic abnormalities reported to date.

Human retinoblastoma cells express alpha B-crystallin in vivo and in vitro

alpha B-crystallin is a major lens protein that is a member of the heat-shock family of proteins. Using immunohistochemical and northern blot techniques, we now demonstrate its presence in freshly-fixed retinoblastoma tissue. The protein is also abundantly expressed in cultured human retinoblastoma cells (Y-79 NEI, WERI Rb-1) as well as two subcultured Y-79 lines (ATCC and GM01232C). High expression of alpha B-crystallin may be involved in tumor growth and/or be a marker for general oncogenic "stress" in the tumor tissue.

'Black cornea' after long-term epinephrine use

Fifteen years after a partial maxillectomy and radiation therapy for left antral carcinoma, a 53-year-old woman presented to the Eye Plastics and Orbit Service of the Massachusetts Eye and Ear Infirmary, Boston, with phthisis and a large, black corneal lesion in the left eye. She had been treated for unilateral glaucoma in the left eye for more than 10 years with topically administered epinephrine borate, timolol maleate, and pilocarpine hydrochloride. Clinically, the lesion was smooth, black, and homogeneous, and was thought to represent uveal prolapse covered by a thin layer of epithelium. An eyelid-sparing anterior exenteration was performed. Histopathologic examination revealed an acellular, homogeneous substance that stained positively with the Fontana Masson stain for melanin and bleached with potassium permanganate, findings consistent with corneal adrenochrome deposition. Since adrenochrome can be easily dissected free from the cornea, this case illustrates that misdiagnosing adrenochrome deposition may lead to unnecessary surgery.

Expanded spectrum of findings in Marden-Walker syndrome

Recently, we examined a small-for-gestational age infant with blepharophimosis, congenital contractures of elbows, hips, and knees, fixed facial expression, and hypotonia. These congenital anomalies are consistent with a diagnosis of the Marden-Walker syndrome. The infant also had an omphalomesenteric duct, left hypoplastic kidney, hypoplastic right lower lobe of the lung, and displacement of the larynx to the right; these anomalies have not been described previously in this syndrome. A summary of the clinical manifestations of the previously reported patients is presented.

Ocular changes in the mucopolysaccharidoses after bone marrow transplantation. A preliminary report

Metabolic correction and physiologic response were evaluated after bone marrow transplantation in mucopolysaccharidosis. Eleven patients were prospectively evaluated to determine the effect of bone marrow transplantation on the progressive ocular manifestations of these disorders. Follow-up of 0.6 to 2.8 years after successful donor stem cell engraftment showed that some patients had slow clearing of the corneal clouding, reduction of intracytoplasmic inclusions in the conjunctiva, resolution of optic nerve edema, and stabilized or improved retinal function as determined by electroretinography. These preliminary results suggest that early bone marrow transplantation may alter some of the progressive ophthalmic characteristics of the mucopolysaccharidoses. Long-term follow-up is necessary to determine if these early alterations in the ocular features are predictive of a prolonged functional improvement in the visual status.

[Gastric adenocarcinoma surgically treated. A multivariate analysis of prognostic factors]

One hundred and twelve curatively resected gastric adenocarcinomas were studied retrospectively to appreciate the survival factors. Twenty different criteria (clinic, histologic and therapeutic parameters) were assessed using univariate and then multivariate analysis (semi parametric regression (COX's) model). Only three criteria were very important according to the multivariate analysis: 1) invasion of neighboring organs (p less than 0.006) with a relative risk score (RRS) of 4.26; 2) intravascular or intralymphatic tumor embols outside the tumor (p less than 0.004; RRS = 2.11); 3) invaded distal nodes (located at the origin of the vessels (p less than 0.04; RRS = 1.88). A prognosis index was described according to these results. A repartition of the patients in three prognostic groups according to these 3 criteria was proposed. Future, trials should consider these three different prognostic groups.